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Little Canada, Minnes®ta <br />APPLICAI"ION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />Applicant <br />.--~ <br />~~ ~~ <br />Plan Review <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />(Name) <br />Owner <br />(Address) <br />(Name) (Address) <br />Property Location (Street Address and Legal Description): <br />~~ ~t1i~ ~7 ~ 5 /~1~,-, sus; <br />~~ _- 925 <br />PAID ~~~ DOO <br />Rec. No. <br />(Phone) <br />(Phone) <br />Description and/or Reason for Request (Cite Ordinance Sections): <br /> <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 proced des. I urther acknowledge the fee explanation as outlined <br />it e application procedures and hereby agree to pay all stateme is r cei ed from the City pertaining to additional applica- <br />t, expense. <br />C 4~ t s,-a''~ ~ s'~ :~ <br />(Signatu of pplicant) Date) <br />WHITE-Office CANARY-Customer PINK-File GOLD-Planner ~~~3, iu <br />