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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 <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 />3. <br />4. <br />5. <br />Name of Owner: (First) (Middle) (Last) (Phone) <br />IS <br />Address of Owner: (No. and Street) (City) y (State) (Zip) <br />Name of Applicant: (First) (Middle) (Last) (Phone) <br />Address of Applicant: (No. and Street) (City) (State) (Zip) <br />Street Address of Property Involved: <br />6. Complete Legal Description of Property Involved: <br />7. <br />Date Property <br />Acquired: <br />/,z_-Z'/- <br />9,5— <br />8. <br />Present Use of <br />Property: <br />L O -" <br />Proposed Use of Property: <br />9. <br />Present Zoning of Property:��-I Proposed Zoning of Property: <br />10. ghat plan or change makes this request necessary? <br />11. What is the expected effect of the proposed change? (For example, on <br />property. Yslues, health, safety, parking, traffic conditions, etc.) <br />__ , - <br />