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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 �6�44 <br />ip <br />PAID "1�/ �/� <br />Rec. No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development ,A-'tENPMENIF <br />Plan Review <br />/cc) so. s*-` 5a ; 4a9O0 ` ipt , 3SYoz 332 -/cc' <br />Iwo S AMlAteae , t44.- <br />(Name) <br />Property Location (Street Address and Legal Description): <br />(Address) (Phone) <br />Sairy— CO- &1TA -a-- <br />(Address) (Phone) <br />SS eani- 6.4.4 Ro 8. IS eLlnti. <br />L eery : pita ,9 4 Jo <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />Amt,9 E, -5 KO. A . A ire - -,- deaf / Y. <br />©M ° alieth3/41 ig.tf t& . <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 />(Signature of <br />WHITE — Office CANARY — Customer PINK —Fife GOLD— Planner <br />cant) <br />Page 18 <br />(Date) <br />