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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 _ Division of Platted Lot <br />Special Use Permit $100 _ $50 <br />Relocation of Dwelling <br />Vacation of Right -of -Way $100 _ Variance to Zoning Ordinance $50 <br />_ Preliminary and Final Plat $100 <br />Minor Variance $25 <br />Please complete form by typing or printing in ink. If the spaces <br />are insufficient, use additional sheets, keying information to theprovided <br />item numbers: proper <br />1. i C Tf 636 - a <br />Name of owner: (First) (Middle) <br />(Last) (Phone) <br />Address of k/- , - ( L L /il #/1/ G(i U G G E i(% <br />Owner: (No. and Street) (City) `/' <br />Y (State) (Zip) <br />3. S/�Yyl <br />Name of Applicant: (First) (Middle) <br />(Last) (Phone) <br />4. <br />Address of Applicant: (No. and Street) (Cit <br />Y) (State) (Zip) <br />Street Address of Property Involved: - <br />6. Complete Legal Description of Property Involved: b/Sj 7 Q`-- <br />C L 0,4-v - o I /h /DI- �✓d V/E 1, - <br />7. Date Property Acquired: 7k <br />8. Present Use of Property: R S. Proposed Use of Property: <br />9. Present Zoning of Property: k,5 Proposed Zoning of Property: /�f <br />10. What plan or change makes this request necessary? <br />• <br />11. What is the expected effect of the <br />property values, health, safety, proposed change? (For example, on <br />��`�k y, parking, traffic conditions, etc.) <br />F V w <br />