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Applicant <br />Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />(Name) (Address) (7s sz-17) <br />Owner <br />N? - 560 <br />PAID <br />Rec. N . 8 <br />_ 1 - <br />` /Conditional Use Permit <br />" Variance <br />1 / Subdivision <br />Planned Unit Development <br />Plan Review <br />V.i i =LLI -% 1401. Gsi • I� <br />(Name) <br />Property Location (Street Address and Legal Description): <br />(Address) <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />1 <br />(Phone) <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 />(Signature of Applicant) <br />WHITE— Office CANARY— Customer PINK —File GO LD—Planner Page 20 <br />(Date) <br />