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N9 76- <br />LittIe Canada, Minnesota PAID c4...35-0 06 <br />APPLICATION FORM 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 Ahod . Lan 34E, oWaSSo vd se-) , -//r3- T71 7 <br />(Name) (Address) (Phone) <br />Owner `.A./01.6 0(5 Q,,601/e <br />(Name! <br />Property Location (Street Address and Legal Description): <br />(Address) (Phone) <br />"73 /)/4M5S I// ,t(). <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />t <br />6 <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 dcnowiedge the fee explanation as outlined <br />in the application procedures and hereby agree to pay all tements receives. m the City pertaining to additional applica- <br />tion expense. <br />WHITE —Office CANARY — Customer PINK —File GOI <br />/1/-4 <br />Page 11 <br />nt) C (Date) <br />