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APP# <br /> Date <br /> (for otfioe use only) <br /> CITY OF PEQUOT LAKES <br /> tSUBIDMSION/RE MPINGAPPLICATION <br /> Name o£Applicant� e ,., A-6 C cAt eia Phone 08— 8?8'-YV OI <br /> Mailing Address yi a����kf l i,e� _ Ema�1 @ Ave— cc,,,J f <br /> City,State,Zip 4,'� r-. . AW SeyZ.ST <br /> Applicant is: Title Holder of Property: <br /> Legal owner Sc u c �=,�.�7t �✓r� e <br /> Contract Buyer {) (Name) <br /> Option Holder <br /> Agent {) (Address) Q K � /nA) S7o Y Z.S— <br /> other <br /> Signature of Owner,authorizing application:L, M <br /> (By aignmg the owner is certifying that they have mad and understood the instructions accompanying this application.) <br /> Signature of Applicant(f different than owner): <br /> (By sigmiag the applicant is certifying that they have read and understood the instructions accompanying this application.) <br /> Location of properly involved in this request <br /> T <br /> Fite No. ,Parcel ID No., A 9'0IS-j`30eZW oning Dist dct <br /> Nature of request(select only one): o!O/Sy yaocoosbP <br /> Preliminary Platen 49004P <br /> Final plat ( ) <br /> Metes and Bounds ( ) <br /> Rezoning ( ) <br /> Note: Applicants may apply for Preliminary Plat and Final Plat at the same time,but they must <br /> be on separate applications. Prelimiaaty Plat and Final Plat hearings will not be held at the <br /> scone meeting Effective date of Final Plat application will be the date of Preliminary Plat <br /> approval. <br /> REV:JAN 2005 <br />