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• <br />Little Canada, Minnesota <br />APPLICATION FORM <br />No <br />PAIDL <br />Rec. No. <br />Comprehensive Plan Amendment Conditional Use Permit <br />a� Zoning District Amendment Variance <br />!' Text Amendment Subdivision <br />Other Planned Unit Development <br />Plan Review <br />Applicant H,i" &.I ZSSo GPeet%01v <br />(Name) (Address) <br />Owner <br />M4tf- 64 164 <br />ST, (63-0 773-7;96'i <br />(Phone) <br />i� It <br />(Name) <br />Property Location (Street Address and Legal Description): <br />._80 6DGeir©N gt <br />(Address) (Phone) <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />Ga i � ce4(e e 3/4%gj1N6 job° 5� <br />QC'G. t'Q 101 FRod+ y4,0 <br />Cl <br />yca rtk/(ty k 11 k ILZyi`U r�1MPiJ "i <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 />in the 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 />VHITE— Office CANARY — Customer PINK —File GOLD— Planner <br />(Date) <br />