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Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment Conditional Use Permit <br />Zoning District Amendment Variance <br />Text Amendment Subdivision <br />Other Planned Unit Development <br />Plan Review <br />Owner <br />(Name) (Address) <br />Property Location (Street Address and Legal Description): <br />Description and/or Reason for Request (Cite Ordinance Sections): <br />0p A q 7Y(Gts52 .'ie,4- et.fi- 7 41“1R to 4. 1 <br />len 1234 <br />PAID n`(DO <br />Rec. No. <br />Applicant 5 I XI,( 28&'/- Mic9o/% 9/, G.? C‘16 ga.' /ASS 1. 72. -Yo 7z- <br />(Name) (Address) (Phone) <br />(67e J <br />(Phone) <br />/ocet" p<l /e <br />In signing this application, 1 hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />ing and Subdivision Ordinances and current administrative procedures. 1 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 />tion expense. <br />(Signature of Applicant) (Date) <br />WHITE Office CANARY Customer PINK —File GOLD Planner iu <br />