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c c <br />Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />Applicant Di Tti 110 <br />(Name) <br />Owner <br />W ILSa3 <br />DA) I OilAJE W (LSo.J <br />(Name) <br />PAID <br />N9 697 <br />Rec No. <br />Conditional Use Permit o?c-. .00 <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />37S-1`150 <br />63C7 Kec.Le)e /94NY 5'e3- 0687 g• <br />(Address) (Phone) <br />636 Kc.cec tgtw7 Y8 3 -0687 <br />(Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />6.gct, Ket to e. rPKay <br />S'oc.tweV-et PA.r1.1- L0 T- % g l cN-arioss PotAyT' <br />Description and /or Reason for Request (Cite Ordinance Sections): <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 />Catsov) 61-26 - <br />(Signature of Applicant) Page 1 (Date) <br />WHITE — Office CANARY — Customer PINK —File GOLD — Planner <br />