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<br />L6ttte Canada, Minnesota <br />APPLICATION -FORM <br /> Comprehensive Plan Amendment <br /> Zoning District Amendment <br /> Text Amendment <br /> Other <br />i1.Q,{i r <br />Applicant f1 <br />~2~ ~Q~ac~"Yi~~~ ~2 (p (,~j I ~ <br /> (Name) (AddrE <br /> <br /> <br /> (Name) (Addr <br />Property Loca <br />t <br />i <br />on <br />S <br />( <br />treet Addre <br />ss and Legal Descrip <br />t <br />n}: <br />io <br /> { <br />~r <br />f <br />- <br />` <br />( <br />~ <br />~ <br />p <br />/ <br />~rH;,. . <br />~ ~ ~~i; ~ `~Qd'71h2 <br />)escription and/or Reason for Request (Cite Ordinance Sections): ~ <br /> <br />Conditional Use Permit <br />____ Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />~SIZ~ (Phone) <br />1- Tto to - <br />(Phone) <br />1N Ssi(~- <br />-Z14 - <br />~a~, ~~~~~ ~ ~~! SSItis~ <br />'..S!^yning this application, i hereby acknowledge that I have read and fully understand the applicable provisions of the Zon~ <br />ig and Subdivision Ordinances and current administrative procedures. },further acknowledge the fee exp!araticr, as cutlir~e< <br />t' ~plication procedures and hereby agree to pay all statements r dived from the City pertaining to additional applica <br />cn „ ense. <br />i <br />„T~_ (Signature of A Iic <br />C"ice ....,J„F`r-Cunomer PINK-File p ~~t) (DatP) <br />GOLD-Planner / ~ <br />~~' I~ ~f 1X.-~~ ~=eL?~dlo <br />