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07/13/2004 14 :45 6517664048 <br />CITY LITTLE CANADA <br />Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />Applicant 5 C-12.e �0- r K � S ciS <br />(Mime) <br />Owner <br />(Address) <br />(Name) (Name) ». (Address) <br />Property Location (Street Address and Legal Description): <br />P2, CCc v"2- <br />eA �t4,lS /a� se1' <br />• <br />PAGE 02 <br />100.9 <br />PAID ' C� <br />Rec No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />1u t Z -Z ?a -c Z s2 <br />(Phone) <br />(Phone) <br />s! ) Lo\-$ <br />jcc \L 3 <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />3,p "2 t54\`,15 lc tk lo <br />In signing this application, I hereby acknowledge that I have read and <br />ing and Subdivision Ordinances and current administrative procedu <br />In the application procedures and hereby agree to pay all statement <br />Lion expense. <br />derstand the applicable provisions of the Zon- <br />her acknowledge the fee explanation as outlined <br />ed from the City pertaining to additional applica- <br />(Sign .. a of Applicant) <br />- re -ouice CANARY— Customnr PINK —File GOLn —Pi. <br />(Date) <br />