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Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />Pgre\ M 91(k 1-\- reOlec.) <br />Applicant <br />Owner <br />N9 43,>Z- <br />PAID E /�J•C� <br />Rec. No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />i1A <br />(Name) <br />417 L1.6\0, 4 <br />(Address) 1 <br />Property Location (Street Address and Legal Description): <br />(Phone) <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />-PCC yEr ^•a, <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 <br />(S re of App <br />WHITE — Office CANARY — Customer PINK —File GOLD — Planner <br />t) <br />6I /Dq <br />Date) <br />tea: <br />