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` • APP# 5'.3 <br /> SF# <br /> Date.57�'/5 <br /> CITY OF PEQUOT LASES DWSMA� <br /> LAND USE PERMIT.APPLICAI'ION For oifice use on�y <br /> Name of Applicant �.o Lc.i s ctr j Q c�eh Phone " l�- SS 3S r��S.�7 <br /> �J <br /> Mailing Address ��9 � �q'S'4E- �VP. ,�.W. Ema.il <br /> City,State,Zip�n���� .�6�{'�c! <br /> T <br /> Applicant is: Title Holder of Property: <br /> (if not applicant) <br /> LegalOwner � <br /> Conttact Buyer () (Nazne) <br /> Option Holder () <br /> Agent () (Address) <br /> Other <br /> (Citq,State,Zip) <br /> Signawre of Owner,authorizing applica,tion(require�:�uiu,�,�.���r� <br /> (BY s�gn�ng the owner is cerdfying tbat they have read and undecstood the' ons accompanying this application.) <br /> Signature of Applicant('if different tha.n owner): <br /> (By signing the applicant is certifying that they have read and undeistood the instructions accompanying this application.) <br /> Loca.tion of p operty�volved in�reques� e � I o <br /> P�-. c��- �V '-�- � r�-1- � <br /> Property Parcel ID (#on Tag Sta.tement) �,�U- `��� � Zd Co �r���(�9 <br /> Zoning Distact�t,t�r��- P2au u�' La�t�� ,Lake Name <br /> Sta.te nature of request in detaiL• (What ate you proposing for the properry? If a new dwelling,indica,te <br /> nurnber of stories and foundaxion type.) <br /> r o or�e.� s w► 2't'x to� ' 3�' - <br /> hG ' ' � � <br /> a�td I P -�w+v � <br /> -o�l�ow�_ �o �ask �i,� o� ba�z.v., �;� I�ovn t oara•p 2 4�X!00�- I,4�-k0 sa �}. <br /> oVY12 t QS2Vv►Q = ���2 S S�i� . <br /> 1 za'x o' , <br /> o a c . - ' , zo o' - o <br /> Approved by the Zoning Departme . Date:� ��—/� <br /> REV:FEB 2015 <br />