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Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />N? 511 <br />PAID 4 ( / <br />Rec.No /� <br />Conditional Use Perr +hit <br />Variance <br />Subdivision <br />Planned Unit Dg�c�iierlji1 iLE cr,�aai <br />kt41' ' <br />Plan Review <br />Applicant /cif / (LH E, 6.,. (12_,__( 0. c. 4-/I0. <br />(Name) (Address) (Phone) <br />Owner C '7 31 / /) C r' <br />(Name) (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />C;-9A<l L <br />/21/1. <br />11 <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />,,A.4 l A )-, i )Lc he f i)e6 Cc 11 ‘;k7/) c, c.ti to /)1 c ,,, <br />cc.,, i c„.., , ii %r° h,. f I c. ' (, n e ) � -7 -v r a'orm <br />).-- ( _re,,..) [of) <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 />(-J, rynl C _ <br />(Signature of Applicant) <br />WHITE— Office CANARY — Customer PINK —File GOLD — Planner Pa g F 1 <br />J " <br />• <br />/z6 /70 <br />(Date) <br />