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Little Canada, Minnesota <br />APPLICATION FORM <br />N° 671 <br />No (4 -4(r,f — <br />PAIDC- tr5T- AG! -(IN <br />Fec, P> t izet <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 g OL(me D <br />(Name) <br />Owner 7-- -7•&i —iL-( <br />&9,1<- t✓ l) YSi- _5'066 <br />(Address) (Phone) <br />(Name) (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />ELT_ // ? --c a}t:h-<-. <br />Ji/- Rip <br />4-1 <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 16 <br />(Date) <br />