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Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />Applicant <br />Owner <br />(Name) <br />X <br />N? 962- <br />PAID 7'(j /27-e <br />Rec. No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />me s /nc. /398/ Al (00 74-€(57- �aniPScOSaeS� "`s <br />(Address) (Phone) (LSI- Z7S -ofoI 0 <br />(Name) <br />(Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />i(lE 'Mc ri 3/s eS Lo-+ acts Z dice FIB Park aOA l ,-)4,s I <br />-1--hrrn>uh 23 13) or K ra,i �) �� h ��K E-4e,5n4.5 ,Ram CW4. j /0/1,ot esc)k <br />ascription and /or Reason for Request (Cite Ordinance Sections): <br />6u[ /c) .Sa/!ior OU r7S ,4 (d iv <br />I signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />i I and Subdivision Ordinances and current administrative procedures. 1 further ledge the fee explanation as outlined <br />in the application procedures and hereby agree to pay ail statements re from the City pertaining to additional applica- <br />rnn expense. <br />Page 14 <br />'1 !ITE Office CANARY — Customer PINK—;;19 GolD Fanner <br />(Date) <br />Cal <br />