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Little Canada, Minnesota <br />APPLICATION FORM <br />N? 876 <br />PAID 1/4-75a---°C) <br />Rec. No <br />Comprehensive Plan Amendment Conditional Use Permit <br />Zoning District Amendment X Variance <br />Text Amendment Subdivision <br />Other Planned Unit Development <br />Plan Review <br />Applicant a VN / L/J /C ad t--S % g,e‘r 87 U0 -4¢d¢ 3 7w -4 ...; / n- <br />(Name) (Address) (Phone) <br />7wner ./1/uF �G 9 1-f4 ° c9,CC/ <br />(Name) (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />3/7 c?a,&GGG�-- <br />)escription and /or Reason for Request (Cite Ordinance Sections): <br />1/A irver 471 <br />cD J/ J /.i ; 21 ,96)4 <br />�%vm 4 ivM / - 77�P,4 /' `L--- - // ;e /// /P <br />/fent, Pe- <br />t signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />ing and Subdivision Ordinances and current administrative procedures. I' further cknowledge the fee explanation as outlined <br />in the application procedures and hereby agree to pay all st ements Keceived om the City pertaining to additional applica- <br />on expense. <br />Page 3 <br />.:RITE— Office CANARY— Customer PINK —File GOB <br />it) <br />(Date) <br />