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t...ittle Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />Applicant <br />~o~~ <br />~°_ ~. <br />PAID `~~ ~G<~ C-` <br />Rec. No. <br />~~// Conditional Use Permit <br />-1~ Variance ~ ~~~ <br />Subdivision ~~ ~CJ~ <br />-_ Planned Unit Development <br />Plan Review <br />(Address) <br />Owner ` ' L J ~--~ <br />(Name) (Address) <br />Property Location (Street Address and legal Description): <br />J~. 7 <br />(Phone) <br />(Phone) <br /> <br />Description and/or Reason far Request (Cite Ordinance Sections): <br />~ ~- <br />/~/ .4J / ,'^~ /y~' /- h.~J A? ~.~. ,~ /i a;^J i7 te'~ .7 r 12 I . i '`_- w %_ --e r <br />r <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 acknowledye 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 />ti~_ axpense. <br />(Signature of Applicantl~ (Date) <br />WHITE-Ofii cu CTNAfiY-Gusto mcr PINK-nie GO LO-Plannor a~~,r»Sj <br />LG 39hd \?Qt'IJtSCi TALI i'!;,I T.'1 Hr,anuoi -cu he ~rT -, r. r.~,-..,~~ <br />xS <br />