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• • x~ 11 <br />Little Canada, Minnesota PAID <br />APPLICATION FORM Rec. No. <br />Comprehensive Plan Amendment ~ Conditional Use Permit <br />Zoning District Amendment. <br />Text Amendment <br />Other <br />`~% V+1 i~%~ ~ t~ I ~ 1 <br />Applicant I'1~2G1 .~~,t~G'1~1~~1~1 ~0'~~ ~3~~ ~g~YYA~ <br />~ p(Name) n-~ ( (Address) <br />~e ~ ~`~ U G~ ~ oV` GVI~DV 15~~ ~ ~ C l 5~ Dfy >z~rU <br />(Name) (-IgdA~ress) <br />Property Location (Street Address and Legal Description): <br />~~~ <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />61Z-b'CS-~kzS <br />SS ~~~{~ (Phone) <br />~a(o "' ~J7iZ. <br />(Phone) <br />51~~ <br />u%~i.. <br />~(4~S ~ti Uccl~v~~viu ~ ~~ ~~ z~~ ' Qo~ l~-c,t,~ Mf~S 5S lzS <br />Description and/or Reason for Request (Cite Ordinance Sections): <br />_ 9 I n n a ~. w 3 n <br />In signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />in- id Subdivision Ordinances and current administrative procedures. I ,f, rther acknowledge the fee explanation as outlined <br />ire :application procedures and hereby agree to pay all statements redei ed from the City pertaining to additional applica- <br />tion expense. ~ ~- <br />L/~~.~~/~' ' J2( <br />l ~-['''~-~L "~ ~' (Signature A` plicanh) (Date) <br />WHITE-Office CANAfl Y-Customer PINK-File GOLD-Planner ~'-~ ~~ <br />~, ~u <br />