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CITY OF ROSEVILLE <br />2660 Civic Center Drive <br />Roseville, Minnesota 55113 <br />Please check item or items for which you are applying: <br />Rezoning $100 _ Division of Platted Lot $50 <br />_ Special Use Permit $100 Relocation of Dwelling $50 <br />Vacation of Right -of -Way $100 Variance to Zoning Ordinance $50 <br />Preliminary and Final Plat $100 :,f Minor Variance $25 <br />Please complete form by typing or printing in ink. If the spaces provided <br />are insufficient, use additional sheets, keying information to the proper <br />item numbers: <br />1. <br />Name 04 owner -� " <br />(F�rst) (Middle) (Last) (Phone <br />2. J15 / 11 l__ /1 �;� .,r M._ <br />3. <br />Cs <br />5. <br />Address of Owner. <br />_;; 14 V r.�, !� <br />Name b Applicant: <br />(No. and Street) (C <br />rst) (Middle)) <br />Address of Applican No. and Street <br />Street A dress o roperty nvolved: <br />(City <br />(State) (Zip) <br />r (Last) <br />( hone <br />(State) Zip) <br />6. Complete Legal Description of Property Involved: �ThP Snc�fti io�.�� /='- t-- - 6 f <br />c? -7fd . 3 -('� . o - _z.%T <br />7. Date Property Acquires? : ,�- _a--- <br />8. Present Use of Property: 1 O5, . Proposed Use of Property:(-,,, <br />9. Present Zoning of Property:4es,��t Proposed Zoning of o .P 7G a� 1,1• ProP erty • , .J , <br />10. What plan or change makes this request necPgcari77 <br />11. <br />/, . ��, �y / �, ivcY ► !o rn"s CLy1 Vc /Vyr t) j C C.✓ "I . <br />What is the expected effect of the proposed change? (For example, on <br />property values( health, safety, parking, traffic/conditions, etc.) <br />