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Little Canada, Minnesota <br />APPLICATION FORM <br />PAID <br />88: <br />7U0 <br />Rec No <br />Comprehensive Plan Amendment Conditional Use Permit <br />Zoning District Amendment Variance <br />/ Text Amendment Subdivision <br />1/ Other Planned Unit Development <br />Plan Review <br />Applicant <br />wner <br />OUC) 5\ R cam. eTR7 r-<..r (a - 35b-H3t <br />(Name) (Address) (Phone) <br />S.GrKe- <br />(Name) <br />Property Location (Street Address and Legal Description): <br />1zSZ - rzr4 Ares- rhea <br />(Address) (Phone) <br />Go rs 4 1 5-/ LOCI .. / ,6fl�i cxnn,.J BF`H' 4i %�i¢iPJL <br />ascription and /or Reason for Request (Cite Ordinance Sections): <br />/ of re) /113-0 1-16i-17 OM X. Z co.vrre up us tag et-e <br />I 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 acknowledge the fee explanation as outline° <br />in the application procedures and hereby agree to pay all statements received from the City pertaining to additional aopiict- <br />I n expense. <br />Page 12 <br />'1 . ITE —Cff ce CAN A RY— C;astomer ?INK —Fie GOLD— ?fanner <br />(0ate) <br />