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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 <br />!_ <br />$100 <br />$100 <br />— Division of Platted Lot <br />Relocation of Dwelling <br />$50 <br />$50 <br />Special Use Permit <br />Vacation of Right -of -Way <br />$100 <br />_ <br />_ Variance to Zoning Ordinance <br />$50 <br />$25 <br />_ <br />Preliminary and Final Plat <br />$100 <br />Minor Variance <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 />- <br />Name of Owntr: (First) (Middle) <br />2. 32, G r n <br />Address of Owne No. and Street) <br />3. Z r w �. <br />Name of Applicant: (First) (Middle) <br />4. -z Z Z G r 4 &e4H' <br />Address of Applicant: (No. an/d� Street) <br />5. 3 Z to ra n .0 U- <br />Street Address of Property Involved: <br />(City <br />s e L1a <br />(City <br />6. Complete L, egalDescrip on c�f Property Involved: <br />�%.. _ fir 1 IA, //.'A , <br />(Last) <br />(state) <br />(Last) <br />(Phone) <br />(Zip) <br />(Phone) <br />(State) (Zip) <br />A ) <<i 5- �;% <br />7. Date Property Acquir(pd: <br />8. Present Use of Property: Proposed Use of Property:_ <br />9. Present Zoning of Property: Proposed Proposed Zoning of Property: -j�=T <br />10. What plan or change makes this request necessary? �n,S4c <br />3 s&a,Ca: a r c[ exCA 6 a, 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 />1 <br />