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Applicant <br />Owner <br />N? 732 <br />Little Canada, Minnesota PAID 4 -G .QG' <br />APPLICATION FORM 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 />3 E / l A c 6 4 / / 4 T 5-6C /4;04' Aies 4/2) T.:1/ -6/S/S <br />(Name) (Address) (Phone) <br />j ool .11/1A 95 / :vti.,a,ec) Lerr cwr>4/44) ((o,4gt3 -006 Sr <br />(Name) <br />Property Location (Street Address and Legal Description): <br />x'X /Lc'wooi <br />(Address) (Phone) <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />filO'L' //i G (K; 5 /6- nc c5 ,q 6'4c 'T .LC <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 />(Signature of Applicant) Page 43 (Date) <br />WHITE- Office CANARY- Customer PINK - -File GOLD - Planner <br />