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Little Canada, Minnesota <br />APPLICATION FORM <br />PAID <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 />Owner <br />Sass <br />(Name) <br />Pick @,SS <br />(Name) <br />c/ 717-°'d <br />69o5 6fmbr'c r St 805-12-2-/ y <br />(Address) (Phone) <br />4 V- 737r <br />(Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />(2 �. 0 St. <br />>escription and /or Reason for Request (Cite Ordinance Sections): <br />Lot- 5f6 t- fi- r~T Sr7 `£ gry f„ v( St <br />1 signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />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 />on expense. <br />(Si. .ture of A licant) (Date) <br />'HITE— Office CANARY— Customer PINK —Pile GO LO —Pia ner <br />