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E <br />CITY OF ROSEVILLE <br />2660 Civic Center Drive <br />Roseville, Minnesota <br />Please check item or items for which you are applying: <br />Division of Platted Lot $50 <br />Relocation of Dwelling $S0 <br />Variance to Zoning Ordinance $50 <br />_s 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. DfA5' L4 <br />Name of Owner. (First (Middle) q-96 70a <br />(Lasfi) (Phonel <br />2. ,) <br />Td, <br />3. <br />Rezoning $100 <br />Special Use Permit $100 <br />Vacation of Right -of -Way $100 <br />Preliminary and Final Plat $100 <br />ss of Owner: <br />ame of App li cant : <br />4. _ r <br />Address o <br />Street Address o <br />T6.: l�j( <br />o. and Street) <br />first <br />cant: (No. an <br />erty Involved <br />(City) <br />idle) <br />City <br />6. Complete legal description of property involved: ,-C7-Lr <br />rAlIV 2- tate) <br />(S(Zip <br />ast) (Phone) <br />tate <br />r <br />P <br />7. Date Property Acquired: <br />8. Present Use of Property:.l proposed Use of Property: <br />9. Present Zoning of Property: <br />Proposed Zoning of Property: <br />10. ,jWhat plan or change makes this re ue t nec ? <br />\�. < qR eSs y. <br />11. What is the expected effect of the proposed change? <br />health, safety, g (For example, on property values, <br />y, parking, traffic conditions, etc. <br />G a2 : SCR <br />