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Little Canada, Minnesota <br />APPLICATION FORM <br />N9 609 <br />PAID 4y0Q J� <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 &51 4e.Ta / Tn-e. Lf•71/4C0_.%` 3o // dott■,-/ay DR, /-e 4127 -,Q 67 <br />(Name) (Address) 55-//7 (Phone) <br />Owner J47nl /'f ? -31.4.4 "--75"--- /q�99,..fret• -o »,n- y3azS £Jt$ 35-oi <br />(Name) (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />3 d 1 / /OGt n t7cy Ate <br />Ti-t/-e- telebrnt-opili <br />?o,ae eTY <br />�• " 040)5%2 211 COO <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />/tt' Arlin /e/ L / ice 7) 4-1f di✓ <br />/ ,rs A/a) /79,1n dA <br />a4.47, d, 6o l..y wit/ a.- 99,47 <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 44 Awe, ,Sid,- <br />Ignature of Applicant) (Date) <br />WHITE- Office CANARY- Customer PINK -File GOL Planner SC) <br />Sin) ,_ ,9Z <br />