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07/13/2004 14:45 6517664046 CIT`! LITTLE CANADA <br />Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning bistrict Amendment <br />Text Amendment <br />Other <br />PAGE 02 <br />10.9 <br />~I° ._~o~ <br />kk ~~ <br />PAID :.1J, ,~G <br />Rec. No. <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review 3 ~ <br />Applicant _l~ S `P-C~ .~ t a r ~ ~ 5 `~rS ? ~.~ .n ~L~ ~~ c:. y h% <br />(N3"me ) <br />1 Add teas) <br />Owner (-''Y"'`s` `"` `~~ <br />_. ..._ -(Name) <br />(Address) <br />Property Location (Street Address and Legal Description): <br />// . nt~~,) <br />'t" v' V C:,I S 1_•~ e. ~ G ti, ~ ~ IL Gi pin S-~'J ~ ~ ... <br />~5 <br />i:plr~~vG`..z t/i\2-27U-i7?.S`2.. <br />(Phone) <br /> <br />L ~~ <br />Description and/or Reason for Bequest (Cite Ordinance Sectional: <br />In signing this application, I hereby acknowledge that I have read and <br />ing and Subdivision Ordinances and current administrative procedu s. I <br />.n the application procedures and hereby agree t0 pay all statement <br />tion expense. ~ <br />(Sign re of Applicant) <br />,7e-O~fica CANARD-Cmtamnr PINK-File GnL0.PIr o, <br />dersiand the applicable provisions of zhe Zorn <br />ar acknowledge the fee explanation as outlined <br />from the City pertaining to additional applica- <br />~- <br />IDatel <br />~7 <br />