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Little Canada, Minnesota <br />APPLICATION FORM <br />Conditional Use Per t <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />Applicant cJ P<M A <br />(Name) <br />Owner <br />(Name) <br />N9 595 <br />PAID aC <br />Rec. No <br />(Address) <br />Variance <br />Subdivision <br />Planned Unit D <br />Plan Review <br />j <br />1992. <br />'J�`i 1, <br />e <br />lrantATTLE CP A% <br />3H z°7 <br />(Phone) <br />Property Location (Street Address and Legal Description): <br />2 3 a It N 4 -sr <br />(Address) <br />(Phone) <br />4Th cam- c1- 2--z -7 -zoo (�-I- --7 <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />A- 2s/ x 30 /ITT ! (f� PCSA _ z..PKTriQ <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 />Page 14 <br />( gnature of Applicant) <br />WHITE — Office CANARY— Customer PINK —Pile GOLD — Planner <br />( 761-2--- <br />( ate) <br />