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c c <br />Little Canada, Minnesota <br />APPLICATION FORM <br />N� <br />PAID Oi5O.o <br />Rec. No <br />Comprehensive Plan Amendment Conditional Use Permit <br />Zoning District Amendment Variance <br />Text Amendment Subdivision <br />Other Planned Unit Development <br />Plan Review <br />Applicant AL144 3 ` &*2:Z. <br />(Name) <br />Owner <br />SAM P <br />(Name) <br />257 TALl&oN1 . 4.(70 -4045 <br />(Address) (Phone) <br />(Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />25zzc -TACW-5014 �T . � LOT 3 J file- Zj WAbFAU PIAT hh. Z.) <br />Description and /or Reason for Request (Cite Ordinance Sections)) <br />cothicAed @cu,c .e. -a h.ep.¢ace s3: n8 ad-cad gaAa. c <br />ELeac. AL *Ada tito w id.elt, goiLot ctet51.- hajeks 0.AL Lour <br />bpi aftU * ..1G b2 J- (cEthS <br />oRp)r.rAnfes $' 251 -D4-46? <br />esta-o4' -2 a i�r LG ODD <br />In signing this application, «hereby ack owledge thatD read and fully understand • - applicable4. ovisions 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 Applicant) (Date) <br />WHITE —Office CANARY — Customer PINK —File GOLD— Planner Page 55 <br />