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Applicant <br />Owner <br />• • <br />Little Canada, Minnesota <br />APPLICATION FORM <br />N? �73y/� <br />PAID "A-3 `� <br />Rec. No <br />Comprehensive Plan Amendment Conditional Use Permit <br />Zoning District Amendment Variance <br />Text Text Amendment Subdivision <br />Other Planned Unit Development <br />Plan Review <br />2)/12- Ainge. -i 674Q., <br />(Name) (Address) <br />5 rJ <br />LSE -no.S zv <br />(Phone) <br />(Name) <br />Property Location (Street Address and Legal Description): <br />(Address) (Phone) <br />l--o i 1 O —ZGock <br />fti. r1 <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. I further acknowledge the fee explanation as outlined <br />in the application procedures and hereby agree t• pa ,fl statements received from the City pertaining to additional applica- <br />tion expense. <br />ature of Applicant) <br />WHITE — Office CANARY — Customer PINK —Pile GO •— Planner Page 1 <br />(Date) <br />