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APP# C <br /> SP#�'18� <br /> Date 5` <br /> CITY OF PEQUOT LAKES (tor ofte use orgy) <br /> CQNDITIQNAL USE APMWION <br /> Nazue o£Applicant M A'q k 61A F—B R _..� Phone 2 i S-929-099 2 <br /> MaWng:A ddr-ess l7 &find''I WT 3,71 Email MAR o N <br /> City,state,zip 8AA Irif,&'D 'My,. ��401 <br /> Applicant is: Title Hol*of Property: <br /> Legal Owner At-4110 S6 A G'(`tl�t� t1 R <br /> Contrast Buyer (Name) <br /> Option Holder () _ /�,� %�' 4�C S74. <br /> . <br /> Agent (} (Addr s) ,.. .— <br /> (City,state,zip) <br /> Signature of Owner,authorizing applicatim(tequited): <br /> (By signing the oyes is cmd*g that dwy have teed and=k-vxtood the instcuctian cc n ' a rum} <br /> Signature.of Applicant(if different than owner): <br /> (By signing the applicant is eetaf*g that they hsvc read and understood the aistmcdons accompanying this applicati m.) <br /> Locsetian U£prop d in this request: <br /> Parcel ID No. Zcrnirtg L3istcict _�inM��c �.► <br /> LegalDesrtKptiozz(if metes and bounds,attach sheet). � j , P-9 54 7-2. <br /> Sta nature of request'n detail: (What ate y t prvposiu for the property?) <br /> + - - k WW 3s <br /> What changes(if arty)are you proposing to mate to this site? <br /> r <br /> Building ,s S -L A^ 1D,.i t A' .as o n W o 2c�X 4©^Fo:e pA 1 l r-+ ttEm.: <br /> Landscaping- c.t O af�t�•2 <br /> , _ ��T/ <br /> Parldng/Signs: ry I di�7 I1F—A k Q'QQ A�� <br /> I <br /> 2 REV:MAR 2009 <br />