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Applicant <br />Owner <br />Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />Ul c- net l\ Lec <br />c )se �c rccci l6? <br />(Na e) <br />S C1 /?-7 e. cL s ° C v e <br />/a fl2e <br />(Address) <br />/030 <br />No 10.0 <br />PAID 700 <br />Rec. No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />E �7 6C i - 77/- -/ `l ( <br />(Phone) <br />(Name) <br />(Address) <br />Property Location (Street Address and Legal Description): <br />/67 YI,'e i7/%6nem( SI, <br />/fLc Cr�hc�J 7 in( `/ SS Ii% <br />`'L D oti— 9 - ,2.' -` ci -coo/ <br />(Phone) <br />I scription and /or Reason for Request (Cite Ordinance Sections): <br />Cif V / CIOY? <br />I signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />i I and Subdivision Ordinances and current administrative procedures. 1 further acknowledge the fee explanation as outlined <br />it application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />ti axpense. <br />v. <br />4,`2e. (h <br />natu e of Applicant) <br />ITE— Office CANARY — Customer PINK —File GOLD tanner <br />(Date) <br />