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Applicant <br />Owner <br />• • <br />Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />(Name) <br />Jd 6 <br />(Name) <br />N° 177 <br />PAID 7om/DD •DO <br />Rec. No <br />Conditional Use Permit <br />Variance <br />/ �/ <br />+' Subdivision TOO <br />Planned Unit Development <br />Plan Review <br />mac. 5 , (trAut tA. <br />(Address) <br />/9/ /4u5flt °A Ar ACC; <br />(Address) <br />i9 c (37 <br />•(P.hone) <br />- ,C <br />(Phone) <br />Property Location (Street Address and Legal Description): <br />( <br />�. (a IS ' <br />/((/ us"INAL%q Aui= le- `a 4,A -F r m6-74 'r -44 Aw,1,r,y <br />a } Flock- L04 q z \- Cellif �' i= .laE%� /'�c'Hr.. 5- 4 1 x72;0 41 <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />/— 7 / // <br />C�2erKt 1 SSeZ lt�rRFA- `Icy poiarh4se tIe X41' /01 rf LA' 4^,P(oa2, <br />‘340int -i }-, E.ISFH MEN?,E.iC? i -4- 6 H'- DD,'h!'�! 4cr.fXt�c' te.'fIz - { /IE..Sro h )4 -4 <br />VAGA) rl 57k'T + 'Y 0ir, Ir`t7t .f- G- / <br />In signing this application, I hereby acknowledge that I have realms d fully unde <br />ing and Subdivision Ordinances and current administrative pr, ures. I further ac <br />in the application procedures and hereby agree to pay all statements received fro <br />tion expense. <br />WHITE — Office CANARY— Customer PINK —File GO LO <br />nd the applicable provisions of the Zon- <br />nowledge the fee explanation as outlined <br />the City pertaining to additional applica- <br />Page 64 <br />70/3/4 <br />(Date) <br />o io <br />