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C C <br />Little Canada, Minnesota <br />APPLICATION FORM <br />Conditional Use Permit <br />AT? 816 <br />PAID ZJViW <br />Rec. No <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />Applicant kvccev <br />(Name) <br />Ownerve— 'CS <br />(Name) <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />)OGl �ian �viv� <br />( Addres) (Phone) <br />Property Location (Street Address and Legal Description): <br />9 (Zyain h \te. <br />(Address) <br />(Phone) <br />z <br />Description and /or Reason for Request (Cite Ordinance Sections): <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 statemen •c- t. a .. ity pertaining to additional applica- <br />tion expense. <br />WHITE— Office CANARY— Customer PINK —Pile GOLD- <br />Page 109 <br />(Date) <br />0 <br />