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Little Canada, Minnesota <br />APPLICATION FORM <br />PAID <br />N° 584 <br />Rec. No <br />Comprehensive Plan Amendment X Conditional Use Permit <br />Zoning District Amendment Variance <br />Text Amendment Subdivision <br />Other Planned Unit Development <br />Plan Review <br />Applicant J05 (P11 <br />(Name) (Address) <br />Owner <br />[pep. L. /o-/ <br />3 s Pa4,6 5 <br />61 / C/ L <br />(Name) <br />Qr4Ss)t' <br />715.0 SPefetIct <br />ygi -9373 <br />(Phone) <br />Property Location (Street Address and Legal Description): <br />3 /S0 sPRLACt: si <br />(Address) (Phone) <br />%, /TJLr Ggrma909 <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />(,/ Sea) &Ace <br />s4Lts . y it,ve, <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. A <br />Page 1 <br />(Signatdr`e of Applicant) <br />WHITE— Office CANARY— Customer PINK —File GOLD — Planner <br />(Date) <br />