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06/21/2004 08:20 FAX 218 568 5880 CITY OF PEQUOT LAKES U002 <br /> f . <br /> APPI° ei�-5��` <br /> pate.:)aJ Q <br /> (far office use oty) <br /> CITY OF FEQUOT LAKES <br /> cONDITIONAL USE APPLICATION <br /> Narne of Applicant Th( �1ry a,x _ Phone /9 7e/c, q <br /> Mailing Address Email <br /> City, State, /Y) szfit <br /> Applicant is; Tide HolderpfProperty: <br /> °w` l awe Y) <br /> () (Name) <br /> Option Holder () --- -. <br /> Agent Other <br /> 0 (Address) <br /> (City, r. ) <br /> Signature of Owner,authorizing application(requirtd):. k a .g414,6/4 <br /> (By signing the or is oatifying that they have read and understood the ..' :anclappanfing this ) <br /> Signature of Applicant(if different than owner): <br /> (By sigma ibe aPPlicani is certifying that they have nod and understood the inm,aica s acconglanying this ) <br /> Locabiort of property ved in this request: <br /> Z► ' ' . •si r&leng <br /> r <br /> Fire No. Parcel ID No.d//5Gi /j i c0 7 Zoning District <br /> State nature of request in detail: (What are you proposing for the property?) <br /> v ft <br /> What changes(Warty)are you proposing to make to this site? <br /> Budding: AO <br /> X / Qra ,P <br /> LandscaPing Ph(4) (mss Paiidng/Signs:- <br /> REV:JAN 2002 <br />