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APP# <br /> Date /C'/E -r <br /> (for office use only) <br /> CITY OF PEQUOT LASES <br /> CONDITIONAL USE APPLICATION <br /> Name of Applicant 21 6s n n c. Phone 9Sa-aqY-D 55 3 <br /> Mailing Address 15126 &A n+4 l D 1 . 5t.+1 k 102 Email PA.U19,904 <br /> City,State,Zip M,,7 11 rh�kre sY1 d <br /> Applicant is: Tide Holder of Property: <br /> Legal Owner () 1U,m toe 4j' a 7em �lri0y/S ��D�r t <br /> Contract Buyer (Name) <br /> Option Holder () <br /> () (Address) <br /> Agent <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 understood the coons accompanying this application.) <br /> Signatute of Applicant(if different than.owner): <br /> (By signing the applicant is certifying that they have lead and underst the'instnxtions accompanying this application) <br /> Location of property involved in this re <br /> qu <br /> 37j I-A�- ors-J�lO• oD�- 08�� <br /> Parcel ID No.a 9-0/5- J VO- W 4-0tr3 Zoning District <br /> 29- cjS---11O•-C40-Corr <br /> State nature of request in detail:- (What are you proposing for the property?) <br /> What changes (if any)are you proposing to make to this site? <br /> Building. �e r, <br /> Landscaping. <br /> Parking/Signs: <br /> REV: JAN 2005 <br /> I <br />