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Little Canada, Minnesota <br />APPLICATION FORM <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 <br />%-%Llf -/l <br />(Name) <br />c iOPF ` ( RSfgp c--/r-‘"6 <br />(Address) <br />psi-- 512-139 Z. <br />(Phone) <br />Owner 174-rAL,'0141 67eic . C A 5; P6/J �)fz Le ' - 5 3,z <br />(Name) (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />6 - /s E'EN C /gC -L-f <br />Z /rrZ, 69Av4pr , m,U. 5-570,1 <br />Iescription and /or Reason for Request (Cite Ordinance Sections): <br />A-ni f A r ' $Pecin P- I -p F_ c.–c-rgp,c -PDA- <br />P ien,T, A Z -- 6 2 °/ 4 /LI)1 77 0N , 5 77-' Hif <br />44- 0/) Amt/ / -TI4 I / 4,01211._ /2t.;Qit) or my HH-oW <br />I signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />.g 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 />'on expense. <br />(Signature of Applicant) / (Date) <br />HITE— Office CANARY— Customer PINK —File GOLD — Planner 1°'t'® <br />