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J <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 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 j/ Minor Variance p& 9-�3 �� $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: (First) (Middle) (Last) (Phone) <br />2 . 60x;�o /-// GL Ooo- L- t. &I r/ <br />Address of Owner: (No. an Street) (City) (State) (Zip) <br />3. ZLRt <br />Name of Applicant: (First) (Middle) (Last) (Phone) <br />4 . <br />Address of Applicant: (No. and Street) (City) (State) (Zip) <br />5. C. <br />Street Address of Property Involved: <br />6. Complete Legal Description of Property Involved: t ✓" <br />7. Date Property Acquir.gd: <br />8. Present Use of Property:zi- <br />Proposed Use of Property: <br />9. Present Zoning of Property: Proposed Zoning of Property: <br />10. What plan or change makes this request necessary? <br />12.CQPC r <br />J- J <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) ice" '11-X 72 7 V aj,tJ <br />