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Little Canada, Minnesota <br />APPLICATION FORM <br />Rec. No <br />Comprehensive Plan Amendment Conditional Use Permit <br />Zoning District Amendment Variance <br />Text Amendment Subdivision /CD <br />Other Planned Unit Development <br />Plan Review <br />Applicant /`ilek5 k //r[1Ze/s 324477'., I— 44e Road <br />(Name) �J (Address) <br />Owner <br />hicks Xi dZ js <br />(Name) <br />g24t1— !Wig t 41Q. goad <br />(Address) <br />Property Location (Street Address and Legal Description): <br />2.4-6 Tie®a L . oaf • -G a <br />137- 4$ / -D4ii <br />(Phone) <br />&V- 4.81 -0489 <br />(Phone) <br />/own 30 Rave_ 22 /4,, Quav-/er 42) <br />0040 7 c/D 1 3 Water SAed 14 School .Lis/; 6a4i s,,.% code /cc, <br />1 ascription and /or Reason for Request (Cite Ordinance Sections): <br />s/,vhd/ v %si o/2 74) me ve "rc,s er /y hale , <br />signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />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 />n expense. <br />(Signature of Applican <br />!TEE -Of rice CANARY — Customer PINK Pile GOLD — Planner <br />n 3 , +n <br />—.L. —�� <br />(Date) <br />•gun; <br />