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(. <br />Little Canada, Minnesota <br />APPLICATION FORM <br />N9 613 <br />PAI D `tcc .co <br />Rec. No <br />Comprehensive Plan Amendment Conditional Use Permit <br />Zoning District Amendment Variance <br />Text Amendment Subdivision <br />Other Planned Unit Development <br />Plan Review <br />Applicant ---#9, ..Cv5\OvJ \ tea "ZV2S\ eciot`r t 4A --2:121.0 <br />(Name) (Address) (Phone) <br />Owner <br />(Name) <br />Property Location (Street Address and Legal Description): <br />\mac \3'\ <br />(Address) (Phone) <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />rt�f�t aA vm -0 `tits' <br />t• P\VF.P— r t- fl ^?)1/4.)■■ P,•\ <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 7 <br />WHITE— Office CANARY — Customer PINK —File GOLD —P . nn r <br />ature of Applicant) <br />(D ate <br />