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� U <br />Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />.■pplicant n <br />(Name) <br />Owner <br />PAID <br />N? //5 <br />Rec. No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />(Address) <br />(Name) <br />rroperty Location (Street Address and Legal Description): <br />(93\ e Pirur . - <br />0 <br />1-/ <br />(Phone1/4 f t/ <br />SPine <br />(Phone) <br />Iscription and /or Reason for Request (Cite Ordinance Sections): <br />64(4, biler A C, kkc'1 l Fr.,A -i7Y kLn <br />sL <br />°igning this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />1 and Subdivision Ordinances and current administrative procedures. I further acknowledge the fee explanation as outlined <br />1 application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />o�. �xpense" <br />"E— Office CANARY — Customer PINK —File GOLD — Planner Signature of Applicant) (Date) <br />