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® _ '. <br />~n~4 <br />Little Canada, Minnesota PAID>~~ <br />APPLICATION FORM Rec. No. <br />Comprehensive Plan Amendment ~ Conditional Use Permit <br />Zoning District Amendment <br />Text Amendment <br />Other <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />Applicant (am,~~l ~~-~c~~nes Pf~c~ie~ts~i ;~71~ ~a~<e5~o~e fJ'lK- (~51-33~-~f3`~ r <br />(Name) (Address) (Phone) <br />Owner ~~Cirn-my ~' ~i <br />(Address) <br />~I"»u- <br />(Phone) <br />Property Location (Street Address and Legal Description): <br /> <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 />ing and Subdivision Ordinances and current administrative procedures. I further acknowledge the fee explanation as outlined <br />it she application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />expense. <br />~~ ~i.~~ ___ 1(~ s , ~ <br />Ignature pplicant) (Date) <br />WHITE-Office CANARY-Customer PINK-file GOLD-Planner ~:ra <br />