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lam, 93 <br />Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />Applicant <br />PAID <br />Rec. No. <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />COLiS� �v� , /// �`�u� ??(X.) <br />(Name) (Address) (Phone) <br />Owner / / --*s L 4. /t---/Z0 <br />(Name) <br />s8go5 A(a6--42. /Q4,sfl7 <br />(Address) (Phone) <br />s / 5�/� ///6 <br />7; • 7 ;o,oca /6 <br />Property Location (Street Address and Legal Description): <br />no-0 Ail „v <br />)escription and /or Reason for Request (Cite Ordinance Sections): <br />ye_n i 024 &-72 /% <br />ee,g,Kieg <br />signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />la and Subdivision Ordinances and current administrative procedures. I further acknowledge the fee explanation as outlined <br />it a application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />*lon expense. <br />(Signature of Applicant) <br />HITE — Office CANARY — Customer PINK —File GOLD— Planner <br />(Date) <br />