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Applicant <br />Owner <br />1�° 808 <br />Little Canada, Minnesota PAID a%W <br />APPLICATION FORM/ Rec. No <br />Comprehensive Plan Amendment V Conditional Use Permit <br />Zoning District Amendment Variance <br />Text Amendment Subdivision <br />Other Planned Unit Development <br />Plan Review <br />et etr f J3 <-7-fe Lo ecic_4-7- Aus C 5(-7 747— 7CC-E: <br />(Name) (Address) (Phone) <br />/ <br />S Cc- Pt- c ccS <br />(Name) <br />Property Location (Street Address and Legal Description): <br />-Zl oL- Lcroev' -014 <br />(Address) (Phone) <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />;c f S e c cr ov <br />c)(4--;‘‘,: j_ S (o �� -' % /� c_ c)(4--;‘‘,: ed- <br />eC i w"eA- -4- 1) 1 f u - sc Itc ( � <br />c(, 2 c s� <br />er5, <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 />Page 10 <br />(Date) <br />