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r • <br />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 <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 <br />are insufficient, use additional sheets, keying information to the proper <br />item numbers: <br />1. <br />2. <br />Name of Owner: <br />Address of Owner: <br />(First) <br />(Middle) <br />(No. and Street) <br />(Last) (Phone) <br />(city) (State) (Zip) <br />3. <br />Name of Applicant: (First) <br />(Middle) <br />(Last) <br />_(Phone) <br />4. <br />Haaress of Applicant: <br />(No. and Street) <br />5. <br />N <br />Street Address of Property Involved: <br />City) (State) (Zip) <br />6. Complete Legal Description of Property Involved: L,6j 1-4VC& <br />r.'s <br />7. <br />Date Property Acquired: <br />8. <br />Present Use of Property: K Proposed Use of <br />Property: <br />9. <br />Present Zoning of Property: e,' Proposed Zoning <br />of Property: <br />10. <br />What plan or change makes this request necessary? <br />-)`f- � <br />11. <br />What is the expected effect of the proposed change? <br />(For example, on <br />property values, health, safeety, parking, traffic conditions, <br />etc.) <br />