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ELOPER DEPOSIT APPUCATION <br />City of Liffe Canada <br />515 Little Canada Road East - Little Canada, MN 55117-1600 <br />651-766-4029 (Fax 651-766-4048) <br />www.ci.little-canada mn.us <br />Applicant's Name Address <br />Phone # <br />. P t. 11-676i3 /7vYde-der e, r. „2910 4.fit Nile le �� 5s1�i 6-s7. y�v <br />lOwner's Name <br />1 Phone <br />�.w a ., n...... <br />Property Location (street address <br />��/and <br />' legal description, if known) <br />/w'n) /..4 /9 � �� �/ % �� � �-• <br />Deposit ft. <br />Descr .Eon and/or Reason for Request cite ordinance sections, if known): <br />L ,44 L) i t tD . o4 rM <br />ivr <br />O4i 61 e. <br />�J�di lL1[I �5 ' ate 1wrLy✓QtQl4s, 5 lie '14y' ek 50e -Le clef 44. at -IX; ,CEI <br />R. <br />de - <br />In signing this application, I hereby acknowledge <br />that I have read and fully understand the <br />applicable provisions of the Zoning and <br />Subdivision Ordinances and current <br />administrative procedures. 1 further acknowledge <br />the fee explanation as outlined in the application <br />procedures and hereby agree to pay all <br />statements received from the city pertaining to <br />additi9rLal application expense. <br />il+h / <br />Signature of Applicant, if not Property Owner <br />Signature of Property Owner <br />P/S.:5" <br />Date <br />ACTION REQUESTED (check all that apply) <br />Architectural Review <br />Concept Review <br />Conditional Use Pet -mit <br />Final Plat <br />Planned Unit Development <br />Preliminary Flat <br />Subdivision <br />Text Amendment <br />Variance <br />Zoning District f_fteidtetent <br />G thea : <br />T -Der o <br />It ����� �=..vli'c_�t w <br />9'c <br />