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N9 7h3 <br />Little Canada, Minnesota PAI(4/ sX <br />APPLICATION FORM Rec. No <br />/ Comprehensive Plan Amendment ✓ Conditional Use Permit '--&5°C <br />V/ Zoning District Amendment 5� Variance <br />Text Amendment ✓ Subdivision X760 <br />Other ✓ Planned Unit Development $96o <br />Plan Review <br />Applicant SC,L).- -Ocedet" –I)t-v Dr A--C) �r?7 — / ('7I <br />(Name) (Addr ss+)1 (Phone) <br />Owner JG .c.v1 2–° 20 ei,e- J l'. <br />(Name) (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />a. 300 <br />cc_ s}'r-c.e4--- 1 p 32_. 0007 <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 />X n t �O �� /q 7 <br />(Date) <br />43 <br />WHITE — Office CANARY— Customer PINK —File GO -en <br />