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'~ ,~e.~ ~~-cozy <br />~• ~!4'- /58~ <br />Little Canada, Minnesota <br />1~~ --883 <br />00 <br />PAID~~- <br />APPLICATION FORM Rec. No <br />Comprehensive Plan Amendment Conditional Use Permit <br />Zoning District Amendment <br />Text Amendment <br />Other <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />Appli <br />(Name) <br />(Name) <br />Property Location (Street Address and Legal Description): <br />r. ,P K /, <br />(Address) ~ (Phone) <br />(Address) (Phone) <br />~/0- <br />3s <br />> e e a ~~ ~F <br />Description and/or Reason for Request (Cite Ordinance Sections): <br />~2 S a I u ~i' v. `e <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. t further acknowledge the fee explanation as outlined <br />le application procedures and hereby agree to pay all statements recefyed from tine City pertaining to additional applica- <br />tlun expense. ~ ~ ~ ~M~ <br />~ -~, ~i~ <br />Page 15 (ate) <br />WHITE-Office CANAR V-Customer PINK-Pile GO ~I yam <br />ki~5 ~OtM /JGHY. ~.;~oy ~~ <br />~« J9n~c~.01.'~.zS~ri <br />