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Little Canada, Minnesota <br />APPLICATION FORM <br />N? 1058 <br />PAID 760 <br />Rec. No <br />Comprehensive Plan Amendment Conditional Use Permit <br />Zoning District Amendment Variance <br />Text Amendment Subdivision <br />Other Planned Unit Development <br />Plan Review <br />Applicant <br />Owner <br />(kieo2 ,4, w,5 l3_n6A MVO , ,2srao /P5LtEx /2 / -w/ os7- y2'V-36s1 <br />(Name) (Address)/MOCIi%Uoli1/ =4J (Phone) <br />)Qv,i = 13i-wail/WO 1 Z ?Gb kka,z,,t /*'w�, /y�/ o57 9s'5' YG5' <br />(Name) (Address) iiii_A,&Wt%)l) 1"! /V (Phone) <br />Property Location (Street Address and Legal Description): <br />25 "2/3' .EDP- tiFn.TWA) 5r , up ,L,z Oi01-12/' j4I,53 7/7 -/G zo <br />SECT /o,v y, /owi✓ Z9 I/MUG-6 zap 2L 001 2— aTu4J to $T %/fii S /Of ror <br />1010k3 PT of E208'Ft of vie 4 /3%u»U6- Pita- of &3PT 407 / SIC? /.v Z9 RA) z z-- <br />)escription and /or Reason for Request (Cite Ordinance Sections): <br />cTut Dff.v)DiL CaXalivr 7,fidiErx /X'7 %u'o Ldi <br />l/F L4UlH4f4WT izE, o T/1-mr 2'''» 2.07" Cgu% <br />BE 71fr»ka/°� <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 />A <br />(Signature of Applicant) <br />IHITE— Office CANARY — Customer PINK —File GOLD — Planner <br />(Date) <br />