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Little Canada, Minnesota <br />APPLICATION FORM <br />N? r,2: <br />PAI D <br />Rec. No <br />Comprehensive Plan Amendment Conditional Use Permit <br />Zoning District Amendment Variance <br />Text Amendment t/ Subdivision — <br />Applicant <br />Owner <br />Planned Unit Development <br />Plan Review <br />R'S- t- `✓ 1 <br />/ V.Seic/ <br />563-0Y0) <br />(Address) <br />116A/44 Se--P <br />(Address) <br />Property Location (Street Address and Legal Description): <br />(Phone) <br />c6 3--a c/oS <br />(Phone) <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />ce_sz. Pera-J <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 receivrd - rom the Ci pertaiging to additional applica- <br />tion expense. <br />(Signature of Applica <br />WHITE — Office CANARY — Customer PINK —Fee GOLD — Penner <br />Page 28 <br />(Date) <br />