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Applicant <br />Owner <br />Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />& <br />(Name) <br />N9 644 <br />PAID 4"f <br />Rec. No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development AMENT M€�r"( <br />Plan Review <br />/co So. 5-` 4 aV00 %4 55L102. 332 -qcc( <br />(Address) (Phone) <br />/ w0 S / d ,o cunt— C 4... Irma— <br />(Name) <br />Property Location (Street Address and Legal Description): <br />(Address) (Phone) <br />ss EE ao 8. tea e;t <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />L P. o. A . A ,d- L,- a& 4 e S <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 />(Srgnaturepoff A{po�li5ant) (Date) <br />WHITE— Office CANARY — Customer PINK —File GOLD — Planner Cd8 �1 <br />