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Little Canada, Minnesota <br />APPLICATION FORM <br />PAID 759'69 <br />Rec. No <br />Comprehensive Plan Amendment Conditional Use Permit <br />Zoning District Amendment Variance <br />Text Amendment Subdivision <br />Other 4----C�71.--- e ✓ --' Planned Unit Development <br />/ / Plan Review <br />` <br />Applicant Ji9N et�G�vKOWSL 144130 <br />(Name) <br />Owner , A}fZS+u `E tAh4 rnkpwsL: <br />(Name) <br />Property Location (Street Address and Legal Description): <br />236'7 it'\c Menem SF <br />LtWtc ( ek1- 4/ IW s *0 33 <br />(Address) ( - 5 <br />70 s Co sr q3‘ ce <br />SS633 (Phone) <br />5 3 o'1-1' S4 S o <br />(Address) 144541115 <br />S ✓kN <br />SSo33 <br />6 st `fz4 56654 <br />(Phone) <br />VAW s o N s <br />�K 4 (o +s z, 3,4,5-,(4, 7 <br />b S <br />9 <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />jo p.-No4-e�( <br />VC.-- C.- on-N, <br />® - 10 c.3 4--e eT <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- staterne• s received from the City pertaining to additional applica- <br />tion expense. ..---/ j' / ' / <br />(Signature of Applicant) <br />WHITE- Office CANA HY— Customer PINK —f=ile GOLD — Planner <br />(Date) <br />