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Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />XOther <br />Nn 967 <br />PAID 4/02SD <br />Rec. No <br />Conditional Use Permit <br />Variance <br />A Subdivision s < LA 3700 <br />Planned Unit Development <br />Plan Review <br />Applicant Ch yUecLiz DeUe!OArn T mpF ")_ CCU )0 <br />(Name) (Address) <br />woo t m J .s -S /I.3 <br />wner s A t\L <br />tsrce <br />41-41 <br />(Phone) <br />LS 1—'9497- l 971 <br />(Name) <br />Property Location (Street Address and Legal Description): <br />(Address) <br />(Phone) <br />G 065wv 4acC A -Y*a tJ v5 S e L f G t- non arw0 eorLoz -..A <br />>c.h- 't-;C.C. Cr�i✓ t A3 to 000CP f i-1)1 ki 4.9 Lt teCr <br />I ascription and /or Reason for Request (Cite Ordinance Sections): <br />3 r, 2 J C 1 Be o i I _C a ■ A a'i 44- PP QC4-1 N., C(__ Le --4 tea 14�Le > A LT-) i (—i9!% Ll <br />NI t- 244�' l <br />signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />r •nd Subdivision Ordinances and current administrative procedures. I further acknowledge the fee explanation as outlined <br />e application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />n expense. <br />(Signature of Ap licant) <br />• nITE— Office CANARY — Customer PINK —File GOLD—Planner <br />(Date) <br />