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APP# <br /> Date <br /> (for office use only) <br /> CITY OF PEQUOT LAKES <br /> CONDITIONAL USE APPLICATION <br /> Name of Applicant c�/ �D r�:^. /C i� Phone 39 0 — (v 0 Y <br /> Mailing Address �� o� ��yt A t!z Email E'c�i�Q i � �n Is Uj t'-C� leSS""C'oM <br /> City,State,Zip f. ► I c; /'r, II C f d. Sl'. </s <br /> Applicant is: Tide Holder of Property: <br /> Legal Owner () t ti, <br /> Contract Buyer O (Name) 7`h <br /> Option Holder () C?aC) <br /> Agent (t�� (Address r��//� <br /> Other !- <br /> (City,State,Zip) <br /> Signature of Owner,authorizing application(required): <br /> (By signing the owner is certifying that they have read and unders o e instructions accompanying this application) <br /> Signature of Applicant(f different than owner): <br /> (By signing the applicant is certifying that they have read and understood the instructions accompan" g this application.) <br /> Location of property involved in this request: <br /> �.. c . <br /> P � L�/ 1�P7f/l'nLon gDistrict� <br /> Fire No. arccl ID No <br /> State nature of request in detail: (What are you proposing for the property?) <br /> e- n <br /> r <br /> What changes(f any)are you proposing to make to this site? <br /> Building: <br /> Landscaping: <br /> Parking Silms: <br /> REV:JAN 2005 <br />