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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 <br />i <br />,r-v5 gdomea <br />(Name) <br />Owner <br />(Name) <br />c <br />N9 -33 <br />PAID PAID CT)0.CCD <br />Rec. No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />y co wt.)c Ait/ <br />(Address) <br />/G / g�G"�� <br />(Address) <br />(Phone) <br />V OP' V9 %O% <br />(Phone) <br />Property Location (Street Address and Legal Description): <br />/t /6/ Fr D` G(971 ?) /At- 2 s ,g, 4/ our- <br />/or ,�/ s), ) t So. <br />(bF nrg- ens r 7o3 Pr o P nr rvevjf o err <br />Description and /or Reason for Request (Cite Ordinance Sections) <br />Kiss o velf <br />/89 FT of 77/r/d24 5A/ ss <br />x op 54Q7ditJ W ru1P29 <br />J <br />47-75e-Y Gang / pht/, <br />ti <br />,a7S/A(7K- irrfi <br />/it///vLV�. � /�`��✓�$ /��� <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 rec ' d from the City pertaining to additional applica- <br />tion expense. <br />fgna <br />WHITE — Office CANARY— Customer PINK —Fife GOLD — Planner <br />u . AppliC3flt(,age 15 (Date) <br />