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Little Canada, Minnesota <br />APPLICATION FORM <br />N9 778 <br />PAID 900 <br />Rec. No <br />Comprehensive Plan Amendment Conditional Use Permit <br />Zoning District Amendment —A— Variance <br />Text Amendment —4____ Subdivision <br />Other Planned Unit Development <br />Plan Review <br />Applicant <br />(Name) (Address) (Phone) <br />Owner <br />(Name) (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />C <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />--C-2‘R—CV t —¢p V AAA es Az, coC \ <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 />(Signaturpgf,- licant) <br />WHITE — Office CANARY— Customer PINK —File GOLD — Planner �J� <br />at1 IC1P <br />(Date) <br />