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/0V7 <br />Little Canada, Minnesota PAID45SZO <br />APPLICATION FORM <br />Comprehensive Plan Amendment 1 Conditional Use Permit <br />Rec. No <br />Zoning District Amendment Variance <br />Text Amendment Subdivision <br />Other Planned Unit Development <br />Plan Review <br />Applicant \ JG -UvA Y vans aoq N S PC°± (5I- D3 I- t;a36 <br />(Name) (Address) (Phone) <br />Owner Mx/ Ee vet ns c ono N LC re Star+ CO3S-r22))-�C?ac17 <br />(Name) (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />inn Lane. <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />'n signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />ng 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 />tiL,,i expense. <br />7// 706 <br />(Signature of Applicant) <br />/HITE— Office CANARY — Customer PINK —File GOLD — Planner <br />(Date) <br />