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Little Canada, Minnesota <br />APPLICATION FORM <br />N9 • 560 <br />PAID <br />Rec. N _>$.: npl: <br />Comprehensive Plan Amendment /Conditional Use Permit <br />Zoning District Amendment /Variance <br />Text Amendment ✓ Subdivision <br />Other <br />Planned Unit Development <br />Plan Review <br />Applicant 1G— v • L..) = 1-- -C-t-i 1/4 "S1a7Eir PSAN/" %i,Liffal <br />(Name) (Address) (7c %0szY7) <br />Owner <br />(Name) <br />Property Location (Street Address and Legal Description): <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 statements received from the City pertaining to additional applica- <br />tion expense. <br />(Signature of Applicant) / (D to <br />WHITE — Office CANARY— Customer PINK —File GOLD— Planner Page L4 <br />.o <br />