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• • <br />N9 -111. <br />Little Canada, Minnesota PAID <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 <br />ri(e61 $0.24— 131Y A-4 <br />(Name) (Address) <br />G rte 1 U L 4 l J 1 J a I OV � 4 / ) mn p rl Sec, - . 1 C , l Ste p f'D 2? <br />(Name) 1 ( d&ress) <br />Property Location (Street Address and Legal Description): <br />31 vq- <br />Ufa UL / 1' Iz- g.c5= 4 & z5 <br />MK, 55 1-22c !! (Phone) <br />et.Mvf.SS 6(,,,0 <br />(Phone) <br />Ld3/4.3qAcik WI 55 1 <br />�1 s netuk A v 11)\,-iL,NEJ7 10 z- tio'cbd Ly(.,, ki kc s s 12-s <br />escription and /or Reason for Request (Cite Ordinance Sections); <br />Q Q2-17A4 &C b <br />signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />°nd Subdivision Ordinances and current administrative procedures. I further acknowledge the fee explanation as outlined <br />in <br />tiapplication procedures and hereby agree to pay all statements receiued from the City pertaining to additional applica- <br />on expense. <br />l/ `: c'�`' �I� mil <br />/z-(-;2-7710 <br />�k k GUS 1 Li t 1 l '/4 it T e <br />( <br />(Signature q AYaplicant)I (fto) <br />4 ITE— Office CANARY— Customer PINK —File GOLD— Planner ! k f h -�r^�� <br />