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Little Canada, Minnesota <br />APPLICATION FORM <br />PAID <br />N° 602 <br />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 />(Name) <br />Sr € r_D `t e. a 9g'l -ydcq <br />(Address) (Phone) <br />Owner P n- lid - as, 4- ve,,4. Q A. q q- 4 3 sr <br />(Name) (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />N -z.k- Xthat lo i, a 2 . <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />d ,s0.e �4 acam- - Pt <br />sakt:6 \51 <br />ADA <br />to, a1.,1T�- y• <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 46 �i� rc� 7/3/ <br />(Signature of Applicant) (Dat <br />WHITE— Office CANARY — Customer PINK —File GOLD — Planner <br />92, <br />