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Little Canada, Minnesota <br />APPLICATION FORM <br />N? 555 <br />PAID Z0(-)• <br />Rec. No <br />Comprehensive Plan Amendment Conditional Use Permit <br />Zoning District Amendment Variance <br />Text Amendment Subdivision <br />Other Planned Unit Development <br />Plan Review <br />Applicant Y42.srq ¥.0 2,,pkyo 1-3c1Vt tt %% 8(2`3_I <br />(Name) II (Address) (Phone) <br />Ci Cv 41232• Mrs K��I< y/90 / 5137 <br />Owner 29ceJ Cu ncQlC' Dhc c�.r K+lP / <e Lj 8'V <br />(Name) (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />S3 weS� <br />81 us-l€ c0 <br />C.ovvvVy Rc) C <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />cyat�cd Ku Me.. Shoff' <br />USi c l Co v w60-\ \ c* ors c?, <br />64-1a 8 l to 5- %GUid7 t) Lo <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 expe <br />WHITE— Office <br />CANARY— Customer <br />Page 4 <br />/1 ,)7-?b <br />(Si(na ure pplicant) (Date) <br />PINK —Pile GOLD —PI nei- <br />