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Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />NC' 981 <br />PAID 46-60 <br />Rec. No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />Applicant( t �. 5t'E 233 PReg atk. <br />(Name) (Address) <br />Owner -tki i hoci'kit j <br />(Name) <br />Property Location (Street Address and Legal Description): <br />(Address) <br />17Acc ST (-(err . efin) cop A- cal) <br />6d2 333 7z72- <br />(Phone) <br />to ( (0(L 33z3oCO <br />(Phone) <br />v2-c& 3e0 <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 />ing 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 />!. <br />(Sig ure of • :: '- -nt) (Date) <br />NHITE— Office CANARY— Customer PINK —File GOLD— Planner ^ +iY(.t�� <br />