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Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />Applicant 1PJft'VlC) <br />(Name) <br />5. n <br />Z ,29v7 cev1eRv,lie_ <br />(Address) // <br />02,L(7 Ce,V/esuille ��I <br />(Address) <br />Owner `IJAvi (7. ee ileA <br />(Name) <br />N9 '71V <br />PAID 4aso.00 <br />Rec. No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />Property Location (Street Address and Legal Description): <br />K* 777 -(3ql q <br />- HIT" yg0-17 o <br />(Phone) <br />wk • 777 — /3L1? <br />WV( - <br />(Phone) <br />27g7 Ce/j egV/ Ile foil Cg,stcd t kw J ' 53---/r7 <br />Description and /or Reason for(( Request ()Cite Ordinance Sections): p n <br />fRn foce� ro YJ0/7cd / o2g%A>� GCNA- 1�4Clxec� 5a.ICct7e, <br />pep S�Na Iti S.Q— . S 46 Ret9-e, <br />Fo< Y}l r Vf" fiG� <br />1/e h, 1-e-s <br />ktocc,nAc19(l S (Soc(+ t LtiJN Eywpv / 5 /Lie cu bfowtie. <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 />!GU" <br />ignature p <br />WHITE— Office CANARY— Customer PINK —File GOLD— Planner <br />