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} <br />Little Canada, Minnesota <br />APPLICATION FORM <br />N ° a <br />� c <br />RAID-MS-0c° <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�O�✓�er 4 /eciro K;cS <br />1 (Name) <br />Ownerc(fl'S � <br />Cowl pan a� o� /:A € ga.rc4JU.i ccl Si �u��1H scut) ACS /-`f 7o --l9a <br />✓J (Address) (Phone) <br />gu, �,'n LLc /9oaf(aJ. 9/'vz.S7 Stwa -f / SZr- — (qs7- 43%-35 <br />(Name) � (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />C4 /L C'u n �Ja �d/ sr. e , / ,4737/' <br />Sc e. Q �7'rRC1T2G �2_Gr,7 :0 Al <br />Description and/or Reason for Request (Cite Ordinance Sections): <br />A !r/ lest Ae vt, <br />In 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 adminisu wive procedures. I further acknowledge the fee explanation as outtinec <br />in the application procedures and hereby agree to pay all statements receiLed from the City pertaining to additional appiica- <br />tion expense. <br />WHITE—Office CANARY — Customer PINK —rile GOLD <br />IJ <br />1LY ),LA. a0 <br />,Date) <br />Page 22 <br />