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N9 613 <br />Little Canada, Minnesota PAID 400 GO <br />APPLICATION FORM 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 t—P C.∎=,∎ *S '7V2°. Cn cte_. Ac�'�4 Z-1Zip <br />(Name) (Address) (Phone) <br />Owner \C-tt4e". -fir Cc . AS.-- \---\00Pst0 \ D <br />(Name) <br />Property Location (Street Address and Legal Description): <br />(Address) (Phone) <br />7c)72.9\ enot-T'CQ1cDv e - V v-wicv <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />�_L--) vt-tcmJP•e, Cc . -Tr) v t,\ <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. 1 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 />l <br />(Sig ature of Applicant) 20 <br />WHITE— Office CANARY— Customer PINK —File GOLD P.nnr tt'' <br />2-4-/ 12- <br />(Date) <br />