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,�� APP# <br /> � SF#_ <br /> Date <br /> CITY OF PEQUOT LAKES DWSMA <br /> LAND USE PERMIT APPLICATION For office use only <br /> Name of Applicant�a.� � �u�• �t,��L,�IUCZ T'hone ��-'f51�-�''lo�F <br /> Mailing Address�l5� �i(�u.tv� �(� ���� Email�f����• flJl'i') <br /> City,State,Zip��.�1� st'a�-� <br /> Applicant is: Title Holder of Property: <br /> �'if not applicant) <br /> Legal Owner () �L,hr,�wi��,�CSiv(`��NI.'�v�YLt$[J�� (,LL <br /> Contract Buyex () (Name) <br /> Oprion Holder O '715� ��hu:r�2C� St��w <br /> ��ge�c () {rldc�ress� <br /> Other���. � �xxa(�, N�t-� �d�f 72 <br /> (City,State,Zip) <br /> Signature of Owner,authorizing application (required): <br /> (B}�signing the owner is certifying that thep have cead and undrrsiot> e ai cfi' s a c pary,rin�this application.) <br /> Signature of r'�pplicant (if diffeYent than owner): <br /> (By signing the appZicant is certifying that they have read and undeistood the iri t�vttio�is accompanying this application.) <br /> Location of��n�erty involved in 's re uesr <br /> � 7�C?t.b��'� d,C.� lrct-�� �l�!'�l— <br /> Pro e Parcel ID # on T�Statemcntij �01� �'� � <br /> r m� ( <br /> Zoning District ,Lake Name <br /> State nature of request in detail: (What are you proposing for the property? If a new dwelling,indicate <br /> number of stories and foundation type.) <br /> 1)��4'i.T�T_l1�!!�P t' C � <br /> Approved by the Zoning Department: Date: <br /> REV: MARCH 2O19 <br />