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Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />PAID <br />N? 550 <br />5500 <br />Rec. No <br />__44 Conditional Use Permit <br />Variance <br />✓ X Subdivision <br />Planned Unit Development <br />Plan Review <br />Applicant ,tt /5 PA- S ,2) 7n ,o- 44Ze <1. <br />(Name) (Address) 2,d. Ss ,' <br />Owner <br />(Phone) <br />(Name) <br />Property Location (Street Address and Legal Description): <br />_2 S 2 re e S-t'- 24 <br />(Address) <br />(Phone) <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 />in the application procedures and hereby agree to pay all state ants received from the City pertaining to additional applica- <br />tion expense. / <br />/,- 2 7r) <br />Signature Page t) (Date) <br />WHITE— Office CANARY— Customer PINK —file GOLD — Planner <br />