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0 • <br />Little Canada, Minnesota PAID <br />APPLICATION FORM Rec. No._____ <br />Comprehensive Plan Amendment V <br />Conditional Use Permit <br />Zoning District Amendment <br />Variance <br />Text Amendment <br />Subdivision <br />Other <br />Planned Unit Development <br />Plan Review <br />y,UI14t1 . <br />pplicant <br />taSeda p q1 �I <br />(Name) �2fp - (�jl lrY Vila iol2- <br />(Address) M SS 12-LN f (Phone) <br />janovrittr ss �>a 101' Elictirtri <br />Thc <br />(Name) <br />F perty Location (Street Address and Legal Description): <br />3i \-- 31(07 S <br />(So n <br />(Addr <br />ss) <br />1t1c7dch-;s rvlaw) 6.91-- 7-66 —U.�2R <br />(Phone) <br />nce � � L�1I��(i , MN ssiIT <br />d e v lost- 2-11/4-( 08`5-5 <br />i rdi ec `'Qx rare �(Lif (� Z, l�Jood iu(�! <br />)^ :cription and /or Reason for Request (Cite Ordinance Sections): <br />Ljt'JUUu 'v 3 " Eby us(.,- <br />a ing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />c nd Subdivision Ordinances and current administrative procedures. ),further acknowledge the fee explanation as outlines <br />t' -tpiication procedures and hereby.agree to pay all statements rd4ived from the City pertaining to additional applica <br />m anse. <br />(Signature of Apolicmt) <br />—Customer PINK —File <br />GOLD — Planner !'1 <br />(Date) <br />