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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 />N° <br />PAID <br />Rec. No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />a-rpe 4:7_71.{ ,/ 3,2 5 0 ALI '1"; 2L- <br />(Name (Address) 577-4, j =jJ � ; (Phone) <br />33 a /ate' vg0 /475 57 <br />(Name) / (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />✓Cost tccry <br />e g r c / / I Q Arr.( /7G gT— ot�k A/a>r Sjs der n -7LZ <br />00--'e4rN /ORc4 risNGsr Set-eg_ Or The , euT)/iz?,57-- / a-yreC <br />c/ c -2 a- 2r, <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />Zor SQ /iT" <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. A /^ <br />(Signature)of Applican <br />WHITE — Office CANARY — Customer PINK —File GOLD — Planner <br />Page 43 <br />(Date) <br />