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APP# /A? - /d <br /> SF# M _ <br /> Date,f`//-/-� <br /> CITY OF PEQUOT LAKES DWSMA &�C <br /> LAND USE PERMIT APPLICATION For office use only <br /> Name of Applicant /1iGt YI ! � Phone 2 j a S ^ ' <br /> Mailing Address Po Z Z E v Email <br /> City,State,Zip �lne �,�iPr, �� ���71'I, ;NG�¢`"Y�n fi'1 ��cI(2� � �,M�?�� .CCU <br /> Applicant is: Title Holder of Property: <br /> (if not applicant <br /> Legal Owner () L(U�2 Gv a SS <br /> Contract Buyer () (Name) <br /> Option Holder () <br /> Agent () (Address) p5��•`�� <br /> Other �7 i S L e 6,Se d <br /> (City, State,Zip) SSG <br /> Signature of Owner,authorizing application (required): <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: 56L2-L <br /> Property Parcel ID (# Tax Statement) 7`zl` .4 <br /> Zoning Disttict ,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 /> Approved by the Zoning Department: Date: <br /> REV: MAR 2009 <br />