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C i <br />Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />Property Location (Street Address and Legal Description): <br />N° 804 <br />PAID %nn °° <br />Rec. No <br />Conditional Use Permit <br />Variance <br />X Subdivision <br />Planned Unit Development <br />Plan Review <br />/ // / - / " `A fl- icir2- 7/0 r <br />(Address) (Phone) <br />/ / <br />(Address) <br />r/ <br />/ / <br />(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 />WHITE — Office CANARY— Customer PINK —File G <br />Page 65 <br />77 >g/92 <br />(Date) <br />