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0 <br />N9 6sa <br />Little Canada, Minnesota PAID 175 _ <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 And/ Qrtow <br />(Name) <br />PC. H 000 Lex n, To., )-c rli Co06-.1thl -1 / t <br />(Address)' (Phone) <br />(Phone) <br />Owner S-aop.,' ,Ai'-c.ln /�. �.4,�,, o &j Po. IvJ,<. let <br />(Name) (Address) .1 (Phone) <br />Property Location (Street Address and Legal Description): <br />23..s E. Cu ro\ <br />/IAA nSzi .2Liy ( urt. {.c4'1e o4 T,"1 nor 3 34777=1 <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />COnc, 1,o �-; 1 4az r.'ul'r., l tA4t (..., H rhfio<... <br />C[:A.ylrw c.t ti ..� Or-rc:ile- cn COAL, - \irnc.a_ .jT4 J.q <br />Vs <br />l .sTS r z ?_, <br />Cn ��JL'•M. Be) <br />In signing this application, 1 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 />ClAtA <br />(Signatufe of Applicant) (Date) <br />WHITE — Office CANARY— Customer PINK —File GOLD— Planner Page 17 <br />