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( ( ~~ -- <br />iV~ 001 <br />Little Canada, Minnesota PAID ~~vo <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 L/IJC~~ m1~~~~,)TI 1 ~~~ I'11~.~ `~~~ ~~~ ~~~r-~"JCJ~~t <br />(Name) (Address) (Phone) <br />Owner <br />(Name) (Address) <br />(Phone) <br />Property Location (Street Address and Legal Description): <br />~zSz- ~ ~zs¢ R~c~ sr.~-sr- <br />c o rs 4' ~ S, !~ ~a ~ ,~«c~~2xJ s~i~i ~ ~°i~,e~ <br />Description and/or Reason for Request (Cite Ordinance Sections): <br />Gmr" con~so~tr~~-f7©N o~ Z ca.urrquous Pi~.e.c~5 <br />Ir 'gning this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />il nd Subdivision Ordinances and current administrative procedures. I further acknowledge the fee explanation as outlined <br />in the application procedures and hereby agree to pay all statements received from the City pertaining to additional appiice- <br />tion expense. <br />-• <br />~ Page 9 x--33 _~; <br />1 _ , ,_ .__.., (Date) <br />WHITE-Office CANARY-Customer PINK-Pile GOLD-Planner ~~,~m <br />