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~ ,~ q <br />Little Canada, Minnesota PAID ~2~_ <br />APPLICATION FORM Rec. No. <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />Applicant <br />(Name) <br />Conditional Use Permit <br />Variance <br />Subdivision <br />y <br />Planned Unit Development <br />Plan Review <br />(Address) <br />Owner _ /`~ l~ n/ ~ 2C~ ~ ~G_ IT l`~S V~ H ~1'~~ f 1 cr N <br />(Name) (Add s) ~oSQ~ <br />Property Location (Street Address and Legal Description): <br />2 <br />ON <br /> <br /> <br />R 22 <br />S <br />~iN~l r/ <br />(Phone)CoS I Zip-/ <br />n nn(o7J'~ <br />I ` ~/-~Q <br />/I'1/~/ (Phone) <br />Description and/or Reason for Request (Cite Ordinance Sections): <br />U ~Co(~~ UN"T' I ~ I~~ I S <br />>L ~ - <br />~m<~r <br />2 S <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 />it ~ application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />ti~.. expense. <br />i_~__~=~~ 1-2 z-~~ <br />(Sign ture of pplicant) (Date) <br />WHITE-Office CANARY-Customer PINK-File GOLD-Planner „10 <br />