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Applicant <br />Owner <br />Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />(Name) <br />(N:U7-) <br />i/Aik <br />N" 1073 <br />PAID D6---043 <br />Rec. No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review O/° @� <br />'fr <br />/off r/7 <br />(Address) <br />LZA- <br />(Address) <br />Property Location (Street Address and Legal Description): <br />(Phone) <br />(Phone) <br />7 o *ziak_ Lif <br />n ),„, , <br />(4-,„-‘7-7 <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />/chQ� <br />et- )19bes <br />in signing this application, I hereby acknowledge that a e read and fully understand the applicable provisions of the Zon- <br />ng and Subdivision Ordinances and current administ ative'procedures. I further acknowledge the fee explanation as outlined <br />in the application procedures and hereby agree to pa a I st . e received from the City per3aining to additional applica- <br />tion expense. Lj, /', <br />(Signature o A pplic <br />NHITE— Office CANARY— Customer PINK —File GO — nner <br />dv <br />(Date) <br />