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Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />Applicant <br />N° 83, <br />PAID 2,f-)0 <br />Rec. No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />602,0 6(2 3gce <br />(Name) (Address) (Phone) <br />Owner (ZiARi-7/rlinlit <br />s <br />(Name) <br />Property Location (Street Address and Legal Description): <br />20 kr ? /// &5% 1/02/ 6ri z9(G�s,n/ <br />(Address) (Phone) <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 statements received from the City pertaining to additional applica- <br />tion expense. <br />/i/ „ ;,� <br />Page 1 <br />Itl <br />WHITE— Office CANARY— Customer PINK —File GOLD — Planner <br />(Date) <br />