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Little Canada, Minnesota <br />APPLICATION FORM <br />Ni? 812 <br />PAID 177/56) <br />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 />*OS) 6/z- 414_W4 <br />Applicant .174-11E-,eA), Ake- 15-y 3-- A L.&zfntcrnAl /¢nc- Af mus 5-5'140 657-127-4 Ste <br />(Name) (Address) (Phone) <br />Owner Sac- <br />(Name) (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />CD 0N77ey O.LU/ " t ..Ge - $y 6701,80 )0 <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />049. e&-70r-,2sc/csW — TAN oF7er_ <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. 1 further acknowledge the fee explanation as outlined <br />in the application procedures and hereby agree to pay all statements received f .m the City pertaining to additional applica- <br />tion expense. <br />WHITE — Office CANARY— Customer PINK —File GOLD <br />Page 1 <br />27/9 <br />(Date) <br />