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Little Canada, Minnesota <br />APPLICATION FORM <br />©o <br />PAID ,D <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 to -CE (\1c)i EC )3 <br />(Name) (Ad ess) (Phone) <br />Owner ' Q K� r \cl <br />(Name) <br />Q(3,' 3dg< its S 6:5/ 2SSZ i3`f, <br />(Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />c f :35 V., CV en s't i N. 17,D. ` l \� I ,999 27/6 aOs <br />escription and /or Reason for Request (Cite Ordinance Sections): <br />v t'r<po,sc ftCcS$ Ccc 10-)cii1 1)c 14 <y do 1r--'ropt(s 7 <br />Ions ���,��� �i�1Cc��USZ C r4 vL <br />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 />le application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />on expense. <br />r \ <br />L� \' %{q �/ c �� <br />(Signature of Applicant) (Date) <br />HITE — Office CANARY— Customer PINK —File GOLD — Planner ere:p...eo <br />