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Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />Applicant <br />Owner <br />as <br />a ,, /o7 7 4 g 17/F47/- ..SaW <br />(Name) (Address) (Phone) <br />CSAric../7ant- <br />(Address) (Phone) <br />? 840 <br />PAID y0e.eo <br />Rec. No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />(Name) <br />Property Location (Street Address and Legal Description): <br />ie-ci2.61-7ci 9- <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />In 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 />tion expense. <br />±—</7 <br />(8ic Page 21 / (Date) <br />WHITE — Office CANARY — Customer PINK —Fill GOLD —Plann <br />x m <br />