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Little Canada, Minnesota <br />APPLICATION FORM <br />N° 7/3 <br />PAID7)0 -00 <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 />Applicant f e�'Ytt G L/a 1"A --m. <br />(Name) (Address) <br />Owner <br />(Name) <br />Property Location (Street Address and Legal Description): <br />(Address) <br />02 3Y a Yv1. <br />rune- Gm-g -y >2h <br />(Phone) <br />Description and /or Reason for Request (Cite Ordinance Sections): <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. 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 —f <br />• <br />Page 32 <br />(Date) <br />