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Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />NO <br />PAID <br />900 <br />Rec No <br />Conditional Use Permit <br />Variance <br />XSubdivision <br />Planned Unit Development <br />Plan Review <br />Applicant /1_474 /e 0 1 X54 ;9 ,L76"-72,4,- �1n3 S�g3 <br />5T N f e3 -_5-3 (- <br />(Name) (Address) (Phone) <br />Dwner 57/i41.€ <br />(Name) <br />Property Location (Street Address and Legal Description): <br />l,A-A. Dide. <br />(Address) (Phone) <br />Description and /or Reason for Request <br />Request(Cite Ordinance Sections): <br />Jeve zop t(6c t„._ 4 X <br />LO .J /o C�- ,p si as_dv / . <br />Q <br />n signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />ng and Subdivision Ordinances and current administrative procedures. I further acknowledge the fee explanation as outlined <br />n the application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />ion expense. - <br />Signature,of Appl+cant) <br />VHITE— Office CANARY— Customer PINK —File GOLD— Planner <br />Page 1 <br />(D <br />(D te) <br />0 CD <br />