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Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />N9 71L1 <br />PAID 4:2670 <br />Rec. No <br />XConditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />�Q Plan Review t,./Kf' 777 -(3W cl <br />Applicant if-t/ +a0 3 ' I I Me-R, ,21g7 cevlze.uf 1I 0 - Ho - 17 Iv -17;0 <br />(Name) (Address) (Phone) <br />p —r (% 1 �,✓ k • '777— /3 y q <br />Owner `��A (7 II �c�l %i7 CeN VI1 e r) .. KtrGi - L(70 -(7,2o <br />(Name) (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />277 7 (7T1_ CG/✓cto2 NW°V ' 5917 <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />P% rocs. <br />ro 6/A ('to <br />a's 3c VIJA -7c AeJ 9a/ca7 <br />�JeK Scn>a L ut S� . S 4a Rote_ r=o K j�1 y !/ 1 o f'Gr2 l/ e lz <br />kocv/Kclor /� ( act F Lguu E7a( . / 5/�c>cJ�owey? / efcc <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 />gn <br />WHITE — Office CANARY— Customer PINK —File GOLD— Planner Page 1 <br />ature � Applica <br />(Date) <br />,iimun 5) <br />