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Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />N9 i'/ <br />PAID 177e) 4 <br />Rec. No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />/ / /hd ° dy 710 L 57— &'? S Applicant d?,z/S <br />(Name) <br />(Address) (Phone) <br />Owner LE AS /4/iti res ` �Tn- Sr.'" <br />(Name) � '(Adds �f <br />(Phone) <br />Property Location (Street Address and Legal Description): <br />_o, <br />Description and /or Reason for Request (Cite Ordinance Sections): <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. l_ , Z.-1 <br />/iT /y y <br />✓ 7 <br />(signature of Applican <br />WHITE — Office CANARY— Customer PINK —File GOLD — Planner <br />./f En"- <br />(Date) <br />Page 64 <br />