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Applicant <br />Owner <br />N° 803 <br />Little Canada, Minnesota PAID c.&) 4. <br />APPLICATION FORM Rec. No <br />Comprehensive Plan Amendment Conditional Use Permit <br />Zoning District Amendment Variance <br />Text Amendment Subdivision <br />Other Planned Unit Development <br />Plan Review <br />(Name) <br />r ii <br />(Name) <br />Get( <br />3 / o / Gou -try D• 6s'/411'/- 733 I <br />(Address) (Phone) <br />3 /e/ Ca -ry /9Y <br />(Address) <br />Property Location (Street Address and Legal Description): <br />G 51 /U/d/ - 23 3 <br />(Phone) <br />3/e / (u � c� .L,-�Lc) 7U i-c - ,4- AS <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 />g // %7 <br />Page 9 ) (Date) <br />WHITE — Office CANARY— Customer PINK —File GOLD — Planner <br />