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,) <br />ITT'`.' 10 9 5 <br />Little Canada, Minnesota PAID <br />APPLICATION FORM Rec. No. <br />Comprehensive Plan Amendment _~~ Conditional Use Permit ~~~~ <br />Zoning District Amendment <br />Text Amendment <br />Other <br />Applicant A C^('~ ~+~ otJ2~_ <br />(Name) <br />Owner SO~_ <br />(Name) <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />(Address) <br />(Address) <br />Property Location (Street Address and Legal Description): <br />O ~ ~. 9 5 8 ~1 ~ ~` ~ ~-o tJ O , v t^ . <br />C~51-7[oro- <br />(Phone) <br />(Phone) <br />Description and/or Reason for Request (Cite Ordinance Sections): <br />ReGv,.¢!~~~NC 4 C~~tl~~~J~4\ t,-SC ~2.rw`,~`F ~ar <br />t9 w~ ~O0 r _S~O ~~ orT O ~.r ~ ~. ~ Q f~..JC - <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 *' -application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />tic <pense. ~ ~1 ~ <br />(Signature of Applicant) <br />WHITE-Office CANARY-Customer PINK-File GOLD-Planner <br />!~ -20-0 <br />(Date) <br />'°yR~'(~ <br />