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Applicant <br />Owner <br />Little Canada, Minnesota <br />APPLICATION FORM <br />1282 <br />PAI D <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 />rhrrycf 4e; ilk /110 OP 4me York ;rid 571 6r -rgY -(7/7 <br />(Name) (Address) (Phone) <br />(Name) (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />�2 5`7(n)— 2(rs ,"ate eV <br />Description and /or Reason for Request (Cite Ordinance Sections): <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 statements received from the City pertaining to additional applica- <br />tion expense. <br />(Signature of Applicant (Date) <br />WHITE — Office CANARY— Customer PINK —File GOLD — Planner <br />