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Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />Applicant \\("c *(a. t'_ <br />(Na) <br />7 7�z. <br />No <br />PAID 900.0° <br />Rec No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />k,e\ \.erc N\ re '-fsb E- C d f\-op\7 <br />(Address) (Phone) <br />Owner C k C �P `' \C\cir\e1\� C7� \ \ \ *---t\C C Z'a,- . 1Kt - O6c7 <br />(flame) (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />9/(L ..f, .< y9L-k_5' C� c <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 />(Signature of Appit 1n't) <br />WHITE— Office CANARY— Customer PINK —File GOLD — Planner Page 35 <br />(Date) <br />.rr(ol <br />