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Applicant <br />Owner <br />• • <br />Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />PAID <br />N° 626 <br />Rec. No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />:so F,H v(-rFA- L-E : 4:4 )--oRR S M4 4 o <br />(Name) (Address) (Phone) <br />cz", 1;- r -1 E <br />(Name) (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />�t 311 KoRi 1s onI ST. LITTLE QA- <br />S). Td' FT OF g• `\73 O F uU X 3 3 OF THE .0 LO w} WR) <br />SCQl. Rft 22 <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />17il <br />VRRIA -P eE OP THE N.u). CcRNER O THE HOI; '1v= <br />rr;R C=OIN`;I c1! CTI N( JF R 20' X22 -1 RitC E <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 36 ignature of pplicant) <br />WHITE — Office CANARY — Customer PINK —File GOLD — Planner <br />Z -i3 <br />(Date) <br />