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C C ? 826 <br />Little Canada, Minnesota PAID 740 — <br />APPLICATION FORM Rec. No <br />Comprehensive Plan Amendment Conditional Use Permit <br />Zoning District Amendment Variance <br />Text Amendment _L. Subdivision <br />Other Planned Unit Development <br />Plan Review <br />Applicant / 4 I G 1< <br />(Name) <br />Owner <br />/6-s- G J/g ock- MK, <br />(Address) <br />6S7 -'/R31)5/} <br />(Phone) <br />(Name) <br />Property Location (Street Address and Legal Description): <br />/ G2.5 E , U //C / /L'G .OrK) ! [/E <br />(Address) (Phone) <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />/- dB1.T /c /c; c,c* y' `/c' 7C-; /.65- C "iii /L'C-0/2. <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 />it `he application procedures and hereby agree to pay all statements received from the City pertaining to additional appiica- <br />t expense. <br />WHITE— Office CANARY— Customer PINK —File GOI.( <br />Page 88 <br />(Date) <br />aOto <br />