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Little Canada, Minnesota <br />APPLICATION FORM <br />622 <br />PAID <br />Rec. No <br />Comprehensive Plan Amendment Conditional Use Permit <br />/ <br />V Zoning District Amendment —`-1 04 Variance <br />Text Amendment <br />Other <br />Applicant <br />7Subdivision co <br />Planned Unit Development <br />Plan Review <br />J 0 la f C'Gyn e- it - J t` nom/ rety,dv `% ?/-,;_� )/!friti-76 -,/% <br />Owner Q � �' 0 /J` o i-f 3 0.) /Jr f /e, ea 04 el led A2 /e (lays o2_ <br />(Name) ) (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />3 03 L/±1-le- C e c/ <br />A 0-5 71-c ett tAyr to 1Ce Po r �! <br />/c /G StvAte- L tttkE Hoe; 9-e r <br />zy a, 1c'/ /07 4 <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />✓LaGr dee d-/ d e 69/ / et_ / 7c7 a" <br />e ✓"Gt / 0r7eflre- (°- ott j4d,r°e_ <br />0-6 fxf 2 g s <br />l'° <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 />WHITE — Office CANARY—Customer PINK —File <br />(S gna(ure <br />GOLD- Planner <br />f Applicant) Page 22 <br />(Date) <br />