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Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />Applicant <br />/ <br />PAID `� -) -%S6 <br />Rec. No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />0„( >5 <br />(Name) <br />(Address) .— <br />Owner Ill bOQ V\a/ Ski S,( (C. of2-, CR/ ( -'=>O /1 \p <br />(Nan-) (Address) <br />Property Location (Street Address and Legal Description): <br />(Phone) <br />(Phone) <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />In signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />ing and Subdivision Ordinances and current administrative procedures. I further acknowledge the fee explanation as outlined <br />in the application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />tion expense. <br />Signature of Applicant) <br />WHITE— Office CANARY— Customer PINK —File GOLD — Planner <br />C_. <br />( AN <br />(Date) <br />io <br />