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APP#4,4-,/�`7 <br /> SF# T <br /> Date 7_ , _ of <br /> CITY OF PEQUOT LAKES DWSMA /r/U <br /> '�� LAND USE, PERMIT APPLICATION For office use <br /> nlonly <br /> Name of Applicant ' )1FU I bR f-1 L4 L 137 Phone 7 -d 5L 7 j <br /> Mailing Address 6 C `t-q- N,, S L /(e77 Finail <br /> City,State,Zip PL- <br /> Applicant is: Title Holder of Property: <br /> (if not applicant) <br /> Legal Owner <br /> Contract Buyer () (Name) <br /> Option Holder () <br /> Agent () (Address) <br /> Other <br /> (City,State,Zip) <br /> Signature of Owner,authorizing application(required): [l/ULf P. 0,14-t-e- <br /> (By signing the owner is certifying that they have read and understood the instructions accompanying this application.) <br /> Signature of Applicant(if different than owner): <br /> (By signing the applicant is certifying that they have read and understood the instructions accompanying this application.) <br /> Location of property involved in this request <br /> tits✓, <br /> Property Parcel ID (#on Tax Statement) a9c:71a o3 cP 94,70? o? OO D ferre 9 <br /> Zoning District . ,Lake Name ,..57&. -y <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 <br /> ,,,,, A <br /> tyke <br /> Approved by the Zoning Department: Date: <br /> REV:MARCH 2019 <br />