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Applicant <br />N9 <br />Little Canada, Minnesota PAID —Mc, <br />APPLICATION FORM Rec. No <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />1/ C( <br />(Name) <br />Conditional Use Permit <br />Variance <br />Subdivision <br />700 <br />Planned Unit Development <br />Plan Review <br />a(7Act_17,c <br />(Address) r (Phone) <br />Owner .I)�1v A 4 f�Arte'c?i.v l-fv�LLt / C v, >c (/ s, G Z/ 3 <br />(Name) (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />C 7/, >, 714 <br />7 <br />0E;t9,a 22, co /! l <br />Se <. 4- 6 7-0 o2 i R/a,1 y r 22 <br />FY A) P tRY R/ gi1 rl ki XY Cam: 4 3 <br />se c yLL r 9 k A)' .-1.k <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />/ c' j /jcr <br />i 1 �> <br />•s' / <br />1 : , C c5 ( 1-9 t o <br />/C .� . �.I <- <br />(°)-, -ice <br />C c c 'f- r",i, <br />/ <br />( <br />In signing this application, 1 hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />ing and Subdivision Ordinances and current administrative procedures. 1 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. j <br />7% <br />(Signature of Applicant) (Date) <br />WHITE— Office CANARY — Customer PINK —File GOLD — Planner *$ in <br />Page 2 <br />