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Little Canada, Minnesota <br />APPLICATION FORM <br />N? 1032 <br />PAID f\Sb° <br />Rec. No. <br />Comprehensive Plan Amendment Conditional Use Permit <br />Zoning District Amendment Variance <br />Text Amendment Subdivision <br />Other >C Planned Unit Development <br />Plan Review <br />Applicant 5AU41; 4^— Sra246,p <br />Owner <br />(Name) <br />5 S Try a <br />(Address) <br />665 -1 ci - as 78' <br />(Phone) <br />SALAG/V W , wire 115C 'VAL Sr 57--C 900 , �v%+ t, [d5 1d4 & <br />(Name) n 5ioo <br />(Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />55 cry ea CArr Ler-ru_ c- 9AJ444 4217 <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />J41)/3 0l2tc n Qn/4L. 5( uiwl c c LL" 4,4_y <br />tirL:-7 NL-r Actin rrrC;9 3 cc✓lr _ <br />In signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />19 and Subdivision Ordinances and current administrative procedures. I further acknowledge the fee explanation as outlined <br />. • the application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />expense. <br />(Signature of Applicant) <br />HITE— Office CANARY— Customer PINK —File GOLD — Planner <br />(Date) <br />