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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 />r <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 />Name of Owner: <br />ress of Owner: <br />0 <br />y <br />(First) (Middle) <br />L17-! 'SeK V�f &C <br />(No. and Street) <br />(Last) (Phone) <br />Rosevi'lle MA/ SSie. <br />(City) (State) (Zip) <br />3. `; a. <br />Name of Applicant: (First) (Mi3c31e) (Last) (Phone) <br />4 . S a -Y\ iU <br />Address of Applicant: (No. and Street) (City) (State) (Zip) <br />5. S 2( S e Ackr\f <br />Street Address of Property Involved: <br />6. Cc-nplete Legal Description of Property Involved: <br />7. Date Property Acquired: u (Ast M 7 7 <br />8. Present Use of Property: reSidehc e_ Proposed Use of Property: .'Corr e- <br />9. Present Zoning of Property: Proposed Zoning of Property: ,5aen e <br />10. What plan or change makes this request necessary?t %S ro,vosc� 71v <br />s i z e o f Y-A e t`�a c �� ed a rce e v o n� <br />Dn <br />"J -CCeV a rof e. rhi (.J r C ive Se,.,P,, {ao71 c� i` iDn hic A Gvi �1e <br />t,�v- fee f'roh. the I/%ne„ r e 5& t <br />11. What is the expected effect of the proposed change? (For example, on <br />property values, health, safety, parking, traffic conditions, etc.) <br />h � o ra(ue of in reg ►�d Ike <br />}`�ro�Jer�-- <br />