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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 <br />Owner <br />vA) <br />A) St ff,coki <br />PAID <br />Rec. No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />ftr tJ.67e,4Akvi&cJ yn' 9i41 <br />(Name) <br />(Address) (Phone) <br />(Nam (Address) <br />Property Location (Street Address and Legal Description): <br />4ffax. 07)-n Miek S% <br />ILL Lots r/ /'o n' ALL /�;I <br />A LI OF )4 1161 <br />(Phone) <br />bock .c <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />S p b t /SS- X li C L* Ufa <br />Lis U 77X X ) 3 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 GOLD— <br />Page 10 <br />(Date) <br />��o <br />