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APP# 6� Duo <br /> Date /3 6 <br /> (for office use only <br /> CITY OF PEQUOT LAKES <br /> CONDITIONAL USE APPLICATION <br /> Name of Applicant Se ra Phone -313 517 03 <br /> Mailing Address N 3 V SR /os 14 A.,e- .t/ Email <br /> City,State,Zip /4o/A,. a-6 rd en N <br /> Applicant is: / Title Holder of Property: <br /> Legal Owner S c, R e t h <br /> Contract Buyer () (Name) <br /> Option Holder () L4-1 y S 3 /e ;A✓E N <br /> Agent () (Address) // p <br /> Other /{a M.n f6 07/1 see 3 f/o <br /> 3,(CiState,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): <br /> (By stgntng the applicant is certifying that they have read and understood the instructions accompanying this application.) <br /> Location of property involved in this request: <br /> I c, _ AIL c d- uy +-lo 4- cs� j,r0,, ,eS k-0 ye-e /l41J,��tn <br /> 0 t <br /> Parcel ID No. IAT GC ("%(;62 IZ- I C� Zoning District <br /> State nature of request in detail:- at are you proposing for the property?) <br /> c;v e3 1 n <br /> e <br /> What changes (if any)are you proposing to make to this site? <br /> Building. cf 0 1z, S OR leo o f- e5 r 6e se i-t r— `'r X -2_12 <br /> Landscaping <br /> 7"c e-e. -+f t.�. J_ ee + y WI►\ L!r,1�'G �`'�►Y ►>c1i' �:, 0 6C C +•i sac <br /> rr <br /> Parldng/Signs: Vu+ b uSEry ss r is n S'►a n- Qn 6f- _<�Vi d(C) l ors.• <br /> REV: JAN 2005 <br />