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Applicant <br />Owner <br />Little Canada, Minnesota <br />APPLICATION FORM <br />N? 767 <br />PAID 7Do <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 />(Name) <br />(Name) <br />C91r';,Ly <br />5/PC <br />Lc.i1� /aX w'y <br />(Address) <br />6 3 7 /Cc i /tom pX i- y <br />Property Location (Street Address and Legal Description): <br />3 3 <br />S 3 Am.- "t—y <br />(Address) <br />(Phone) <br />Wi'"w Sasy <br />(Phone) <br />11c.11er el<wy °i,.rA ,Vot 4c�-A Lo?' <br />1,07( 1 / Sled I, ',., SPot°srr 0i/em /Y/•,y Lor 7, ,Q/OCA.Z, /9/ Arree v,s7'Lat44 <br />I/cLe.._.,+ La Y-- L0+- 5 / 6/4•IC <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />L 0 t,,,c.416'l 1C,0,. 1.4 9 W, l) /G.1,: et- <br />May.ny 'r J; c. .90 /'9e-`l Jo fort a7-6..c.c./( <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 />WHITE— Office CANARY — Customer PINK —File GO'' <br />Page 14 <br />,t) <br />(Date) <br />7 <br />crOgteat <br />