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. -~ ~-~ <br />1~'+l_ ~ 11a0 <br />Little Canada, Minnesota PAID 3 dd <br />APPLICATION FORM Rec. No. <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />~c <br />Plan Review <br />='J~~1 ~E l <br />A <br />li (~["(7 5 S~ S']~Z~'~'~"' ~-,~ ~~VhO <br />~1 <br />pp <br />cant f ~ <br />WIiC~~}gL p1EYV1 (Address) ~•~ ~•~i~ • a~POCa <br />owner _N/~N~ l~~~~SE1 ~l ~~3b~ W DDD G~sT' ~(L-~V~ N~/~/ <br />(Name) <br />~`f1" ( ~ <br />COIN ~l`~'dp~) MN S.S.q'37j (Phone) <br />"16 3 ~ ~~ •36 3~ <br />Property Location (Street Address and Legal Description): <br />Zo <br />(~ ~ Su <br />Z~ Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br /> <br />Description and/or Reason for Request (Cite Ordinance Sections): <br />~ • `1~74~ ~IYyE~O!'t~~xJ~ ~ ADV ~'~na t-tfi-EO ~tSe S To 13w 2.~NiN <br />2•TCx"(' AYYI~NO-v7~J.r(": ~I,eL?~oN(C ~iIG~N~ iti~55~t6~ t3o~j D <br />3, G N oN G ~ I N I~ ~ <br />~: CoN o~-noN~L use f'~~ T ~ P~no_~~ off' • PA~~~NC~ <br /> <br />In signing this application, Thereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />inq and Subdivision Ordinances and current administrative procedures. I further acknowledge the fee explanation as outlined <br />he application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />tion expense. <br />/~G------ S~ y 3 • ~~--- <br />(Signature of Applicant) (Date) <br />WHITE-Office CANAfaY-Customer PINK-File GOLD-Planner •~S~o <br />