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. <br />i <br />i <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 p Division of Platted Lot $50 <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 $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 />Name of Owner. <br />(First) (Middle) (Last) (Phone) <br />Address of Owner: (No. and Street) (City) (State) <br />3. <br />Name of Applicant: (First) (Middle) (Last) (Phone) <br />4. `5 IZ/ S 3,4( <br />ddress of Applicant. (No. and Street) (City) (State) (Zip) <br />5. j `7/57 /61/. e6)0Z1E ' <br />Street Address of Property Involved: <br />6. qomplete Legal Description of Property Involved:Z-07" J L-oC4 a <br />7. Date Property Acquirgd : 1'2 60'c"H <br />8. Present Use of Property: MlVe B"446Proposed Use of Property•Agwk &Z.0/1%G <br />9. Present Zoning of Property: Proposed Zoning of Property: <br />10. What plan or change makes this request necessary? <br />_ cti c L 9 r <br />11. What is the expected effect of the proposed change? (For example, on <br />property values., health, safety, parking, traffic conditions, etc.) <br />