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:, <br />Applicant <br />Little Canada, Minnesota <br />X097 <br />PAID S~~ _ <br />APPLICATION FORM Rec. No <br />Comprehensive Plan Amendment ~ Conditional Use Permit <br />Zoning District Amendment <br />Text Amendment <br />Other <br />(Name) (Address) <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />-r~l <br />(Phone) <br />Owner ' J~~t\J IC'~ K ~' \/('` nC ~CUC~C( N ~t P cj>j'(g°~" (ocj'~-~~~-~(1;30~ <br />(Name) (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />Description and/or Reason for Request (Cite Ordinance Sections): <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 />i =application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />ti~,~ expense. <br />(Signature of Applicant) (Date) <br />WHITE-Office CANARY-Customer PINK-File GOLD-Planner ,,.~~~ <br />