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Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />X <br />Other <br />Applicant 1 /l AI/` <br />(Name) <br />Owner <br />/ f 4/0- /r <br />N9 76, L/ <br />PAI O ` '18 <br />Rec. No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />96,P0c4.: vty o9vt <br />(Address) (Phone) <br />(Name) <br />Property Location (Street Address and Legal Description): <br />(Address) (Phone) <br />7/ iMuccc. S A I 77-1 r^ <br />/2//y X. p- 3/-2o- a.2 -3Y- oog <br />7) -30 - 022.33 -o /0 <br />C.9 V4,F%L <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 />Page 24 <br />WHITE — Office CANARY — Customer PINK —File <br />4gignature of Aplicant) <br />GO LO— Planner <br />/021/9" <br />(Date) <br />