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z <br />.r <br />CITY OF ROSEVILLE <br />2Civic <br />MinnesotaDrive <br />55113 <br />Roseville, <br />e check item or items for w �,,c�h^ you are applying:� <br />Pleas vI%W70L �t.�4- iiltih at d Lot $50 <br />$100 _tivision of plDwelling $50 <br />Rezoning $100 Relocation ° Ordinance $50 <br />Special Use Permits $100 _ Variance to Zoning $25 <br />Vacation of Right -of -Way Minor Variance <br />— Preliminary and Final Plat $100 _ <br />__.. printing in ink. If the spaces provided <br />Please complete form badditionaling rsheets, keying information to the proper <br />are insufficient, use �I�`0 item numbers: Tq-3-59 <br />( La t ) (Phone) <br />1• (First) (Middle) <br />Name of owner: <br />I �V SS <br />2. � � C �� nd Street ) ( Ci y ) ( State) (zip) <br />Address of Owne ( NO • <br />(Phone) <br />( Last ) <br />3. (First) (Middle) <br />Name � qf Applicant: <br />Q�A Higwler'� K�a%P/hP.st C�,�'/7C• <br />(State) (Zip) <br />4• <br />Address of App licant: (No• and Street) (City) �'� 3 �i n�S <br />5. Involved: <br />Street Address of Property <br />Complete Legal Description of Property Involved: <br />6. P � ,, <br />�.e — <br />7. Date Property. <br />Acquired: ^ <br />5 <br />Ck S Proposed Use of Property: <br />8. present Use of Property: _ u__._.o- <br />Of Property: D Proposed Zoning of Property: �...._._ <br />9. Present Zoning <br />10. What pla <br />n or change makes this request necessary? <br />expected effect of the proposed change? (For examples on <br />11. What is talues, health, safety, parking, traffic conditions, <br />property v <br />/Yo.� <br />