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Applicant <br />Owner <br />Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment ✓ Conditional Use Permit <br />N9 566 <br />00 <br />PAID *66 <br />Rec. No <br />Zoning District Amendment Variance <br />Text Amendment Subdivision <br />Other Planned Unit Development <br />Plan Review <br />[L <br /><f-"0 141 ,-rrr" f C7 L <br />.f' 5— /-77,-..6.IJr cS, e / <br />C/ Urr L f-(S <br />(Name) J (Address) (Phone) <br />a'"1 G,n <br />tL /c1.J f!i ge.y, <br />(Name) (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />2 re== Cos— C-0,:.i—.t y <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />Nuil (/.rte— genre r fo e, Co rtsvil PO24rr -% <br /><��YL ✓i c�.-TS - <br />In signing this application, I hereby acknowledge that_Lhave read and fully understand the applicable provisions of the Zon- <br />ing and Subdivision Ordinances and current aanrrnistrative prccedures. I further acknowledge the fee explanation as outlined <br />in the application procedures and herebypgree to pa all statern -rjz received from the City pertaining to additional applica- <br />tion expense. 7 <br />4-lkc. [ ( <br />/(Signature of Applicant) (Date) <br />WHITE– Office CANARY — Customer PINK—Fite GOLD — Planner Page 5 "i10 <br />