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Little Canada, Minnesota <br />APPLICATION FORM <br />Conditional Use Permit <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />Applicant 3)41 VA /cAli ) <br />(Name) <br />Owner <br />vefrle r)/v <br />(Name) <br />828 <br />PAID t50 <br />Rec. No <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />Fey E ,ifeRQ old ''Yes' FV. A! y'e s EL <br />(Address) (Phone) 33-9 3/ <br />Property Location (Street Address and Legal Description): <br />SI 7/g «5,cRu o e- vM. <br />(Address) <br />Zee3/ 777- 4/723' <br />(Phone) <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />6(7L144, <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 cedures. I furth acknowledge the fee explanation as outlined <br />in the application procedures and hereby agree to pay all tements receive from the City pertaining to additional applica- <br />tion expense. <br />41/% / <br />Page 84 <br />WHITE— Office CANARY— Customer PINK —File GOL6 Planner // <br />it) <br />6 -aa -99 <br />(Date) <br />