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Applicant <br />Owner <br />• <br />Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment Conditional Use Permit <br />PAID <br />Rec. No <br />Zoning District Amendment Variance <br />Text Amendment Subdivision <br />Other Planned Unit Development <br />Plan Review <br />(Name) <br />3-7 F y4A( 7s'/ 4l<4ey- 73 7 <br />(Address) (Phone) <br />(Name) <br />Property Location (Street Address and Legal Description): <br />(Address) (Phone) <br />//' C-io nr 67/7/41.4 s 5 7 /s ie 1/25'7\i/ 5 <br />Description and/or /]Reason for Request (Cite Ordinance Sections): <br />/'lc'9 /iC. /1- /i19% ,9•_ 7,V-Nf %c S ".f,‘ <br />Act(' % /1C *� __y -='C' /i`'C cxe3/ � % ✓ice /- za • <br />C jam- T /?/ 7? - /17 Ye() /��y <br />i'2'%6K. 64(11 gr /7727(-673 1,(2/ 61e.— )c // 5 s / ' . <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 />he application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />expense. <br />(Signature of Applicant) (Date) <br />VHITE— Office CANARY— Customer PINK —Pile GOLD — Planner ,,;d0o <br />• <br />