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Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />N9 791 <br />PAID 360 <br />Rec. No <br />XConditional Use Permit <br />Zoning District Amendment Variance <br />Text Amendment Subdivision <br />Other Planned Unit Development <br />Plan Review <br />ApplicantS • C(2cx SCf2e P12(N tit? ZI W, 11(L(N4 OYL 2--ci3,-i‘o <br />(Name) (Address) (Phone) <br />/fcdc( ffL( &b4xhe /" <br />Owner t- EN(tEPIZi Kerr( Ahd / cn / 21 Iry Vlklndibe KZ- cg, -/(a <br />(Name) (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />21 W Dr. L.iNtL CdG�ud� <br />1 F ;Isev, n67,3ers (�+ 39 <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />4memt(L.At 7L0 Cov,d-t h 0 A l V( ��rn i t <br />- H((D)/t) F3v (-XQiCIASIOVl <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 />(S�gnat Page 1 (Date) <br />WHITE— Office CANARY — Customer PINK —File GOLD — Planner „a <br />