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Applicant <br />Owner <br />7 7 <br />Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />(Name) <br />(Name) <br />I/ <br />(Address) <br />Property Location (Street Address and Legal Description): <br />—OOO Z —3 <br />/71-z9 -22- 2 /- aoz / -oe <br />NY 696 <br />PAID c?DO. <br />Rec. No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review L .C.2j�?/- <br />fie 7.5-z 9.4,e4_ 4 <br />(Address) <br />z 9- zx -,zz - co oa3 - o <br />�-X7 -zz .s9/- ooz1— L <br />1/4,30700. <br />‘0 <br />(Phone) <br />(Phone) <br />goe; —ozG o <br />(Phone) <br />2c- z- z- oOo1 -9 <br />Description and /or Reason for Request (Cite Ordinance ections): <br />/D SGG 7-0 o!/=' ni3O ,7F -,e £ /Frfi1T <br />/V &J 7` <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 />1_50 ) l 3. <br />(Signature of Applicant) (/ (Date) <br />WHITE — Office CANARY — Customer PINK —File GOLD— Planner Page 7 <br />