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Little Canada, Minnesota <br />APPLICATION FORM <br />/y <br />PAID !( -6, <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 PA ---f- Y' 1 d / A tTn 1 C/( Ai / (y ,ft`L- rly, „it ✓ ! <br />(Name) (Address) (Phone) <br />Owner {�- i'vf�' /k� �GtICXSa N %!,�l l,A.yd, "— r- 7- �;_S � `// <br />- -- (Name) / (Address) <br />Property Location (Street Address and Legal Description): <br />Lit2/`-c_ br- e -c fi,,I1 r 1 -ev <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />YJ c7 %6 G 2 <br />n signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />no and Subdivision Ordinances and current administrative procedures. I further acknowledge the fee explanation as outlined <br />application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />tion expense. <br />(Signature of Applicant) <br />VHITE— Office CANARY— Customer PINK—File GOLD — Planner <br />(Date) <br />