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Little Canada, Minnesota <br />APPLICATION FORM / <br />Conditional Use Permit <br />Comprehensive Plan Amen <br />PAID <br />Zoning District Amendment <br />Text Amendment NOV 0 <br />Other <br />CITY OF LITTLE CANADA <br />Applicant Jo RN l_7 RNBR ICK. <br />(Name) (Address) <br />1W° 614 <br />PAID k !J. cC <br />Rec. No <br />Variance ?yDv <br />�I <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />035y GAscavLRlc,e. nail. <br />Owner ShMs Al About <br />Vsi as a s <br />(Phone) <br />(Name) <br />Property Location (Street Address and Legal Description): <br />a 3 y GrcEa,vm,ukg- <br />(Address) (Phone) <br />CI mat � btick4 AAM+rl £41.04 /s <br />U I,Lw <br />ADD, no ti LOTS &az_ <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />do uktn: MrsPLA -ct,b raw) DFl7-iait) TOO Ctosc <br />To SID*- ti- LoT. %{ou,J�. <br />,Th.. .Js rot ac- fo l aN -S-6. CaRn a,. <br />r/AVIL Tint <br />T'o <br />P4ReHA-SC- ADD,T,o.JAI-L 1..n b To .Souzy ,Bar ditXt. GJIe .- No-r- SELL. <br />r, 'n AbD 2,41> $raay aLAIL Ckitkc4. FOIL Ned DED Lwuuc. CP/0C&. <br />HOC S PEq'ct ,11 3 Botoo,, Aust- <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. 1 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 8 <br />nature of Applicant) (Date) <br />WHITE— Office CANARY— Customer PINK —File GOLD— rlanner <br />