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Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />KOthe r /�Cil'✓'�� <br />Applicant ��9N Le,,JCw∎ 6w5h 1(1130 !07',1`1-'3 105 /4(3 c‘ce <br />N? 99q <br />PAID <br />Rec. No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />Owner <br />(Name) <br />� h M2-b N <br />(Name) <br />CPt.4.14Akpw3K� <br />(Address) 0633 (Phone) <br />/y 53 o 54 So <br />(Address) 1,/,45'4,15 <br />Property Location (Street Address and Legal Description): 55o3 <br />23 &7 II^ eAQM SF 1}�JA,wsQN, <br />,i+le_ (4.4., 4,- /Lt.i s ko 33 K 4 (ads 2 3, 4, 5, (o / % <br />Lbfs 3, 4,5 <br />4C1 `Z <br />(Phone) <br />Skin- ,-,,,.L...:- I o -I-s <br />" '5' <br />escription and /or Reason for Request (Cite Ordinance Sections): <br />■- Q c.2) ce..Qy 44 :v:IA Q ..,.-\a \o�s Lek <br />p ry 4-e cJ- Lo e± (a J <br />signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />..,g and Subdivision Ordinances and current administrative procedures. I further acknowledge the fee explanation as outlined <br />i •e application procedures and hereby agree to pay atl-- stafemje- s geceived from the City pertaining to additional applica- <br />expense. �(' <br />Zy_oLf <br />(Signature of Applicant) (Date) <br />' UTE— Office CANARY — Customer PINK —File GOLD — Planner <br />