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N9 755 <br />Little Canada, Minnesota PAID <br />APPLICATION FORM <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 />Applicant <br />tAc y' 4 zl it Cc , zsH . <br />(Nam) ( Address) <br />'34/ .c1i4 t (w) <br />(Phone) <br />Owner <br />(Name) (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />/%-b s ANib Cu;23 cut <br />Giza -a-cr SO 10 <br />0 / %D'� <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 <br />WHITE — Office CANARY— Customer PINK —File GOLD —Plai <br />Page 30 <br />(Date) <br />