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<br />~3 Cj • -~ ~7 <br />Little Canada, Minnesota PAID ~.~~~<~. <~~ <br />APPLICATION FORM Rec. No. <br />Comprehensive Plan Amendment ~ Conditional Use Permit <br />Zoning District Amendment Variance <br />Text Amendment Subdivision <br />Other Planned Unit Development <br />Plan Review <br />Applicant <br />Owner <br />I~a~L ~~Jc~.t2S 1`~Z ~uc~~ (m,~~ C~~I--Z~1 <br />(Name) (Address) (Phone) <br />~~~ -~~~ ~ S I ~ 2 f~ >~-L(C~~. (~a,4~-e~ (n ~~ i -'?g~ -D <br />(Name) ( ddress) (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 />i ~e application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />i. expense. ~} <br />(Signature of Applicant) (Date) <br />WHITE-Office CANARY-Customer PINK-File GOLD-Planner ~,.y~2~3„(01 <br />