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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 <br />Special Use Permit $100 <br />Vacation of Right -of -Way $100 <br />Preliminary and Final Plat $100 <br />Division of Platted Lot $50 <br />Relocation of Dwelling $50 <br />Variance to Zoning Ordinance 0 <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. <br />2. <br />Address o <br />3. <br />Name of A <br />4. �ZI29 I <br />Address of <br />5. 10?Y1� <br />Street Addr <br />6. Complete le <br />ner:-1 (No. and Street <br />cant: (First) <br />pplicant : (No. and Street <br />ss of Prt-.1perty Involved <br />(City) ` (State) <br />e) (Last) <br />(City) �4 (State <br />description of property involved: 4 <br />e <br />we <br />7. Date Property Acquired: <br />8. Present Use of Property: ,c:��j���� Proposed Use of Property: <br />9. Present Zoning of Property: Proposed Zoning of Property: <br />10. What yl , or change makes this request necessary? <br />►'1 Q Q. E' d C? �? <br />11. What is the expected effect of the proposed change? (For example, on property values, <br />health, safety, parking, traffic conditions, etc.) <br />�. S-/ <br />°Z • S'�d �-P ��► f �� o/►���'C �� o�,�r�h�f Foy <br />