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10 <br />CITY OF ROSEVILLE <br />2660 Civic Center Drive <br />Roseville, Minnesota <br />Please check item or items for which you are applying: <br />$100 Division of Platted Lot $50 <br />X p Rezoning Relocation of Dwelling $50 <br />Special Use Permit $100 Variance to Zoning Ordinance $SO <br />Vacation of Right:oal Plat $100 lay $100 Minor Variance _ $ZS <br />X Preliminary and Fin - . <br />' typing or printing in ink. If the spaces provided are insuffi. <br />Please complete formby YP g <br />use additional sheets, keying information to the proper item numbers•. <br />770-9133 <br />Health Resources Assistance 'Corporation (Last) (phone) <br />Name of Owner: (First) <br />(Middle) <br />Ma lewootl Minnesota55109 <br />2G�6 HaxelitiTood Avenue (State) (Zip' <br />2.111_. Cit <br />Address of 0•,�'ner: (h®. and Street) l Y <br />3, See #1 Last) (Phone) <br />Ap11 plicant <br />Nave of : (First) <br />(Middle) <br />4. See .#2 ate)et (C�.ty (St(Z�• <br />Address of r�pplica,Lt: (No. and St <br />S. Unknown <br />Street Addr�ess•of Property Involved <br />involved-. Si-awik Park, Outlot A <br />6. Co.i fete legal description of p:cope Y . <br />7, Date Property Acquired: Option signed:_ (8/22/84) Health Care <br />Vacant Proposed Use of Prop exty:Faci� lit} <br />8. Present Use of Property*.* <br />on in of Property: I-1 �i B-2 (see map) proposed Zoning of Property: B.�2 <br />9. Present Zoning <br />10. What plan or change makes this request necessary? <br />See Atta-1 en _ <br />e ected effect of the proposed change? (For example, on property val <br />11. What' is thexP etc-) <br />health, safety, parking, traffic conditions, <br />See Attachment <br />