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Little Canada, Minnesota <br />APPLICATION FORM <br />N? 871 <br />PAID <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 /'M*S 6rte0Y <br />(Name) <br />02503 <br />(Address) <br />Owner /'OM Scot% PQO,4LJ7tS 11 %4A.rta. 45 Ace <br />(Name) (Address) <br />Property Location (Street Address and Legal Description): <br />V33 ,- Z,Ti Ls 6dNA4 /% e7 <br />oFf /- <br />65/- -,5-oO 9 <br />(Phone) <br />65� - Co3ta <br />Os/— 51/ -os77 <br />(Phone) <br />(St E 4_77A ei9g4 5U20'‘.Y c; l <br />Description and /or Reason for Request (Cite Ordinance Sections): 2 tt- <br />Saczc 49-7` e t _AA. tc ,im a e-vv . <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 administrative procedures. I further acknowledge the fee explanation as outlined <br />in the application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />tion expense. <br />WHITE —Office CANARY — Customer PINK —File <br />e;7/ le-, frc _2 5-- d'e <br />coo_ Page 16 <br />(Date) <br />