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'�� APP# <br /> ' � SF#_ <br /> �� Date <br /> CITY OF PEQUOT LAKES DWSMA <br /> LAND USE PERMIT APPLICATION For offi�use only <br /> Name of Applicant n.� ��;�f�rK.�t,��L,�Wtz- Phone ��-45r�-'73[c�} <br /> Mailing Addxess"?l� ��f�hu.v� 12l� �.-�� Email C3�i c�cey���• CCJI'i'1 <br /> Ciry,State,Zip�C�;(`,11l1k� 5ta�-� <br /> Applicant is: Tide Holder of Ptoperty: <br /> �'sf not applicant) <br /> Legal Owner () �,��n�_1m St�►��tSlvl��r_l�l'�hYLt$r�� (�LC- <br /> Contract Buyer (j (Name) <br /> Oprion Holder () "115� �i�r�ur��G� Ste-�w <br /> 1lgent () (rldc�r�s) <br /> Other�, t' , �t�f-►°, N�F—� �d�l 72 <br /> (City,State,Zip) <br /> Signature of Owner,authorizing application (required): _ <br /> (By signing the owner is certif��ing that thej�have cead and unc�rtstcw e ai cti' s a c j�ary,rin�this application.) <br /> Signature of Applicant (if different than owner): <br /> � (By signing the applicant is certifying that the}�have read and undeistood the in ttuctiot�s accompanping this application.) <br /> Location of p���erty involved in us re aesr D <br /> �-(_�U�J�"'�' d.C.� : lriE.i� T"�1'�l— <br /> Property Parcel ID (#on Tax StatemCcttj��',(�j,�-�7�� ( ��01Q'�!���`' <br /> Zoning District ,Lake Name <br /> State nature of request in detail: (What are you proposing for the properry? If a new dwelling,indicate <br /> nutnber of stories and foundation type.) <br /> 1)�iL i� ClTL�,P�(�f C �f� L <br /> Approved by the Zoning Department: Date: <br /> \... <br /> REV: MARCH 2O19 <br />