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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 $100 _ j/' Division of Platted Lot $50 <br />Special Use Permit $100 Relocation of Dwelling $50 <br />Vacation of Right -of -Way $100 '— Variance to Zoning Ordinance $50 <br />Preliminary and Final Plat $100 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. A (0-- <br />Name ofOwner: (First) (Middle) Last) (Phone) <br />2. `�51 \Ak- t ocj -6 <br />is± ��, Rj�,. f� W :SCIL G <br />Address of Owner: (No. and Streetl (Citv ) (State (Zin) <br />i <br />3. M ni <br />Name of pp (cant: (rirs,., <br />4. LL I Ih/I(7. <br />Address o Applicant: (No. and- ttrreet) <br />Ys_� ./C <br />- (State <br />Street Address of Property Involve <br />6. Co lete// 1e)ga� descripptio/n of proper('ty inv�ollvesd: Or <br />a <br />(Zip) <br />7. Date Property Acquired: <br />8. Present Use of Property: S p Proposed Use of Property: 4nm p <br />0. Present Zoning of Property: Proposed Zoning of Property: <br />10. What plan or changenmakes 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 />