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jam: ___ ______.. <br />;'-1 <br />Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Fext Amendment <br />Other <br />PAID ~~ DU <br />Rec. No._ <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />Applicant r "-' - <br />lName) (Address) (Phone) <br />3~ao~ C_-_~...~i.(~oc.~ _~\ E c c~\@ '~2c~c~ v~1~ SC.o~~Lo <br />Description and/or Reason for Request (Cite Ordinance Sections): <br />~c\• <br />Q \ ~ ~ ~-i1 _ \_ _.--- <br /> <br />in signing this application, i hereby acknowledge that I have read and fully understand the applicable previsions 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 />(Signature of Applicant) (Date; <br />WHITE-Office CANARY-CUatomer PINK-Elie' GO LO-Planner ~© <br />Owner <br />(Name) (Address) (Phone) <br />Property Location (Street Address and Legal Description): ~~ <br />