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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 />$100 <br />Division of Platted Lot <br />Relocation of Dwelling <br />$50 <br />$50 <br />Special Use <br />Vacation of <br />Permit <br />Right -of -Way <br />$100 <br />Variance to Zoning Ordinance $50 <br />$25 <br />Preliminary <br />and Final Plat <br />$100 <br />Minor Variance <br />Please complete form by typing or <br />printing in <br />ink. If the spaces provided <br />are insufficient, <br />use additional sheets, keying information to <br />the proper item numbers. <br />1. i4LI) Name of Owner: <br />(First) <br />(Middle) (Last) <br />(Phone) <br />p/ W,, (;r'aAID <br />ress of Owner: (No. andStreet) <br />52 <br />ame of Applicant- (First <br />ress of Applicant: (No: and Street <br />reet Address of Property Involved <br />11ZI-, <br />ty) <br />tate <br />,M/Y <br />tare) <br /><-i 5-)A-� <br />(Lip) <br />;Phone) <br />5Y %)3 <br />(Zip) <br />6. Complete legal description of property involved: -- <br />C c 'hi i. I l f c 0,3 t= N. W <br />J A- r I �y % 6 i k 1, C. - W a X i G J4 /% c? y B" <br />Date Property Acquired: <br />8. Present Use of Property: V Proposed Use of Property: <br />9. Present Zoning of Property: Proposed 'Zoning of Property: <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.) <br />k 0 A/ �'� <br />