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N? 818 <br />Little Canada, Minnesota PAID 4 -2so.00 <br />APPLICATION FORM Rec. No <br />Comprehensive Plan Amendment / Conditional Use Permit <br />Zoning District Amendment Variance <br />Text Amendment Subdivision <br />Other Planned Unit Development <br />Plan Review <br />Applicant <br />Owner <br />Robert DE 8,4 -Cie <br />(Name) <br />Qo begirt- ID g4-cfr- <br />(Name) <br />�� dr <br />(Address) <br />Property Location (Street Address and Legal Description): <br />6L7-1/P- >Jb 57/ <br />(Phone) <br />Si e G(5-7- 4/g/-4f57/ <br />(Address) (Phone) <br />3) 5-2 Cown[y .briva LiJF`El A- A/AcIA l liNA/, <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />lJ 9)ivtare <br />In signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />ind 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 />Page 117 <br />WHITE — Office CANARY — Customer PINK —File GOLD — Planner <br />51V -99 <br />(Date) <br />