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Little Canada, Minnesota <br />APPLICATION FORM <br />Applicant <br />Owner <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />1 l' V (/ <br />(Name) <br />~~ - 897 <br />s <br />PAID SOO <br />Rec. No. <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />(Address) ~ <br />(Name) / (Address) <br />Property Location (Street Address and Legal Description): <br />.C ~~,~ ~ ~LP ~' d"1~'I J 1 ~ <br />~s % 7~s._ ~~ 7 <br />(Phone) <br />s/~~Gs~y~7s <br />(Phone) <br />Description and/or Reason for Request (Cite Ordinance Sections): <br />In signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />ino and Subdivision Ordinances and current administrative procedures. I further acknowledge the fee explanation as outlined <br />le application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />tion expense. ^ /7~~ <br />Pa/ge/21 / _' ,-/ 'Y -~~ ~ bi <br />it) ( ate) <br />WHITE-Office CANAfiY-Customer PINK-File. GOLD-Planner .,.~zmon <br />~~ <br />