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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 QN R <br />(Name) (Address) <br />Owner <br />N9 733 <br />PAID <br />Rec. No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />— `.%/ //! ( �C <br />act: ,%7 , (Phone) <br />SS4ly/ <br />(Name) <br />Property Location (Street Address and Legal Description): <br />k.\ <br />(Address) <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. 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 />._7, <br />i <br />(Signature of Applicant) <br />WHITE— Office CANARY -- Customer PINK —Fiie GOLD— Planner Page 58 <br />(Date) <br />