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,pp(icant <br />Owner <br />1 J r 1 OU R <br />1 1 1.-1 1 I L.C. 1_nl IML1S <br />Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other fef 4I <br />�Tkv� <br />J(Name) <br />(Name) <br />\'lo <br />N&t <br />1J <br />r rear <br />4' 951 <br />PAID5�0 <br />Rec. No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />X Planned Unit Development <br />Q T■N`%rtZle �� QCa� Tt,Vice t3 <br />Plan Review <br />(Address) <br />` 2; r <br />roperty Location (Street Address and Legal Description):. <br />(Address) <br />o2 960 . Pen.. -.•, �c�� <br />OS C21 <br />(Phone) <br />(Phone) <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />11 signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />ng and Subdivision Ordinances and current administrative procedures. I further acknowledge the fee explanation as outlined <br />r :he aoplication procedures and hereby agree to pay all statements received from the City pertaining to additional applies- <br />-I a expense. <br />(Signature of Applicant)___ <br />-vMTE —Of fice CANARY —Cusco mar PINK —Fila GOLD — Planner <br />(Date) <br />