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Applicant <br />N° 568 <br />Little Canada, Minnesota PAID J sd. <br />APPLICATION FORM <br />Rec. No <br />Comprehensive Plan Amendment ' / Conditional Use Permit <br />Zoning District Amendment r Variance <br />Text Amendment Subdivision <br />Other Planned Unit Development <br />Plan Review <br />J wiS <br />1 <br />(Name) (Address) <br />(Phone) <br />Owner (o14uCA -- A-4(ArS 13,26 e4 5/16 —O 79 <br />(Name) (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />3c/6 n47r6_ eo-riQ ace <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 />igth'ature of App cant) <br />WHITE— Office CANARY — Customer PINK —File GOLD — Planner Page 1 <br />(Date) <br />