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Applicant <br />Little Canada, Minnesota <br />APPLICATION FORM <br />N9 76-6 <br />PAID 700 <br />Rec. No <br />Comprehensive Plan Amendment Conditional Use Permit <br />Zoning District Amendment Variance <br />Text Amendment Subdivision <br />Other Planned Unit Development <br />Plan Review <br />z'vvt 605s <br />(Name) <br />719 Le—bore rd. <br />(Address) <br />787 -0675 <br />(Phone) <br />Owner <br />(Name) (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />Lc -6C /rz re <br />.l - 1.37c0- too- GA Cu &sr %oP !vr Ij o./!oe tarIC / &cckc3., &iko A�J,r,an) <br />Description and /or Reason for Request (Cite Ordinance Sections): <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 />.1 i -27 <br />Page 1 (Date) <br />WHITE—Of flee CANARY — Customer PINK —File GOLD —P <br />