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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 />T:efi <br />(Name) <br />(Name) <br />PAID <br />N? 1173 <br />Rec No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />(.3 d WOOci`1)r,'hl <br />(Address) <br />e PLC 13 <br />Property Location (Street Address and Legal Description): <br />(Address) <br />Ce12 -2_1 ( -3 00C <br />(Phone) <br />&lc. Ce dq 2s3 --o.3z <br />(Phone) <br />PTV = 0(02_912 ((0017 , 5e cbovi Cv IOW n 29 K6.45 2 z <br />`IUI -t 0"7 S e OLJct Sa (Blvd E. <br />Description and /or Reason for Request (Cite Ordinance Sections ): (91 -c+ t1 `g I\ <br />0 1 a s f e r 5 1 ph f l a n -Cot' b vtz I t i t , " 5 ( 2 02 h (n,�, Q 5-c-(- Gv cc e) <br />©`“ - kc-kh.} � pqS� q± ?'K <br />Y <br />O Y\-e S � 5h e c k f t \ ✓ 1 3 1 5 0 4 tl af We ( ) "- <br />C ,42 Av6I,5 .-c4Cti SOUK q.f T.-1 0 <br />5 <br />`(^hf t s tits AC‘r v +1., + K3 avt. -1,, 3f C't^Caks <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 A <br />WHITE — Office CANARY — Customer PINK —File GOLD— Planner <br />7 <br />