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Little Canada, Minnesota <br />APPLICATION FORM <br />N9 563 <br />PAID einti <br />Rec. No <br />Comprehensive Plan Amendment Conditional Use PAID <br />Zoning District Amendment Variance ��g� <br />1\? IP;R 8- <br />Text Amendment Subdivision <br />Other Y Planned Unit efrfteinuat ago <br />Plan Review <br />Applicant /1)01 giCAL51xer Z &25 '1/V1/ ar q q'a> /) <br />(Name) (Address) (Phone) <br />(1 <br />) 1 ( <br />11 1 <br />Owner <br />(Name) <br />Property Location (Street Address and Legal Description): <br />�SN <br />(Address) (Phone) <br />06, 29 <2a `/7 Good. g <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />/,./ or ego, <br />U /•� // ✓ / n /G <br />7b in-, or,- ;re l'/Y71/4 , /Cf /d /..,,/ <br />a 7( GPI-1 r.t.f f4YJ <br />74 ,S-frn <br />7 <br />Afro, i' 7L FCo N�ti c% �C n.�C�q <br />7( 19 C Gr,PC- <br />0 /7* 7ttr C �" t� 4 / 7%.,, i7 <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 GOLD— Planner Page 38 <br />(Date) <br />