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Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />N97192' <br />PAID <br />is-0 co <br />Rec. No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />iS913y <br />Plan Review <br />Applicant ict)i,evimo �0 0�� &Tv 5' A' 75.51737 <br />(Name) a (Address) (Phone) <br />Owner <br />57me <br />(Name) <br />Property Location (Street Address and Legal Description): <br />(Address) (Phone) <br />L D % // .�Cocit / � YOXfO»/ A/0ieTAL ;75(i'56 -grr <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />Assad 4. <br />fir �'✓ P l dio2.. Pi ✓G��Lc� 11(R->d <br />"V /e JAZ /A/Lz <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 al atements receiv-.from the Cit .ertaining to additional applica- <br />tion expense. <br />/ ." ats/z;47 <br />•�atu e of Applicant) (Date) <br />WHITE —Offi ea CANARY— Customer PINK —file GOLO —PI_ nor <br />Page 10 <br />