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N? 1076 <br />Little Canada, Minnesota PAID s `>6c ) <br />APPLICATION FORM <br />Rec. No <br />Comprehensive Plan Amendment \\ Conditional Use Permit D Q <br />Zoning District Amendment Variance <br />Text Amendment Subdivision <br />Other Planned Unit Development <br />Plan Review <br />Applicant S`1- 9 MR /4,67 LLP 1'3'35 .'\ l lu�� � � (9r) l — `%5y -T d Sd <br />(Name) 1 (Address) �..cv3O fl �n 55a; (Phone) <br />Owner <br />(Name) <br />Property Location (Street Address and Legal Description): <br />Co\ i<s a I, n t acalcds <br />(Address) (Phone) <br />a9 oo R co &k U, k\ i),nc.ckc■ �� 51\3 <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />•BI,tt`t4r - hp. bA1i vc,S c-roon ` \RQ (5 LrYtf1- C(.Ofle(S, <br />(°")kn `l day ()twee k <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 Applic <br />NHITC— Office CANARY — Customer PINK —File GOLD— Planner <br />(Date) <br />