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Little Canada, Minnesota <br />APPL]CAT]ON FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />Applicant R• Lava Jole‘ lnuon <br />11,2 <br />PAID $350 <br />Rec.INo <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />Zgao c:Y4w. <br />(Name) (Address) <br />S�. <br />(,st "fez : t`13s <br />(Phone) <br />Owner S.av+AC <br />et <br />(Name) (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />2't gal telZSn SA • , l 141v_, &A040, , \MA S S 1CI- <br />A kAsk‘ is &tiloc.tCI■tan 1\10, f3 5 loo` of W 2354 f' i of 1N 31Z 4 /to F'T Gf tof 1 <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />—T(nri,s ?Ao;c<:k stwuld sae Gpprn ct5 LS <br />' *- rtA.c'-'i &yt W h l CC\ <br />Ca NS &+n.c4 u.S <br />• u L. .+ <br />s r; / <br />a3` Xco a� � <br />� <br />0. Citrons 1 tci tav1/4-1G -\ <br />tu 64 lcE. cp,tZSc slono..\ 'QUA.* 0.ccorcQt 417) p2`S(-4- <br />r Ccn'rncr r-s, <br />o• • t > r. ► O,+A-A &l.rrourtclvu r oPe;✓hES , Ro \u ✓I <br />Slne r, �19i . Q <br />In signing this application, I hereby acknowledge that I have remand 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 />to application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />t..,n expense. <br />4S <br />1 <br />(Signature of Appli <br />NHITE —Offiee CANARY — Customer PINK —Pile GOLD— Planner <br />nt) <br />- <br />(Date) <br />