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Little Canada, Minnesota <br />APPLICATION FORM <br />977 <br />PAID $900 <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 />Applicant t r71 tt4 ( DEvaureivr L1k s S <br />(Name) t9t £L 1 <br />Owner <br />Property Location (Street Address and Legal Description): <br />ST &,S(-4301200 <br />ZI g (Phone) 4. , Cs 2_ <br />(Address) oat. 'emit., CIA Ai (Phone) <br />M> cim y t V t tcf)rf <br />-� j- LE2 At • <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />In 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. 1 furt. • ackno edge the fee explanation as outline, <br />r the application procedures and hereby agree to pay all s ' ng to additional applica <br />tion expense. /! <br />('Ignaureof Applicant) (Date) <br />WHITE — Office CANARY — Customer PINK —File GOLO —Plenn <br />