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.; L <br />r :.a-:ua <br />tea <br />ss <br />'/ <br />RECEIPT <br />iTTLE CANADA <br />Road,. it•te Canada, Minn. 55117 .— <br />1 / <br />From 12 /2lT� /i -1 <br />Date <br />N° 10 t 20 <br />-- 7/ tg.i� <br />o <br />/c',-2-e"7L <br />S� 1./..1-r. -e <br />4../er e-ert 4' .L i%Ze <br />//a 27e2 .st.c c__ <br />$1« <br />Dollars <br />,<7 <br />Name /CD': -tee 2-72(?/? <br />Account No. <br />Amount <br />Account No. <br />Amount <br />Applicant <br />(Name) <br />(Address) <br />s"s <br />C ner s- <br />" r2� (Address) <br />Property Location (Street Address and Legal Description): <br />(Nome) / <br />e Permit <br />Planned Unit Development <br />�.2 /?L..,-u <br />1/ )( c --3 <br />(Phone) <br />y3'.3 ` 3 <br />(Phone) <br />in ..7 y y <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />-tom _C'.t _k <br />Ike <LC c . <br />7 <br />.0 <br />c — <br />, <br />In signing this application, 1 hereby acknowledge that I have read and fully understand the <br />cpplicable provisions of the Zoning and Subdivision Ordinances and current administrative: <br />procedures. 1 further ocicnc•.vledge the fee explanation as outlined in the application <br />procedures and hereby agree to pay all statements received from the City pertaining to <br />odditional application expense. <br />Clerk's exhibit no. <br />1 <br />