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6 <br />Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />Applicant 3rn C.a,n S <br />(Name) <br />Owner <br />■G&,,,,, to Lf4 <br />(Name) <br />c <br />N9 705 <br />PAID 4 96° <br />Rec. No <br />Conditional Use Permit <br />Variance <br />/ �� % <br />Subdivision f <br />V Planned Unit Development �ry"""��—' <br />Plan Review <br />93 S1 1444,4 t eytkAt44 <br />(Address) C'-i.a `t ' U/ <br />3J clot- u:.o ke- f -/e �, <br />30 6a C.4414^14 gediv <br />(Address) <br />Property Location (Street Address and Legal Description): <br />3o do <br />\5 4J S 353 <br />Phone) 0 Sy/4 <br />Yea -75t6 <br />(Phone) <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />*)ch /012--ikefittlVd.-6111 <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 />Page 1 <br />(Signature of Applicant) <br />WHITE— Office CANARY— Customer PINK —Pile GOLD— Planner <br />/a 3 -95 <br />(Date) <br />