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VAw Q 0,A%- wl 5-+c6 Ate r �`-t- <br /> " oµ�u be , yvt^n rA I L-' A P P# <br /> � <br /> RECEIVED C; T, 0 1 2012 SF# <br /> Date <br /> CITY OF PEQUOT LAKES DWSMA <br /> LAND USE PERMIT APPLICATION For office use only <br /> Name of Applicant 1(-r, 6 o 5G44 e F- (4om o S Phone (o);- y)+" ss-o 5 <br /> Mailing Address 253-0 /J, ,SOe►,L ,Sc Email A 13,DSC-We (&Cz,,AcA5s <br /> City,State,Zip )<0 SZV,'�L e, M�, 5Si 13 3) 145 <br /> Applicant is: Title Holder of Property: �rj t3©S C i4C <br /> A0-5(-i4zL not applicant) <br /> Legal Owner () rAM�� <br /> Contract Buyer O (Name) n <br /> Option Holder () 9 77 �AIJI J U ew ord v-p— <br /> Agent () (Address <br /> Other e�evLr„ ('exs ru.c c fL /1 /�I L r�, 11603 aZ <br /> (City,State,Zip) <br /> Signature of Owner,authorizing application(required): V4�E <br /> (B signing the ov4ier is certifying that they have read and understood the instructions accompanying this application.) <br /> VZSignature OrAp tnntdiffi*ent than owner): <br /> (By signing the applicant is certifying that they have read and understoo the instructions accompanying this application) <br /> Location of property involved in this request: <br /> ,�73 a In We-5 lW nl �Aite- Jrz yE <br /> Pe-3u o- zA Ice s , M!y S�'�7� <br /> Property Parcel ID (#on Tax Statement) 2 Ci 12, 0 0 0 0 A CC) <br /> �1 <br /> Zoning District ,Lake Name Ul fs 5 1 wl <br /> State nature of request in detail: (What are you proposing for the property? If anew dwelling,indicate <br /> number of stories and foundati n type.) <br /> a 7( '9`I s 1 ' AJA---r'+0-12 - CE1.�ss T 11 X9`7'0 0� e� ;s T pug s_,� <br /> ��2 pr �acWN D ��5 -Z rJ )c-+4-' ;` Fou-,o.4 turd `7*'y0e d- <br /> tz o d+ N g- O.—t- <br /> Approved by the Zoning Department: Date: <br /> REV: MAR 2009 <br />