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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 <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 Minor Variance <br />$25 i <br />Please complete form by typing or printing in ink. are insufficient, use additional sheetsf keying information the spaces provided_' <br />item numbers: mation to the proper <br />1 <br />Name of Owner: <br />2. .zz <br />Address of O <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />9. <br />10. <br />(First) (Middle) <br />(No. and Street) (City) <br />1'.4aiil= Ur Applicant: (First-) <br />Address of Applicant: <br />(Last) (Phone) <br />State) (Zip. <br />(Middle) (Last) -(Phone) <br />(No. and S treet) �r�� - a <br />(City)'`a` (State) (Zip <br />AA <br />Street Address of Property Involved: <br />Complete Legal Description of Property Involved. f <br />-- T G7..".4 G.9 / ., i / _ -1 <br />Date Property Acquired: 44Z2_4 <br />Present Use of Property: _A�� Proposed Use of Property: <br />Present Zoning of Property:_ Proposed Zoning of Property: <br />What plan or change make-q fir; <br />11. What is the expected effect of the <br />pro ert values, health safet proposed change? (For example, on <br />Y, parking, traffic conditions, etc.) <br />P I <br />