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Appl icant <br />Owner <br />Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />lerfl 4(14* Mob <br />(Name) / <br />(Name) ( <br />2t2 kiv <br />Property Location (Street Address and Legal Description): <br />PAI D <br />N? .262 <br />Rec. No. <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />(Address) (Phone) <br />�S/ oZ9 <br />(Address) <br />-6%z‘ ail <br />(Phone) <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />a`VX (a ' C^ u ^r4S c-ti <br />In signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />ing 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 />tion expense. <br />(Signature of Applicant <br />WHITE — Office CANARY— Customer PINK—File GOLD — Planner <br />2 <br />(Date) <br />