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N? 74/0 <br />Little Canada, Minnesota PAID goo oo <br />APPLICATION FORM <br />Rec. No <br />Comprehensive Plan Amendment Conditional Use Permit <br />Zoning District Amendment Variance <br />Text Amendment Subdivision <br />Other X Planned Unit Development <br />Plan Review <br />Applicant /9/4 -.4 anre.i,fd 44c', wra, / ' S/G VA/ <br />(Name) (Address) (Phone) <br />y/9 ©/D C/f'D/94P <br />Owner ,4'/ ,�3'294/S'Z `' AS—S4 <br />(Name) (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />y -90 n'. cd <br />2Z7TG,d c29A601.o,,5), mid` <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />if ,e7.De/ zero /P 774r: i .sAC f <br />D,e Ave/ i.4.izs". ,000/S , S 4s , <br />Ol/ /rif, /°voz ,o°S.m's ; // "te ,IOOM.V ,�G'/�. 'ai c//�'6_ , d -- . <br />/°/f0Oae, r' ',/ 0,07,16/"P A ' 6'U Si OIL /%I/'C O," , 2 &/4 li" <br />In signing this application, I hereby acknowledge that 1 have read and fully understand the applicable provisions of the Zon- <br />ing and Subdivision Ordinances and current administrative procedures. 1 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 GOLD- <br />Page 1 <br />(Date) <br />