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a <br /> Litpptle Canga'd° a, Niinnes®ta PAID ~ <br /> /ELI B ~ Rec. No. <br /> ` / Comprehensive Plan Amendment ~ Conditional Use Permit <br /> V Zoning District Amendment Variance <br /> Text Amendment Subdivision <br /> Other Planned Unit Development <br /> Plan Review <br /> ~ ~ lI I <br /> Applicant ,/V/~/SC'n ~S~ ~S D~I"uNe_ S''f X5-,3- C~a~d' <br /> (Name) (Address) (Phone) <br /> <br /> Owner~6~~ ~~a ~e ~~le~S~c~l/i ~7`/y~Co OFF GJeha~evC~l s"Y?93~ ~/6~d~G~dc,FY <br /> (Name (Address) (Phone) <br /> Property Location (Street Address and Legal Description): <br /> 3 G~ 7~' ~ r u C s~ <br /> Description and/or Reason for Request (Cite Ordinance Sections): <br /> ~~-~or'[~e ~"c~~rev~~ '~o / ~ lJ' ~ ~k i`h C cr~ J7JY Oc~ y'~~~oo~^ <br /> f~~~Q`7~ <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 the application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br /> <br /> tion expense. <br /> c._./~ <br /> I/~( ignature of Applicant) (Date) <br /> WHITE-Office CANARY-Customer PINK-File GOLD-Planner io <br /> <br />