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Little Canada, Minnesota <br />APPLICATION FORM <br />N? IOra <br />PAID A bU co <br />Rec. No <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 />Applicant 5-T--CA/ 575ti 7n S oZ76i `Y 5t 6 57 yS82270 <br />(Name) (Address) (Phone) <br />Owner /f-,I4(?� t M?J 11 ?An Jot/ i7- fte (4-L9 �S/ <br />i ��-(iet, ✓) �V1ld /Sir✓/ ach? 114/06 <br />(Address) (Phone) <br />(Name) <br />Property Location (Street Address and Legal Description): <br />SIt3 <br />7 B rte' Sr t't-t-/e (otnctd, nizv <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />n signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />.ng 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 />:ion expense. <br />(Signature of Applicant) <br />NHITE— Office CANARY— Customer PINK —File GOLD — Planner <br />(Date) <br />