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Little Canada, Minnesota <br />APPLICATION FORM <br />N 979 <br />PAID 700 <br />Rec. No <br />Comprehensive Plan Amendment Conditional Use Permit <br />Zoning District Amendment Variance <br />Text Amendment Subdivision <br />Other Planned Unit Development <br />Plan Review <br />6S1- 77) -9c\05 <br />Applicant G- tEGOR`( T. GALL.owAt 2121 SLoiw si-. rivirpLENOcC5 It/W.55)17 <br />(Name) (Address) (Phone) <br />sp) <br />Owner �D u N�AM� Y 523Leo � Canad a a 651 —szA 4--539q <br />(Name) (Address) <br />(Phone) <br />Property Location (Street Address and Legal Description): <br />515 LievtaRiE <br />The we s-1- 0o$ - o- (A-} -S [ G <br />rc- I^1 <br />BLocK- <br />evve is R- eLik-- c4-1 (A. The cameo &a 1 sej cots„u-i- <br />escription and /or Reason for Request (Cite Ordinance Sections): <br />S kA #I. 1`v t s 1 b +..s v- L'1`_ <br />PAID <br />JUN 19 2003 <br />;IIYOFLII IL.F.L.101A© <br />I signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />and Subdivision Ordinances and current administrative procedures. I further acknowledge the fee explanation as outlined <br />n' application procedures and hereby agree to pay pl statements received from the City pertaining to additional applica- <br />:io, xpense. ,GAS <br />;„ (7 L. Ate(t ui t /.F //o 3 <br />(Signature of Applicant) �rDate)/ <br />TE— Office CANARY — Customer PINK —File GOLD — Planner .'t <br />