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Little Canada, Minnesota <br />APPLICATION FORM <br />,�cr? 926 <br />PAID5'J?%0 <br />Rec. No <br />Comprehensive Plan Amendment _ Conditional Use Permit "--S <br />Zoning District Amendment Variance <br />Text Amendment Subdivision <br />Other [ct fQ�JK Z� Planned Unit Development <br />Plan Review <br />Applicant <br />Owner <br />•eta) \.J <br />(Name) <br />,µ>�ku, a CV) <br />(Name) <br />3 o9 E C QMAOv) Gc: I) _ `-)a �J <br />(Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />o x-t r. 4 `7 R )005,— <br />(Address) (Phone) <br />l E; -sr 0 vJ Oc 2`i 7-2 Ck d©Tk. <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />n 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 />in the application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />ion expense. <br />(Signature of Applicant) <br />VHITE — Office CANARY— Customer PINK —File GOLD — Planner <br />af� <br />(Dat <br />