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~1"" ~_ 899 <br />Little Canada, Minnesota PAID ~Jo <br />APPLICATION FORM Rec. No. <br />Comprehensive Plan Amendment ~ ` Conditional Use Permit <br />Zoning District Amendment Variance <br />Text Amendment <br />Other <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />Applicant f ~ ~ S_$' ¢ C~ G~~~ ~ ~! ~C/ r! .C ~ ~/- y~/-Cj aS'0 <br />(Name) (Address) (Phone) <br />Owner <br />S g' H^ P_ <br />(Name) <br />Property Location (Street Address and t_egal Description): <br />/ ~~ ~ r! i <br />(Address) <br />~G v1 q ~2 /-l /V <br />(Phone) <br />~~ <br />Description and/or Reason for Request (Cite Ordinance Sections): <br />/d a' d S, <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 />tl~~, expense. <br /> <br />Page 13 t) <br />~~~f <br />(Date) <br />WHITE-Office CANARY-Customer PINK-File GO ~a~®Lm io <br />