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�► --5 �.p� 1 a th -�- <br />0 <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 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. &F12 <br />Name of Owner: (First) (Middle) (Last) (Phone) <br />2. o <br />Address of Owner• (No and St <br />3. <br />4. <br />5. <br />• <br />reet) (City) <br />(State) (Zip) <br />(O 3 2 <br />Name of Applicant: <br />(First) <br />(Middle) <br />(Last) <br />_(Phone) ; <br />Address of Applicant: (No. and <br />Street) (City) Y <br />(State) (Zip) <br />-7 <br />Street Address of Property Involved: <br />6. Complete Legal Des ri t iono Proper y I,nvo ved : h0r 1% . S�08 <br />7. Date Property Acquirgd: <br />8. Present Use of Property: S. Proposed Use of Property: L 9 _, <br />9. Present Zoning of Property: Proposed Zoning of Property: <br />10. Whit plan or ch g� makes this reguest neces °ary? <br />-f <br />11. What is the expected effect of the proposed change? (For example, on <br />property values, health, safety, parking, traffic conditions, etc.) <br />l <br />