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Little Canada, Minnesota <br />APPLICATION FORM <br />x <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />Ageril <br />PAID( 50G•66) <br />Rec. No. <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review ft 65-1-63-q, 1 Y?-O <br />c cs/,02 ai3 'Era 41 <br />Applicant, 0 IA 1\k 6-, Ci ( R ( N Li 41 V 1 i'C 1 N G '4D R1 ti e E, <br />(Name) (Address) <br />Owner A wt t. <br />(Phone) <br />(Name) (Address) <br />Property Location (Street Address and Legal Description): <br />�1 12 7 VlickN& v r r b5.r Lt.TtLE <br />(Phone) <br />CA-N /A04 MN <br />SS <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />PEiZ.5oNAi_ c.577) lR/k6- F (leio'i t =oC" CisM \Ulefi <br />5 <br />6R AA Y jP R O P t, i' -T Y, O R 1 NA M t_ 6-E- R. g A L,/ <br />-1` L✓%1,0 /C) L..CI i a` t p / 1 e 2i. <br />I xi151 i,4) C" <br />,9 v/),e /3 ix c.R y 10 3, 0 2 5, DAL P A; A <br />In signing this application, I hereby acknowledge that 1 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 stet4 • •nts recited from the City pertaining to additional applica- <br />tion expense. <br />PE PS F. O Rav(A N c F. EQUtRREF( <br />w' YTE— Office CANARY— Customer PINK —Pile GOLD —PI ner <br />nature of Applicant) <br />2 <br />-(,. f APRIL ?O(`-12, <br />(Date) <br />