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__ _ ~, <br />- ;t <br />~ Ng 1014 <br />Little Canada, Minnesota PAID ~~ U <br />APPLICATION FORM Rec. No. <br />Comprehensive Plan Amendment ~ Conditional Use Permit <br />Zoning District Amendment <br />Text Amendment <br />Other <br />Applicant ~~'r <br />(Name) <br />l~~L yVl-~-/~~ <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />3l S 5~>l~Z ~ )--~ <br />Owner ~~ ~ ~~'~' ~ 5 <br />(Name) <br />(Address) <br />Property Location (Street Address and Legal Description): <br />~ i s s ~ v~- ~ ~- <br />5 i ~l5 L r_ ~- <br />c~ ~ <br />~ rvt i ~ <br />L t ~l" J/ ~ <br />hone) <br />(Phone) <br />G~4N/~~f~ v/~ RJ SS~)° <br />Description and/or Reason for Request (Cite Ordinance Sections): <br /> <br /> <br /> <br />~v~~ ~ ~G~~~ti~a, <br />G FE' ~1 ~- ~- S , <br />In signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />i nd Subdivision Ordinances and current administrative procedures. I further acknowledge the fee explanation as outlined <br />in ine application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />tion expense. <br />( ignature of Applicant) (Date) <br />WHITE-Office CANARY-Customer PINK-File GOLD-Planner ,;,,(~ <br />f~~~y 6 <br />(Address) <br />s 1 ~'l5 ~s36 n <br />7~ 3 '~6 -a~ ~ ~ <br />