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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 <br />$100 <br />Division of Platted Lot <br />$50 <br />_ <br />Special Use Permit <br />$100 <br />Relocation of Dwelling <br />$50 <br />_ <br />Vacation of Right -of -Way <br />$100 <br />_ <br />Variance to Zoning Ordinance <br />$50 <br />_ Preliminary and Final Plat <br />$100 <br />Minor Variance <br />$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. 7- J-0S F01Q& 17'-1 Y?P-?J(o <br />Name of Owner: (First) (Middle) (Last) (Phone) <br />Address of Owner: (No. and Street) (City) (State) (Zip) <br />3. nab ry r � � `�1 4� r/ 1CT <br />Name of Applicant: <br />4. Y13< <br />(First) <br />Address of Applicant: <br />(Middle) <br />(No. and Street) <br />5. e R R a�1S <br />Street Address of Property Involved: <br />(Last) <br />f6Sn116Z-&" <br />(City) <br />4- i/D. <br />6. Complete Legal Description of Property Involved: <br />POLL /M U' G kF,,61t l 1-6 7- R 4 G a (7, < <br />(Phone) <br />(State) (Zip) <br />7. Date Property Acquired: <br />8. Present Use of Property: Yj Proposed Use of Property: PW '('4Lr4'z <br />9. Present Zoning of Property: Proposed Zoning of Property: <br />10. What plan or change makes this request necessary? -to I-Ilve ve <br />441�5 F arm t4 cz- 4F y G %flrC <br />11. What is the expected effect of the proposed change? (For example, on <br />property values, health, safety, parking, traffic conditions, etc.) <br />/V r <br />11 <br />