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Applicant <br />Owner <br />N? 1087 <br />Little Canada, Minnesota PAID !SQ <br />APPLICATION FORM <br />Comprehensive Plan Amendment Conditional Use Permit <br />Rec. No <br />Zoning District Amendment Variance <br />Text Amendment Subdivision <br />Other Planned Unit Development <br />I <br />�.�r Rosso <br />Plan Review <br />3 /e/ SpRf/c /z sr <br />(Name) (Address) (Phone) <br />S/0 irrl ' <br />(Name) (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />/ 9'1//96 R Y /44, L+AI tiz <br />3 /6 y /Z/,' v tiro,- <br />-3/ Or <br />y/ati Ais,vt <br />)escription 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 />n 'd Subdivision Ordinances and current administrative procedures. I further acknowledge the fee explanation as outlined <br />in application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />ion expense. <br />(Signature of Applicant) <br />IHITE— Office CANARY — Customer PINK —File GOLD — Planner <br />- 2 - :,?Dad <br />(Date) <br />