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~~ 1023 <br />Little Canada, Minnesota PAID ~~a~~~ <br />APPLICATION FORM Rec. No. <br />Comprehensive Plan Amendment Conditional Use Permit <br />Zoning District Amendment Variance <br />Text Amendment <br />Subdivision <br />Other Planned Unit Development <br />('~ /` Plan Review ~o,,, «~~ <br />A (Cant ~ A/~7 ES' C~'~ S7~i c. ~ ~ y (, l,fA+ ! <br />(Name) (Address) (Phone) <br />Owner ~=F't~"~' <br />(Name) (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />O/~ ~ ~,. <br />6~ <br />Description and/or Reason for Request (Cite Ordinance Sections): <br />~~ <br /> <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 />I .e application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />tion expense. <br />!`, <br />-(? t-/ <br />i 'i-,~. i.-, <br />(Signatil~ o'~Ag4olicant) (Date) <br />WHITE-Office CANARY-Customer PINK-File GOLD-Planner ;!/ ,t~~o <br />