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Little Canada, Minnesota <br />APPLICATION FORM <br />`/331-,r/77 <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />74,-o =2--• <br />PAID <br />Rec. No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />>policanr /"�� (717fiejl'1)C-- '5yff3 £ 7 <br />(Name) rtig-. P (Address) /eax <br />MN. $S/#2 ^I, <br />,?SSS sMAM tj..a �— Ate& 4/ <br />/Cofc�vic.ct zlv(grei3 <br />Owner AM.1 k ,,,ez% )' <br />(Name) <br />froperty Location (Street Address and Legal Description): <br />"3_3 . 'ad /1771.4. (AI 4 n A /2 /' <br />-5, t 4 4G//<4 So MR 2S4C,4 .5 ( <br />�` <br />/05 /- 77o -G //o <br />6S! Phone) oat <br />lost -634 roc <br />(Phone) <br />3G.'SS'4/z <br />(o5/ <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />o .<;- Al- a_ C Sf Z4-t. P..n./A /' fr J <br />L <br />'a%1L,tAQ ., -� . ate • 74 AY: l,iel.u.GI <br />In signing this application, I hereby acknowledge that I have read and fully understand the aop)icaole provisions of the Zon- <br />ig and Subdivision Ordinances and current administrative procedures. I further acknowledge the fee explanation as outtinec <br />the application procedures and hereby agree to pay all statements received from the City pertaining to additional apptica- <br />don exoense. <br />"'HITE —Office CANARY — Customer PINK —Rte GOI <br />Page 21 <br />/1 -1- eo <br />Date) <br />