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A <br />®4tlg <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 $100 <br />Special Use Permit $100 <br />Vacation of Right -of -Way $100 <br />Preliminary and Final Plat $100 <br />Jivision of Platted Lot $50 <br />Relocation of Dwelling $50 <br />Variance to Zoning Ordinance $50 <br />Minor Variance $25 <br />Please complete form by typing or printing in ink. If the spaces provided are insufficient, <br />use additional sheets, keying information to the proper item numbers. <br />1. C7G� p0�v <br />Name of Owner: (First Middle -/1��56i� `.�`3 -33 1 <br />( ) (Last) (Phone) <br />2. <br />3. <br />4. <br />5. <br />actress of Owner: (No. an <br />.JAOt�_S <br />ame of Applicant: (First <br />treet <br />I;i,6y L/'� '44) 'Vd <br />ress of Applicant: (No. -and'Street <br />"'Il7 I WA <br />treet Address of Property Involve <br />(City) (State) (Zip) <br />.ddle) (Last) (Phone) <br />IVCIU A f �r kl Al <br />(City) (State) (Zip) <br />6. Complete legal description of property involved: e-67- <br />7. Date Property Acquired: <br />8. Present Use of Property: 17cSl nI-- A-1cL Proposed Use of Property: p P Y: 5A4.14:- <br />9. Present Zoning of Property: Proposed Zoning of Property:�� <br />10. What <br />� or chZ,,ge akes this request necess ry? <br />-ry e Qr V h Z0_1 ! h c". (�-- <br />v <br />11. What is the expected effect of the proposed change? (For example, on property values, <br />health, safety, parking, traffic conditions, etc.) "'Q/VLr <br />©� hlp(k y <br />y <br />