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r''~ <br />Applicant <br />Owner <br />Text Amendment <br />Other <br />Comprehensive Plan Amendment ~ Conditional Use Permit <br />Zoning District Amendment Variance <br />r ~"" - 9S 3 <br />Little Canada, Minnesota PAID ~'-~~o ~~ <br />APPLICATION FORM Rec. No. <br />(Name) <br />(Na <br />Property Location (Street Address and legal Description): <br /> <br />~h 5-a~-~-a~a - o~ <br />T ..t ~o~ ~5 -~~.~.~ e~ k1, 'N6~~-~, a, 5~ ~i -E'~~-~- o~-~h~ F' ~~- ~~ <br />~~, <br /> <br />Description and/or Reason for Request (Cite Ordinance Sections): <br />bR~~~ GOt~~` d~ <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 ree explanation as outlined <br />in ' application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />tio, .xpense. <br />~ (Date) <br />WHITE-Office CANARY-Customer PINK-Fiie coo- Page 5 .-.;~„~~ <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />(Add ss) (Phone) <br />(Address) (Phone) <br />