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APP# '— .�- <br /> SF# <br /> Date�� ,C'' I <br /> CITY OF PEQUOT LAi�S {tor otflce use on�y) <br /> CONDITIONAL USE APPLICATION <br /> / � « � ' <br /> Name ofApplicant ��1E%�`� �1�G9� d�7L�2i`rl Phone r���—��1� `f����� <br /> Mailing Address ����`�� �aly Email ��`E/�lSG�` j'1'��a�� �•<_�.�.�-j� <br /> Ciry,State,Zip¢��l�'/ �-i��' �' y1/v lf�i-� ��a ' <br /> Applicant is: 'tle Holder of P�o�per :///k f I <br /> Le�alOwner �( � ���.. (9 . ', <br /> Contract Buper () (N��� L., � �� / � �y`2� <br /> Option Holder () ,�l L ����� < � _ <br /> O r () (A�SS) ,���� "�� l����� <br /> (� �5 �, ) <br /> S' ture of Owner autho ' ' a hcation uit ` � � <br /> � , � pp� �re9 �� <br /> (By�'�the owner is certifying that thep ha.ve read and understood the instructions a panyu�g this appfication.) <br /> Signature of Applicant(if different than owner}: I <br /> (By signing the applicant is cerdfying that they have read and undecstood the instructions accompanying t6is applicauon.) <br /> Location of property involved in this reques� <br /> Patcel ID No. Zoning Disuict rC � <br /> Lega1 Description(if inetes and bounds,attach sheet): S� ;� � ��`Ch'P� <br /> State nature of request in detail: (What are you proposing for the property?) <br /> ��`f�� 4 cr <br /> What changes('if any)ase you proposing to malie to this site? <br /> Building: <br /> Laadsca.ping: <br /> Parking/Signs: <br /> 2 REV:FEB 2015 <br />