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Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />Applicant <br />(Name) <br />(Address) <br />~"~ ~.dUl <br />PAID'~'G) ~~>~ <br />Rec. No <br />Conditional Use Permit <br />- Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />L'o uu <br />n r <br />Ownerl,~~C-/~~ ~ (''U~~L'~ ~/~ / ~_ ! i~7Ui+Y2i yC /~ ~y 1-~ f~ F <br />(Name) ( ddressl <br />Property Location (Street Address and Legal Description); <br />e <br />7i 2, <br />~ ~ Z ~.~/- <br />(Phone) <br />5~ ~/'7 <br />(Phone) <br />Description and/or Reason for Request (Cite Ordinance Sections): 5,f1R1~, <br /> <br /> <br />G <br />In signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />ir end Subdivision Ordinances and current administrative procedures. I further acknowledge the fee explanation as outlined <br />il. .e application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />tion expense. <br />+'i. ~. 1 <br />I'V 1 " Lim ~ ~~ J ~"L~U_.r- <br />(Signature,~f Applicant) <br />WHITE-Office CANAiiY-Customer PINK-File GOLD-Planner <br />(Date) <br /> <br />