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~i:~ -_ ~ <br />Little Canada, Minnesota PAID ~ ~{>c~ <br />APPLICATION FORM Rec. No. <br />Comprehensive Plan Amendment Conditional Use Permit <br />Zoning District Amendment <br />Text Amendment <br />Other <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />Applicant ~/¢T~-/C../< ~~~F ~~J 1i,5P~/~ ~/~'-'~ ~S~'-S~Z-,~~,7z. <br />(Name) (Address) (Phone) <br />Owner _ ~~"1-/E'/G'~~ ~l~/~f' ~~~ ~TI' ~/fJ !~J/<%GG~ ~o,i j'J~`lZ ~ J ~~~-- <br />(Name) (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />X6.5 .~i'Sl"1FN ~-(~t'GL~ Z-~rjG~ G~RN~'oAi Yy1~y 5~'~ IoR <br />Description and/or Reason for Request (Cite Ordinance Sections): <br />A'6M /~-~(~~ ~ /N~ F6~ fJ- ,~ ~~ ~/~' L ~-l-~~~ r oG:c:iiJ~4T/~h <br />PF/1 VYJlT • ft G-~T"T~2 ~1~ ~X ILL ~'/ j /'d// 1 5 ./'y7"7"fYGN/ rrI <br />G~i <br />In signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />inn 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 />tion expense. <br />(Signature of Applicant) (Date) <br />WHITE-Office CANARY-Customer PINK-File GOLD-Planner .~~., ~o <br />