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Applicant <br />Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />&tor at -Lerprl c,e_ (4.0, <br />(Name) <br />OwnerUI <br />(Name) <br />Property Location (Street Address and Legal Description): <br />• <br />(1 t 77 <br />PAID <br />Rec. No. <br />Conditional Use Permit /fG6 1,G'Ai1L{ ('ItiC-C± <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />/05 7 6 3- <br />(Address (Phone) <br />3i05 7 - m,tu, <br />(Address) <br />p/c � ilui 2S-d, 4'�a -o -% <br />1 (Phone) <br />)escription and /or Reason for Request (Cite Ordinance Sections): <br />Amiti(-0(t0/144± (15e io(,KIAAL e (-c i ac (led • <br />signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />.g and Subdivision Ordinances and current administrative procedures. I further acknowledge the fee explanation as outP.- <br />n the application procedures and hereby agree to pay all statements received from.the City pertaining to additional api. <br />in expense. <br />(Signature- 2 -ppiant) <br />iUTE— Office CANARY — Customer PINK —File GOLD — Planner <br />(Date) <br />