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~d g~7 <br />Little Canada, Minnesota PAID ~~.~~~ <br />APPLICATION FORM Rec. No. <br />Comprehensive Plan Amendment Conditional Use Permit <br />Zoning District Amendment ~- Variance <br />Text Amendment Subdivision <br />Other Planned Unit Development <br />Plan Review <br />Applicant ~\,~'~ C'_, i ~u'~S ~ (~U ~,5:~,"\~d<<l~ ~,~`dc.~~~:~ll~ `7J•7-'fG <br />(N/a~me) (~- (Address! (Phone) <br />Owner~'tico~C,~,~.~ C . Q- Ca~~v.,c:.i. 1~ t~~ ~'~~ ~ C7~21 ~(c4.s<.u~- .~~. S~. IJ~~ <br />(Name) (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br /> <br />Description and/or Reason for Request (Cite Ordinance Sections): <br />5'CC ~~~ L~~o.;~ <br />I :~ ~~ ~. u..:4.-~ <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 to999~~~XX'...___all statements received from the City pertaining to additional applica- <br />tiun expense. ,~~ / <br />(/, :/L '~% /.., ~>. .riCJ is/v~', ~~i`I <br />,~ <br />Page 16 (Date) <br />WHITE-Office CANARY-Customer PINK-File GOLD- .~~.ilo <br />