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Little Canada, Minnesota <br />APPLICATION FORM <br />N9 _528 <br />PAID / 6'n (r'U <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 7C/Y14S <br />(Name) <br />G{/ Sibwatr gig? oAKtVCop ,04 ,9J V 7S&-8YV ? <br />(Address) (Phone) <br />Owner RILL, 5/ &A-oat; sly LOSE Lew-E. <br />(Name) (Address) <br />Property Location (Street Address and Legal Description): <br />SW/31S 7 £c.SE LI r <br />F <br />ale i P -K -- l.o r- l' Stock / <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />X90 - Mc?3 <br />(Phone) <br />161/41P <br />OUR <br />cfly of u c`oA <br />co .ACCESS 70 Rosa 7A ,UEL f e717 Lo <br />?Ec`7( ue r £>46Eniei - Fla?' Goes r Orr oc <br />SMt4G LANE . <br />In signing this application, I hereby acknowledge that 1 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 p. atements received t • ity p% aining to additional applica- <br />tion expense. <br />. <br />(Signature of Applicant) <br />WHITE— Office CANARY — Customer PINK —File GOLD — Planner Page 18 <br />S 4//qo. ate) <br />