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Little Canada, Minnesota <br />APPLICATION FORM <br />N? 1110 <br />PAID c--0() <br />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 />(Name) <br />/ /, <br />* -47-0 y 4, 174.,,.1 or 5t- /G GS <br />(Address) / , (Phone) <br />Jwner Kam; C >r! 6 53 /, <br />` <br />(Name) (Address) <br />property Location (Street Address and Legal Description): <br />SS. /3 <br />/dCId Or <br />75 ''Ft- • /(, G,.S <br />(Phone) <br />9 / <br />Jt94 n, <br />_, Z-n, (' rU ...�M �. 1 L t„,, / <br />ry�yy <br />Description and /or Reason for Request (Cite Ordinance Sections): C(,(P Iry 4eELECAN; A <br />' , /!Y" _ 0 ��� <br />7/' el. ,ham '4 ,e,c_flam <br />-fk rT c �, n� .54 -...f t>x vtin,r I `'- 3_ V ^`. <br />1 <br />,1 A use <br />4- -" lQ,./ L 6c. .r 1/''t. ^.<<.,..... t / ^•f/. <br />t-c 9-7., !' //n ' ^,\ <br />) <br />S , nn t.v r // m 1."-< l <br />✓ 4 t• ( r. <br />/? ? <br />4 ?y fN.a rfinf <br />1 signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zan- <br />, and Subdivision Ordinances and current administrative procedures. I further acknowledge the fee explanation as outlined <br />,le application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />on expense. <br />J, /' / /,7 <br />L <br />(Signet 'of ppl WHITE— Office CANARY— Customer PINK —File GO LD—Plann <br />an )/ <br />A A <br />/G- rz• <br />(Date) <br />C���io <br />