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Little Canada, Minnesota PAl O.00 <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 />Applicant <br />Owner <br />tTL CG „,40, sec L, I_c eA, Imo. *A. yd3 -sr <br />(Name) --1 (Address) (Phone) <br />C.RrAvd1 <br />Via, \ <br />(Name) <br />Property Location (Street Address and Legal Description): <br />7057 /Cleat 2k,Cr 0)780 - c37C <br />(Address) (Phone) <br />30G 4141A_ ffC���d�. <br />i,b a5 clo,, l� p'ZCa S'E. Saks C � `i�� f �. wr i� ail i�nai- <br />Ve f� 0 i *LA_ 'OW �R 0,5±- <br />ter cl--t o+ s z C G tnrv. e h i a I �u cy .9`.- <br />'rJ <br />DeZv` b4. tcr-v. +Ls_ E�s.stt \y a�.t -2i ��r.rsf /y (; �5 Le 6 St” Tc1,its <br />ript�h and /or Reason for Request (Cite Ordinahce Sections): c k7 �x��n� s 0. ft, ,1 3 (,�r< <br />a� o,,4ct Lek —'L� <br />1 C e -OtOt o v- Cr a LA,,) 05 <br />yr-,L6{_no <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 <br />1i • <br />Page 41 <br />9 <br />Date) <br />