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Applicant <br />Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other vA6/?Ao,J <br />0n2- <br />(Name) <br />Owner drip <br />(Name) <br />1 'D 841 <br />PAID 12oa <br />Rec No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />(Address) ep <br />(Phone) <br />Property Location (Street Address and Legal Description): <br />3o17 S1 a, c.,/ CC :, . P <br />d/ tic / <br />(Address) (Phone) <br />/te <br />rn` ��J� J a N <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />ge k. <br />urrrnf 1e74r /.fr <br />£/r /h /N..71PdN <br />a <br />AA'd ce1/4 1.- /A ore e /meet ( tLt lar+ f <br />.o x..14 .^- <br />d <br />�J Ca1e.run, <br />( l/ 44,-) cil /( ✓ey <br />A <br />/.f tyle rr.C. (i1ec A144k, Cles <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 />Page 19 <br />1JI13lIa lUIa UI Myyuw'n <br />WHITE— Office CANARY— Customer PINK —File GOLD — Planner <br />(Date) <br />s /r y <br />. to <br />