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6 <br />N9 665 <br />Little Canada, Minnesota PAID <br />APPLICATION FORM` / Rec. No <br />Comprehensive Plan Amendment Conditional Use Permit L/OO <br />Zoning District Amendment Variance <br />Text Amendment Subdivision <br />Other Planned Unit Development <br />Plan Review <br />Applicant es.A Sl� s. y,SZ E G7 ��O i� Yel-X00 <br />(Name) (Address) % (Phone) <br />Owner <br />(Name) <br />Property Location (Street Address and Legal Description): <br />VS: <br />(Address) <br />Zor 3 Act& / Ncci7ii6c. o -fvcc oPP-oe-/C. <br />(Phone) <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />7 <br />or x/37 / } r. cc, JSC- 3o , Dc sec-woos /SQL Z y <br />% /i4Lf T%ir.1 J 1c Han 4 r p/i H/^ <br />#X6 55,-?7,45 SiZG. 7a �! ZS' /�OOO ..s.? �7 <br />SiZc or" S7/7-^'c7.-.0 Z;tna yp F) <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 Applicant) <br />WHITE — Office CANARY— Customer PINK —File GOLD — Planner Page 107 <br />7 %f <br />(Date) <br />