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Little Canada, Minnesota <br />APPLICATION FORM / <br />Comprehensive Plan Amendment ✓ Conditional Use Permit <br />PAID <br />N° 805 <br />S 250.00 <br />Rec. No <br />Zoning District Amendment Variance <br />Text Amendment Subdivision <br />Other Planned Unit Development <br />Plan Review <br />Applicant AS er. u. >; .3 -/7.2 Ry,4...1 1- 5 (a 5 /- -g 76 <br />(Name) (Address) (Phone) <br />• <br />Owner <br />(Name) <br />Property Location (Street Address and Legal Description): <br />31n4 (�.�,n Latm, <br />(Address) (Phone) <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />. Gk ..,- 17c— ton <br />In signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />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 82 <br />WHITE — Office CANARY — Customer PINK —File GOLD— Planner <br />t) <br />(Date) <br />