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N9 665 <br />Little Canada, Minnesota PAID <br />APPLICATION FORM` / Rec. No <br />Comprehensive Plan Amendment Conditional Use Permit y6° <br />Zoning District Amendment Variance <br />Text Amendment Subdivision <br />Other Planned Unit Development <br />Plan Review <br />Applicant <br />Owner <br />[vAgD?Na &Zos. /,$o 5 G7, A - 017-1‘v0 <br />(Name) (Address) (Phone) <br />(Name) <br />Bps <br />Property Location (Street Address and Legal Description): <br />/_57) c cJ (20,oe t7 sit/ -S6o <br />(Address) (Phone) <br />X07' 3 &It / He t/ of-Pc e, /pP-ort/C <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />57o¢.S rei-,u.¢ w a wG 31, S /t2 TNe s+7o,- 45 <br />} 7oe3cS2 3 s <br />tpiaa <br />7xB Sc'47oaI5 /4.�0.C' -5 %zc. <br />Z <br />1/0 Zs- // 000 <br />S'Zc ck, yP el r <br />In signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />ing and Subdivision Ordinances and current administrative procedures. I further acknowledge the fee explanation as outlined <br />in the application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />tion expense. <br />(Signature of Applicant) Page WHITE— Office CANARY— Customer PINK —File GO LD—Planner `J' ^'$!o) <br />9y <br />(Date) <br />