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Applicant <br />Owner <br />Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />17y 4t- a Xtily SNl <br />(Name) <br />Mt- EX &Mva -r n.rt7 <br />(Name) <br />Property Location (Street Address and Legal Description): <br />N9 797 <br />PAID 9\50•uQ <br />Rec. No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />31 & Vt/ L4. <br />(Address) <br />3/6 e ,4y,'. <br />(Address) <br />- 6.57 z/Y3—SO/ / <br />(Phone) <br />6-57 - z/13 -3.3/ / <br />(Phone) <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />/' o jny S-174/-4„.7c, . s o h <br />/42 re_.:e. ziat 4e. /,j` t Zile £r c ` LlGC6�tt.l�f <br />In signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />i• and Subdivision Ordinances and current administrative procedures. 1 further acknowledge the fee explanation as outlined <br />ii... le application procedures and hereby agree to pay all state ents rived from the City pertaining to additional applica- <br />tion expense. <br />Page 64 <br />WHITE— Office CANARY— Customer PINK —File GOLD— Planner <br />