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Little Canada, Minnesota <br />APPLICATION FORM <br />N? 1014 <br />PAID S U <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 / `o -A-r ID: #CtEt " `fo-Aiic <br />Owner <br />(Name) <br />(5 ICE <br />(Name) <br />Property Location (Street Address and Legal Description): <br />(-Io s t 'CGS X186 0 <br />ztS 5146c i /Jwi763 756 -0930 <br />(Address) (Phone) <br />(Address) JJJ (Phone) <br />I S SA -VA-6E t-1 rrbC CA -AIAin vvi A} s <br />6 p iv- i z y 1---f a i>tA. L� <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />'To ,fie Eb <br />L�uLz_ <br />-Fa 2 <br />2, 5( 2 2 s r-f e it 6 R/16c <br />s i -Of,A-6;� <br />k ti FU %', /U r u K C icL ies ? elm <br />In signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />i nd 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 />tion expense. <br />(Signature of Applicant) (Date) <br />WHITE— Office CANARY — Customer PINK —File GOLD — Planner <br />.•�q'Ra��po <br />