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r <br />CITY OF ROSEVILLE <br />2660 Civic Center Drive <br />Roseville, Minnesota <br />Please check item or items for which you are applying: <br />Rezoning <br />$100 <br />Division of Platted Lot <br />$50 <br />Special Use Permit <br />$100 <br />Relocation of Dwelling <br />$50 <br />Vacation of Right -of -Way <br />$100 <br />Variance to Zoning Ordinance $50 <br />$25 <br />Preliminary and Final Plat <br />$100 <br />Minor Variance <br />Please complete form by typing <br />or printing in <br />ink. If the spaces provided are <br />insufficieT <br />use additional sheets, keying <br />information to <br />the proper item numbers. <br />1�_, ia re/ <br />�/c, ) le Ile— <br />Name of Owner: (First <br />- <br />(Middle) (Last) <br />(Phone) <br />2. <br />s o <br />3. A-1 <br />1141,v 6-(CZ <br />er: (No. and Street <br />/I - <br />Name of Applicant: (First) (Middle <br />4. s - <br />Address of Applicant. (No. and Street <br />Street Address•'of Property Involved <br />;City) (State) (Zip) <br />{Last) (Phone) <br />(City) (State) (Zip) <br />1 U Ts; Bki c K Z, a-#-vn A"- <br />6. Complete legal desLri tion of property involved: ct G , i,n_r- &, ,v /_ <br />i <br />7. Date Property Acquired: Z& /. <br />8. Present Use of Property: ' Proposed Use of Property: <br />9. Present Zoning of Property: Proposed Zoning of Property: 9­1 <br />10. What plan or change makes this request necessary? <br />11. What is the expected effect of the proposed change? (For example, on property values-, <br />health, safety, parking, traffic conditions, etc.) _ 11 , r,e. !-o +Y �L l c"cr r-r, <br />