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Applicant <br />`lwner <br />Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />N? 995 <br />PAID <br />Rec. No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />C/o ife-noe <br />G Si - t/86 <br />�o7ssi2mo / / °Ce'�i� �SSOG /GZ n�,—, _7)-2(7. <br />(Name) 02 7 O Sire tdress )osiv, %/P 4/0✓ (Phone) <br />GhP/9 <br />(Name) <br />A r0/'" cSi o)-7CC-/ 7 2 r/< s--7-7(o . <br />Property Location (Street Address and Legal Description): <br />(Address) <br />( s hji °ne) <br />a 9 70 — a 9 9e7/ if; / Z-7'211/4 7a oz <br />v / 9, /6,2 cot- / %nAd 64/ /V 4_6,3 rr-,E c2l <br />escription and /or Reason for Request (Cite Ordinance Sections): <br />/f-e f e°_.5"7 i7,1 � 62-G- C &/ / CZ,,9,0r v v / <br />�°c Y1f7Lrae7 1 7 S /4Yl <br />(9 -'-Pre <br />k <br />r— <br />signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />Ir- -nd Subdivision Ordinances and current administrative procedures. I further acknowledge the fee explanation as outlined <br />iI e application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />)n expense. <br />(Si 'nature of Applicant) (Date) <br />IITE— Office CANARY— Customer PINK —File GOLD — Planner <br />