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x <br />Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />Qr�1, m P eft r� <br />Applicant a'x5 ct,ici.141cA <br />(Name) <br />Owner <br />Property Location (Street Address and Legal Description): <br />c <br />N9 :-3 <br />PAID C° <br />Rec. No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />(Addr ss) (Phone) <br />1417 L1.CMA t <br />(Name) l (Address) 1 <br />(Phone) <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />--1--1-co\ovN\Cgl <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 21 <br />WHITE— Office CANARY— Customer PINK —File GOLD — Planner <br />q3 <br />(Date) <br />