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® • <br />N9 656 <br />Little Canada, Minnesota PAID Wo--_ <br />APPLICATION FORM Rec. No. <br />Comprehensive Plan Amendment ✓ Conditional Use Permit <br />Zoning District Amendment <br />Text Amendment <br />Other <br />Applicant <br />(Name) <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />1000 Le x D„ F'_ Go& 01� <br />(Address)' (Phone) <br />Owner J.r.,Artr. l41 / 0 ",ut o r Ak \uhA( OJ Pc. ivou, L. �un ((� Taro_ <br />(Address) <br />(Name) <br />Property Location (Street Address and Legal Description): <br />,2-3s- F. CU'y"i' re <br />(Phone) <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />A CO:,�, rio ,:%, k ('.w'n. i 1't14t l... li alive. <br />J <br />Car... -la l`o� � �Z [7 •,.. 1 I 1 ?an, _di 1.)' �. L h k I .1 Cn 7�.. M AL) <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 />WHITE— Office CANARY — Customer PINK —File GC <br />(SignatUfe of Applicant) <br />Page ' u <br />(Date) <br />