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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 ! u / 0 9 Sasatu <br />(Name) <br />N? 519 <br />PAID 00 <br />Rec. No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />Wihia rant -; i00 4i ca s 1 .L i4 -/e C�n/a 4 .. <br />(Address) (Phone-) 5S m 1�w2 <br />Owner <br />(Name) (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />200 ece S� VQ�?, IJ �; �� �-a�Vaiir, %y%. SS /l3 <br />o+ 1� , B10ci< .t, Park ( 0a/ AcCa roi✓ <br />I <br />APR 2 a 990; <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />cAnt lQ d / ke Et IS re- 2.0AiP CL Pvv Pe aref ((f 1 et <br />Seen aI Irt ftidn r 4- tic 2-3, <br />1-o 'ica4— <br />at) a LLet, i e 2G l iS9".40 AL5 CLAie.c1 a'/vA 4/50 40 <br />Malts crve tre4- 9 U M e1&s er 7h. & -.3 204 u;v_s $ Afe_ca 5 <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 9ppl�iycaaht) <br />y <br />WHITE— Office CANARY— Customer PINK —File GOLD — Planner h 2 <br />(Date) <br />