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' -- - <br /> APP#�� <br /> SF# <br /> _.__._ <br /> �1��1_ <br /> CITY OF PEQUOT IA�S DVIiSMA �O <br /> LA11TA I7SE PE� PLICA ON For ai�ce uae on�y <br /> ,� <br /> r _ /1J <br /> Name of Applicartt— �l�,s��; ��,��^��,phon�����7 07-.�302 (fr <br /> Addr+ess �/ � . � � (�' fet2�'�'f Q..�7o�.�7� r. <br /> M� , ..{ �. :;�,-� �d` vnsn r,cvr+'� <br /> . <br /> �y,S'��7�p � /,� ��A/ �!IL.� � �+ S6 l I <br /> , , <br /> Applicaat ix Tlde Halder of Pmpertp: <br /> �I�� � (sf not applic�nt) . <br /> Con�ctBuyer {) (N�n�3 <br /> Opdon xoldet () <br /> D�t �) (Addt�ss} . <br /> ��9� ' ) . <br /> , <br /> , <br /> Signatune of Owaer,anthorizing applicatioa(rec�uitec�. <br /> c <br /> (�Y�C"n8 the oovnes is cectifying�at t�ey�ave read and tbe' �'PP��-) <br /> Signad�re of ApplicAnt('if different tbaa ocv�nar): <br /> �Y��aPP�t��ymg t�at they have read�nd undessiood the instr+utions accompmyiug�is ippdi�tio�,) <br /> Irocation of p c involved ia :ec�es�:.� <br /> -.� �' `�.1.1� <br /> __._.�,..., , <br /> PropertyPatcelID(#onTaaStat,�mentpZ�/G7L�'���Oz�-d �`-v2�/d �;G O� q <br /> ZoaingDistdct—_ �7�' . ,LakeName,.`�. •f--�'{�. . _�„ . <br /> State natvre of reqnest ia dem1; (qpf�at ar�you proposing far the psoperty? If a neav davellno�indicaxe <br /> mimber of st�ories aad tton� <br /> ���y '��- � CQ <br /> �� .�iC. �• � �' �,� <br /> / 4,l� <br /> APPmved b3'the Zoning Depa�rmn Date:��-�� <br /> ���(�� ���� REV:FEB 2045 <br /> -�/�$ <br />