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Applicant <br />Owner <br />/srQ? 1121 <br />Little Canada, Minnesota PAID 522 <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 />�t4� Ie C&v \cam 551) <br />ocKen L9oo R\ e S�, 65t uly36h <br />(Name) \0L15 C 'ce-„'S'kn <. reCa Q.1 » r 5sit °n ) <br />(Name) <br />Property Location (Street Address and Legal Description): <br />a cw o <br />(Address) (Phone) <br />RA U- Si-, Le-0-1-e- GLAD, A oc- <br />i. <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />(-actg._ Earner-A- V\ a Lit)/ / <br />fug a.\ <br />n signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />ir- and Subdivision Ordinances and current administrative procedures. I further acknowledge the fee explanation as outlined <br />i. e application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />ion expense. <br />(Signature of Applicant) (ate) <br />VHITE — Office CANARY— Customer PINK —File GOLD— Planner <br />pro <br />