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Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment 1-/ Conditional Use Permit '4=25-O <br />PAID o23.-- <br />v 00 <br />Rec. No <br />Applicant <br />Zoning District Amendment Variance <br />Text Amendment Subdivision <br />Other Planned Unit Development <br />Plan Review <br />GAir R QGA.A 0 9 3 `-/ 2 A er= E Q ,Vat/- -0 <br />(Name) (Address) (Phone) <br />Owner /9 iv) <br />(Name) (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />OS / 3 ! L Gi... b o'/c' ,'a f"-9 Ifth I L. S n-c Cy fi'+J A-b `m / s s/ o I <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />Ky <br />6-74- ; 000 <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 />(Sign <br />WHITE — Office CANARY— Customer PINK —File GOLD— Plann <br />re of Applicant) Page 32 <br />//y <br />(Date) <br />