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1 _~ <br />Little Canada, Minnesota <br />I~~' 1067 <br />00 <br />PAID ~bD <br />APPLICATION FORM Rec. No <br />Comprehensive Plan Amendment Conditional Use Permit <br />Zoning District Amendment Variance <br />Text Amendment Subdivision <br />Other Planned Unit Development <br />Plan Review <br />Applicant ~} y s$<./~l S~Sfs flit S G~7le'~' /~~CE S7" 6 S~~$8a9P~ <br />(Name) (Address) (Phone) <br />~S/ <br />Owner (~7~i1,`~.w.. I'1%~lic~('zvt Ja~?3P(•F-~vf~ /~c.~P ~•(Jet /i ale/~S'ia~ p`Z~S~ ~l/~6 <br />(Name) (Address) T- (Phone) <br />Property Location (Street Address and Legal Description): <br />~-~ m ~r- f-rrr--tom <br />5~~3 <br />Description and/or Reason for Request (Cite Ordinance Sections): <br />In signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />ing and Subdivision Ordinances and current administrative procedures. I further acknowledge the fee explanation as outlined <br />it ~ application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />tic,,, expense. <br />___.. <br />(Sig ture of Applicant) (Date) <br />WHITE-Office CANARY-Customer PINK-File GOLD-Planner ~i~a <br />