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CITY OF ROSEVILLE <br />1160 Civic Center Drive <br />Roseville, Minnesota <br />Please check item or items for which you are applying: <br />Rezoning $100 <br />Special Use Permit $100 Division of Platted Lot <br />Vacation of Right $100 <br />$100 Relocation of Dwelling $SO <br />SO <br />Preliminary Variance to Zoning Ordinance $So <br />z'Y and Final Plat $50 <br />$100 Minor Variance g <br />. Please complete form by typing or printing in ink. If the $25 <br />use additional sheets, keying information to the proper spaces <br />provided are insufficient <br />P ' <br />P P item numbers. <br />I• � ✓ <br />Name of Owner; (First) <br />(Aiiddle) (Last) <br />2. �S r, (Phone) <br />Address of QS �� �' d FS` Q ICe <br />and Street) <br />(City) (State) (Zip) 3. <br />Name of pplicant: <br />(First) (Middle) <br />4. .IUD Last) (Phone) <br />Address of licant ; v tip Z_ ' <br />No. and Street p,Z <br />u <br />j� (City) (State) <br />5. do (Zip) <br />Street of AdressertY n�1/ 114volved <br />6. Complete legal description of property involved: 5 ,e <br />----------------- <br />7. Date Property Acquired: <br />8. Present Use of Property: <br />Proposed Use of Property; <br />9. Present Zoning of Property: <br />Proposed Zoning of Property: <br />10. What Plan or change makes this request sa <br />necessary? <br />11. What is the expected effect of the proposed change? For e <br />health, safety, parking, traffic conditions, etc.) ( xample, on property values, <br />y 4, Tr <br />