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Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />Applicant t 1 o & IQ / 5 <br />(Name) <br />Owner <br />Peal- <br />1V° 615 <br />PAID "7DDD6 <br />Rec. No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />1 Si'/-KS7 /✓ ‘,—S% i6i'aRee <br />(Address) <br />0, e Affit5779 <br />4725 P rern ( o r? /'/ VgN/ ' <br />'zc <br />(Name) (Address) <br />Property Location (Street Address and Legal Description): <br />Co_5-7-A LTA,LE: <br />fty- 3S975- <br />(Phone) <br />(Phone) <br />osi psi 74s 3 Tie Al <br />Description and /or Reason for Request (Cite Ordinance Sections): <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 he fee explanation as outlined <br />in the application procedures and hereby agree to pay all statements received from the Ci yip- gaining to additional applica- <br />tion expense. <br />Page 28 <br />///D -92 <br />gnature of Applicant) (Date) <br />WHITE — Office CANARY — Customer PINK —File GOLD— lanner <br />