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Little Canada, Minnesota <br />APPLICATION FORM <br />PAID <br />N9 <br />Rec. No <br />Comprehensive Plan Amendment X Conditional Use Permit o}S-! <br />Zoning District Amendment Variance <br />Text Amendment Subdivision <br />Other Planned Unit Development <br />Plan Review <br />Applicant Kerwin Tilleskjor 8502 Coral Sea St.N.E. Blaine, MN 55449 734 -6298 <br />(Name) <br />(Address) (Phone) <br />Owner Same as above. <br />(Name) <br />Property Location (Street Address and Legal Description): <br />XXX Australian Ave. <br />(Address) (Phone) <br />See attached survey. <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />To move a single family r:or,e onto XXX Australian Ave, <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 17 <br />WHITE — Office CANARY— Customer PINK —file GOL.,— rammei <br />(Date) <br />