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Little Canada, Minnesota <br />APPLICATION FORM <br />N(? 544 <br />PAID \ cD <br />Rec. No <br />Comprehensive Plan Amendment Conditional Use Permit <br />Zoning District Amendment Variance <br />Text Amendment X Subdivision Lot Split $100 <br />Other Planned Unit Development <br />Plan Review <br />Applicant Direct Builder's, Inc. 1477 -80th Avenue N.E. MDls. 55432 785 -1443 <br />(Name) (Address) (Phone) <br />Owner Pearl Bronson Same As Below 484 -5006 <br />(Name) (Address) (Phone) <br />Property Location (Street Address and'Legal Description): <br />Back half of 61 West County Road C <br />(X)C Rosewood Drive — Centre Place) <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />PAID • <br />In signing this applic rw�� cknowledge that 1 have read and fully understand the applicable provisions of the Zon- <br />ing and Subdivision t�a .44urrent administrative proced I urther acknowledge the fee explanation as outlined <br />in the application procedures and hereby agree to pay all ..:. 'ceive g9. e City pertaining to additional applica- <br />tion expense. ,. <br />CITY, OE LITTLE CANADA <br />(Sign . ure pf <br />WHITE— Office CANARY — Customer PINK —File GOLD — Planer a <br />SC) <br />