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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 />Division of Platted Lot <br />$50 <br />Special Use Permit <br />$100 <br />Relocation of Dwelling <br />$50 <br />Vacation of Right -of -Way <br />$100 <br />Variance to Zoning Ordinance $50 <br />Preliminary and Final Plat <br />$100 <br />_ Minor Variance <br />$25 <br />Please complete form by typing or <br />printing in <br />ink. If the spaces provided are <br />insufficient, <br />use additional sheets, keying information to <br />the proper item numbers. <br />1. <br />2. <br />3. <br />4. <br />S. <br />re-a - 3 <br />Name of Owner: (First) (Middle) (Last) (Phone) <br />Address of Owner: (No. and Street) (City) (State) (113 <br />Zip) <br />3 �. <br />Name of Applicant: (First) (Middle) Last) (Phone) <br />e e M <br />Address of Applicant: No. and Street ity (State)(Zip) <br />.741 7-ey-ale.0 irisep I/, lie <br />1hA It -Z <br />Street Address of Projl(:rty Involved <br />6. Complete legal. description of property inv <br />rof. s s La o Lo,, -�.!iA <br />7. <br />Date Property Acquired: 7-� <br />� <br />8. <br />Present <br />Use of Property: <br />nrr� Proposed Use of Property:` m <br />9. <br />Present <br />Zoning of Property: <br />,nrv� Proposed Zoning of Property: <br />10. <br />What lan or change makes this <br />request necessary? e. ` <br />GL <br />11. <br />What is <br />the expected effect of <br />the proposed change? (For example, on property values, <br />health, <br />safety, parking, traffic <br />conditions, etc.) <br />c <br />n 'tt <br />�. <br />