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Applicant <br />Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />✓t s/ /&t-C� d <br />(Name) <br />Owner r%2-1- <br />(Name) d <br />Property Location (Street Address and Legal Description): <br />(Address) <br />(Address) <br />s J4/0 7Z--/pt- let,6es <br />N? 810 <br />PAID "7Ol%oo <br />Rec. No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />77nfl x /41 a <br />(Phone) <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 />Page 1 <br />WHITE — Office CANARY — Customer PINK —File GOLD — Planner <br />