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Little Canada, Minnesota <br />APPLICATION FORM <br />PAID <br />Rec. No <br />Comprehensive Plan Amendment Conditional Use Permit <br />Zoning District Amendment Variance <br />Text Amendment L1 Subdivision <br />Other Planned Unit Development <br />Plan Review <br />Applicant <br />To rig t. au- A/ <br />(Name) <br />Owner <br />66( 1/161MC PRr <br />(Address) <br />OK-7uc <br />(Phone) <br />(Name) <br />(Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />60 ( !/74 /d/G PA1VL' <br />54 V R It-EY S C4V4,S LAK A- DoiT/- N <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />LoT 5PL <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 staterr,jents received from the City pertaining to additional applica- <br />tion expense. <br />(Sig riatur offApplicant) <br />WHITE — Office CANARY— Customer PINK —File GOLD — Planner'] g 8 3 <br />