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Applicant <br />Owner <br />N° 495 <br />Little Canada, Minnesota PAID /CO <br />APPLICATION FORM Rec. No 2-3 I <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 />!v4)`coi catisi caed /A/6 s r44; 7Al0 C�'' -f / 9 Y`f <br />(Name) (Address) 7 (Phone) <br />(Name) (Address) <br />Property Location (Street Address and Legal Description): <br />cryy .2o <br />-/83- 9s 3 <br />(Phone) <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />it %mil.- / ✓6c 45 i idd /esz/ <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 furtrier 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 />4/ /fl. <br />(Signature of Applicant) (D e) <br />WHITE— Office CANARY— Customer PINK —File GOLD— Planner <br />Page 36 <br />