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APP# (-,jj <br /> S F# /. `12;L-,;Z <br /> Date ���- - C <br /> � (for office use only) <br /> CITY OF PEQUOT LAKES <br /> CONDITIONAL USE APPLICATION <br /> Name of Applicant Z- y6e.1,'i,,,4,-f g-4 i*�6+W Phone "12 t Z°6 57 7<- <br /> Mailing Address P 0,ac,n F-4 2-- Email <br /> City, State,Zip it/'�S s+<.-✓ , ��`lam <br /> Applicant is: Title Holder of Property: <br /> Legal Owner L 4- T uw.�5• "4,-Y,�S <br /> Contract Buyer () (N aA e) <br /> Option Holder () ''I•+'4k <br /> Agent () (A dress) G 3q <br /> Other � <br /> (City,State, Zip) <br /> Signature of Owner,authorizing application (required): 4Z�^ <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: <br /> 5"6 3 6:4— 4k r L r u 13 in,k ` <br /> Parcel ID No. 21(3 l O o zo i o e oo 4 Zoning District 1 �eS cdcw�f�-L <br /> Legal Description (if metes and bounds,attach sheet): Lo T I 0 `3 tom Z- &,6�-' <br /> State�nature of request in detail: (What are you proposing for the property?) <br /> c 12-1�) i;IV Q4!�fC AXF- 141 fe.-c-Pct 4"A <br /> What changes (if any) are you proposing to make to this site? <br /> Building: A-,�4 1�s�,& � 0114-1 <br /> Landscaping: Ae7 .eEd 44.A- z t 49 <br /> Parking/Signs /h rt ,u x f �I�, r l — z- s J S y: y p Sg fT -.j;ACk 3'r CU <br /> 2 REV: MAR 2009 <br />