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APP# <br /> Date('=;� , -<1 <br /> (for office use only) <br /> CITY OF PEQUOT LAKES <br /> �jj %71 S <br /> CONDITIONAL USE APPLICATIO <br /> AL N <br /> Name of Applicant Phone 21ol-Z-7 Cf'77 <br /> Mailing Address fo7. ,6ZIAI II All fl Emil llK� Q�/1�+9t%1c A�✓1,VyGf�yPCE %'1 <br /> City,State,Zip keyuo 'lea- y ^V 5z v7 z- <br /> Applicant is TItlF Holder of Property: <br /> Legal Owner jt 46-- Ch%r1t'1 'cS '1 � <br /> Contract Buyer () (Nam <br /> Option Holder O �„�rV[!, / ,e.,0 � <br /> A nt <br /> ge ddress <br /> Other A-SU&-Z4-ta- /OA/12W,72- <br /> (City,State,Zip) <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)qandferstood V!�`��•'�`�•� <br /> (By stgniog the applicant is certifying that they have mad the ins 'ons accompanying this application.) <br /> Location of property involved in this e t: <br /> Parcel ID No. ;N'913,11MM 2 Zoning District_4 P, <br /> . <br /> State nature of request in detail: (What are yqu proposing for the property?) <br /> What changes(if any)are you proposing to make to this site? <br /> Building 1VA41E <br /> Landscaping. &&-- <br /> Parking/Signs: L_ C%�S'�l,,�'5 � `7tlJf�/t D/✓ t S/�;� <br /> REV: JAN 2005 <br />