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Applicant <br />N° 580 <br />Little Canada, Minnesota PAID a ) <br />APPLICATION FORM <br />Comprehensive Plan Amendment Conditional Use Permit <br />Rec. No <br />Zoning District Amendment Z Variance )--(S`\---C)-- <br />Text Amendment Subdivision <br />Other Planned Unit Development <br />Plan Review <br />V\ A I�APeC l \ _ ? `.c 17 CY <br />(Name) (Address) <br />Owner C ro�W- <br />(Name) <br />(Phone) <br />Property Location (Street Address and Legal Description): <br />(Address) (Phone) <br />(mow-, \ �r �? R� ccV <br />Pry s-\c, c'nt cw- ■ cc Co - er mc( -m (--c P<JF l - <br />OF \ R Pcr1n Pc\ ? m\ V- <br />Description and /or Reason for Request (Cite Ordinance Sections): <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 pay all statements received from the C. y py ai ing to additional applica- <br />tion expense. <br />gnature of Applicant). <br />WHITE— Office CANARY— Customer PINK —File GOLD- 4j4nner Pa J 11 <br />