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Little Canada, Minnes®ta <br />~~? ._...858 <br />0 <br />PAID `f SOLI ~ <br />APPLICATION FORM Rec. No <br />Comprehensive Plan Amendment Conditional Use Permit <br />Zoning District Amendment <br />Text Amendment <br />Other <br />Applicant (-~= ~~ <br />( ame) <br />Variance <br />!/~ Subdivision <br />Planned Unit Development <br />Plan Review <br /> <br />(Address) <br />/~--,~7-'~yvs~ <br />(Phone) <br />~~ p G1~--7~C -G,ooc~ <br />Owner ~7nv,~~ C~,~~e,F1i.c /333 t l~-c~> /r~cc-G~ S~ri,aS ~•-?G"~-r~ /~r~ S'>`~-13z~ <br />~ (Name) (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />(u,,~ <br /> <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 />i nd Subdivision Ordinances and current administrative procedures. I further acknowledge the fee explanation as outlined <br />in one application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />tion expense. <br />~~ i <br />Page 6 <br />WHITE-Office CANARY-Customer PINK-File GOLD-Planner <br />w~~-- / - 7 - c~ c~ <br />icant) (Date) <br />'~ w <br />