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APP# ,/7-/7 <br /> SF# <br /> Date /(- '/� <br /> CITY OF PEQUOT LAKES DWSMA <br /> 1.-- LAND USE PERMIT APPLICATION For office use only <br /> Name of Applic, u t ' ✓ � r�t�c���� r✓�� C Phone /�f',S`.3fi—�5 6,_? 7 _7 <br /> Mailing Address f ' C.�� � - v Email <br /> City,State, Zip 06--7t <br /> Applicant is: Title Holder of Property: <br /> (if not applicant) <br /> Legal Owner (lye <br /> Contract Buyer O (Name) <br /> Option Holder () <br /> Agent () (Address) <br /> Other <br /> (C ' te, dor <br /> Signature of Owner,authorizing application (required): ��;a <br /> (By signing the owner is certifying that they have read and understood the instructions a ompanying this application.) <br /> Signature of Applicant(if different than owner): <br /> (By signing the applicant is certifying that they have read and understood the instructions accompanying this application.) <br /> Location of propty involved in this request <br /> Property Parcel ID (#on Tax Statement) 2 % /''40 O / ()r�_ err?' <br /> Zoning District ,Lake Name /v4. <br /> State nature of request in detail: (What are you proposing for the property? If a new dwelling,indicate <br /> n//as ber of stories anddfoundation. e.) <br /> . �, CC (t om, L L/ /� i3 <br /> 0 <br /> Approved by the Zoning Department: Date: <br /> REV: FEB 2015 <br />