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N° <br />Little Canada, Minnesota PAID <br />APPLICATION FORM <br />Comprehensive Plan Amendment Conditional Use Permit <br />581 <br />Rec. No <br />Zoning District Amendment Variance <br />Text Amendment Subdivision <br />Other Planned Unit Development <br />Plan Review <br />cl Applicant k cite —`.7> C f \K%l a 5 <br />� c�%k C� Iv% ��`J—.3` <br />(Name) (Add) (Phone) <br />�ss) <br />Owner ( PAy( S (k i / N'I (i �cS�S —D( <br />(Name) (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />WO\ <br />oil OF 1.11ittcp,NAQA <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />P'(.-L-t VJ fact. l 0 EPA f ( NEC _ <br />t- 2nk\1NC -7 171 Mlca- <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. 4...ieno L } <br />Page 1 <br />WHITE — Office CANARY— Customer PINK —File <br />(Signature o Applicant) (Date) <br />GOLD — Planner <br />