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D � 1�J � 0 � 2 � APP#� <br /> � <br /> SF# <br /> OCT 3 0 2017 oate D' /7 <br /> CITY OF PEQUOT LAKES DWSMA � <br /> By LAND USE PERMIT APPLICATION For o�ice use on�y <br /> Name of Appli Phone <br /> Mailing Address E� <br /> Ciry,State,Zip <br /> Applicant is: Tide Holder of Property: <br /> ('if not applicant) <br /> Lega1 Owner (� <br /> Contract Buper () ��e� <br /> Option Holder () <br /> Agent () (Address) <br /> Other <br /> (City,Sta.te,Zip) <br /> Signature of Owner,authori7,�applica,tion(requirec�: � u�. `�-- <br /> (Bq signing the owner is certifying that they have read and understood e ins � ons accompanping this application.) <br /> Si�mature of Applicant(if different tha.n owner): <br /> (By signing the applicant is certifying that they have read and understood the instructions accompanying this applicarion.) <br /> Loca.tion o property invo ed in this reques <br /> � <br /> Property Parcel ID (#on Tax Statement) � / Qp� � �(�� �— /�-�jp �/ <br /> Zoning District_ Lake Name �t/�/�- <br /> � <br /> State na.ture of request in detail: (What are pou proposing for the property? If a new dwelling,indicate <br /> numb of s ories and fo tion type.) , , <br /> �ccti7�.�' <br /> � � i� ���� <br /> � <br /> Approved by the Zoning Department: Date: ��`o�—/� <br /> REV: FEB 2095 <br />