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Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />Applicant <br />Owner <br />N? 957 <br />PAID d gs <br />Rec. No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Han Review <br />pox F--c68. <br />(Name) (Add4ss) (Phone) <br />�cSoc.t - 10017'446 <br />(eel(-1?ij /` <br />) t -1767- cg <br />(Phone) <br />SP" t'7.7 <br />gto <br />(Name) <br />Property Location (Street Address and Legal Description): <br />JOB SE' f eCt(Li <br />l2Pm e 0,611n1-( <br />(Address) <br />d Lo-l5 . 54-heL4 <br />DL4A t r3L-15± u o RQ cee,nee c?W 63 <br />scription and /or Reason for Request (Cite Ordinance Sections): <br />• <br />ga2(ncj c \oLo f� ao54 -c;��� {��ma. --n dL i_� -bft Won h)210 \ ()01h. , _L n± �-o eQ c c �" <br />r igning this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />i -, and Subdivision Ordinances and current administrative procedures. I further acknowledge the fee explanation as outlined <br />1 application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />expense. <br />re— Office CANARY— Customer PINK —File <br />Cz 7612th <br />($ig iature o Applicant) <br />GOLD —Plan er 1, <br />//77-6/ <br />(Date) <br />