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CITY OF ROSEVILLE <br />2660 Civic Center Drive <br />Roseville, Minnesota <br />Please check item or items for which you are applying: <br />Rezoning $100 <br />Special Use Permit $100 <br />Vacation of Right -of -Way $100 <br />Preliminary and Final Plat $100 <br />Division of Platted Lot $50 <br />Relocation of Dwelling $50 <br />Variance to Zoning Ordinance $50 <br />Minor Variance $25 <br />Please complete form by typing or printing in ink. If the spaces provided are insufficient, <br />use additional sheets, keying information to the proper item numbers. <br />i1 <br />Name of -r: (First) (Middle) (Last) (Phone) <br />11 + <br />2.3/)Za011ikILZI©f <br />5�fl% <br />Address of Owner: (No. an <br />Street) <br />(City) (State) <br />(Zip) <br />3. <br />_ i.. <br />Az <br />Name c1fcant: (First) <br />(Middl-.:) (Last) <br />(Phone) <br />4. <br />��� <br />��a✓.i// l�i/1� <br />�'r�/ <br />Address of Applicant: (No. <br />and Street) <br />(City) (State) <br />(Zip) � <br />5. <br />3d/ LL' , , /,///, , <br />J- <br />Street Address of Property <br />- <br />Involved <br />6. <br />Comple e legal description <br />of property <br />involved: <br />Unplatted <br />lands, the <br />West 1102.68 feet of the <br />NW 1/4 of <br />the NW 1/4 <br />of Section 4, Township 29, <br />Range 23, <br />except the <br />North 1,265 feet. <br />( includes <br />33 feet of <br />Cleveland Ave. right-of-way <br />7. <br />Date Pr perty Acquired:Z <br />8. <br />Present Use of Pro ert <br />P Y' <br />f <br />iti / lam )Proposed Use of Property:' <br />4r qr <br />9. Present Zoning of Property: _k-S Proposed Zoning of Property: t-1'4 /C <br />10. What plan or char e makes this equest�neces ary`? <br />11. What is <br />health, <br />the expected effect of the proposed <br />safety, parking, traffic conditions, <br />change? <br />etc.) <br />(For example, on property values, <br />