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APP# 1 <br /> SF# <br /> -%iii <br /> Date r <br /> CITY OF PEQUOT LAKES DWSMA <br /> LAND USE PERMIT APPLICATION For office use only <br /> Name of Applicant <br /> r > .� � Phone . <br /> Mailing Address Email <br /> City,State,Zip <br /> Applicant is: Title Holder of Property: <br /> (if not applicant) <br /> Legal Owner (� <br /> Contract Buyer O (Name) <br /> Option Holder () <br /> Agent O (Address) <br /> Other 1 <br /> (City,State,Zip) <br /> Signature of Owner,authorizing application (required): <br /> (By signing the owner is certifying that they have read and understood the instructions accompanying this pplication.) <br /> I <br /> Signature of Applicant(if different than owner): <br /> (By signing flee applicant is certifying that they have read and understood the instructions accompanying this application) <br /> Location of property involved in this request: <br /> Property Parcel ID (#on Tax Statement) f <br /> Zoning District ` , ,Lake Name � <br /> State nature of request in detail: (what are you proposing for dze property? If a new dwelling,indicate <br /> number of stories and foundation type.)' <br /> r , <br /> Approved by the Zoning Department: , f _� f Date: <br /> REV: MAR 2009 <br />