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Little Canada, Minnesota <br />APPLICATION FORM <br />N° <br />PAID <br />Rec. No <br />Comprehensive Plan Amendment Conditional Use Permit <br />Zoning District Amendment X Variance <br />Text Amendment Subdivision <br />Other Planned Unit Development <br />Plan Review <br />Applicant <br />Owner <br />(JA.r t 6 s. N-E t 1 <br />(Name) <br />(Name) <br />E. utKuti(c) bite- <br />(Address) <br />(-VW- t o l S <br />(Phone) <br />Property Location (Street Address and Legal Description): <br />(Address) (Phone) <br />117 f_ \J Z v PA-Aft.- <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 />Page 1 V <br />(Signature of Applicant) <br />'HITE— Office CANARY — Customer PINK —File GOLD— Planner <br />1 <br />(Date) <br />