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• • <br />Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />Applicant -3 -71-OC /CNeSS !/rorer7ties <br />(Name) <br />/63 <br />PAID *°'SOO•QQ <br />Rec. No <br />✓ Conditional Use Permit <br />1.7----Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />/9G �n / Stic�.�`✓ <br />(Address) (Phone) <br />Owner <br />(Name) (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />nn. 7Z5 0 2.9.2 ,2 1Go3r <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />ci <br />rt " <br />SO <br />In signing this application, I hereby acknowledge that 1 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 C. • pertaining to additional applica- <br />tion expense. <br />(Signature ol.�p�lliicant) (Date) <br />WHITE — Office CANARY— Customer PINK —File GOLD — Planner �a I <br />