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r <br />CITY OF ROSEVILLE <br />2660 Civic Center Drive <br />Roseville, Minnesota <br />Please check item <br />or items for which you are <br />applying: <br />$100 <br />Division of Platted Lot <br />$50 <br />Rezoning <br />•�- <br />$100 <br />Relocation of Dwelling <br />$50 <br />Special Use <br />Permit <br />$100 <br />Variance to Zoning Ordinance <br />$$50 <br />Vacation of <br />Right -of -Way <br />and Final Plat $100 <br />�- Minor Variance <br />Pre lir►unary <br />P1� ase complete form by typing or printing in ink. If the spaces provided are insufficit <br />use additional sheets, keying information to the proper item numbers. <br />1. <br />2. <br />ame of Owner: <br />ress of Owner: <br />3. �j ✓�7 <br />Name of Applicant: <br />rst) (Middle <br />(No. and Street) <br />(First) (�Li( <br />4. <br />Address of Applicant: (.No. and Street <br />so <br />Street Address•ot Property Involved <br />6 Co lete legal description of property involved: L <br />+CC r 7416, <br />Last) (Phone) <br />A) Ss� <br />(State) (Zip <br />Last) (Phone) <br />tate <br />I. <br />0 <br />� 7. Date Property Acquired: 9— • <br />� f Property: ^ S"�� �� Proposed Use of Property: <br />$. Present Use o_ Pro erL � �� �� y <br />• �+- Proposed Zoning of Property: �- <br />9. Present Zoning of Property: . �. <br />10. What plan or change makes this request necessary? <br />i <br />11. What is the expected effect of the proposed change? (For example, on property values, <br />health, safety, parking, traffic conditions, etc.) <br />