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Little Canada, Minnesota PAID ~~0 °~ <br />APPLICATION FORM Rec. No. <br />Comprehensive Plan Amendment Conditional Use Permit <br />Zoning District Amendment ____/ti_ Variance <br />Text Amendment Subdivision <br />Other !/ ~ Planned Unit Development <br />~aDD.OC~ <br />Plan Review <br />~' _ <br />Applicant JQ?M ~ `~~'R~~ ~~"7 ~0.1m>;-S f~VP-.' ~~ cu.t,, N'~N. rJJ~U~j <br />(Name} "~ (Address) ~p,~ {Phone) bt2-5`IJ-75~`I <br />Owner ~i,~.q ~PV~, 110~~1~~~ ~a~- M0.~`~rt IaVC, ST~ciu.I Y tN~ ~J J~~dlp <br />( me) (Address) (Phone) <br />+as~-7~9--3~~~j <br />Property Location (Street Address and Legal Description); <br />~RV6~C--{C t_.A6UC l_o'T PI-~~ ° O`~2~1 'Z11Qo~8 <br />~~`72.`122.t1~C7~`~ <br />Description and/or Reason for Request (Cite Ordinance Sectional: <br />SCE ~~C~ac~l-1~~ 1._ -CT"Ej~ <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 />in application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />tion expense. <br />~ 1. <br />r. e~ C5-~,~ T~ I ~ ~ Z to ~ ~ ~ <br />(Signature of Applicant) (Date) <br />WHITE-Office CANARY-Customer PINK-File GOLD-Planner ~~~nn <br />