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Little Canada, Minnesota <br />APPLICATION FORM <br />PAID <br />N9 548 <br />Rec. No <br />Comprehensive Plan Amendment Conditional Use Permit <br />Zoning District Amendment Variance <br />/ <br />Text Amendment `� Subdivision <br />Other Planned Unit Development <br />Plan Review <br />Applicant D/f/1/ /f Z <br />(Name) <br />Owner <br />5,`%%C' <br />(Name) <br />f r? $ IgLWRf , J 2/7y /x/66, <br />(Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />ha - Z -age%e <br />(Address) (Phone) <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />; ✓ a C. )/zC�fit //v . e,T K7 4 t cQF <br />2_4 A Re.. is 7` /a c h /v MA71_ n tRL. $ E <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 />C. --tat,; -</ t <br />Jo/ 8/ ,O <br />(Signature of p I a <br />Page 2 nt) / (Date) <br />WHITE— Office CANARY— Customer PINK —File GOLD — Planner <br />