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Little Canada, Minnesota <br />APPLICATION FORM <br />PAID S ,as-0 <br />Rec. No <br />Comprehensive Plan Amendment Conditional Use Permit <br />Zoning District Amendment Variance 4'3S-C) <br />Text Amendment Subdivision 900 <br />Other Planned Unit Development <br />Plan Review <br />Applicant G l 1 r. S E . <br />(Name) <br />C vner ,l� i K 4 /� 2 "/ :Pe ) Z.-CS <br />(Name) <br />(Address) <br />302 i A st. <br />(Address) <br />651 -y83 — SI I � <br />(Phone) <br />651-L191- E:7-CS <br />(Phone) <br />P--)perty Location (Street Address and Legal Description): <br />3o-, I Ar<<dz s� Jti1� C i111ti) (oei <br />N1 � u52_c\- 00 IT <br />C_scription and /or Reason for Request (Cite Ordinance Sections): <br />p i; C 2 1 +� � A e �-�e,�d �� e c\_) <br />0 <br />b„: ,\ <br />1t.LL, <br />k 0 <br />Ir 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 />it the application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />ti i expense. <br />Page 12 <br />(Dianacure u. ,,N,,,,,.,,,.,, (Date_) <br />