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APP# �S(� �-/9 <br /> Date J---�' -G J <br /> (for office use only) <br /> CITY OF PEQUOT LAKES <br /> CONDITIONAL USE APPLICATION <br /> Name of Applicant /�HD E�� �, _✓��- Phone ZI IK-3,57-3 RU-1 <br /> Mailing Address-(9C5`7 �fb9D'�/���G5 �T. F..mail Oc�7Ldb� <br /> City,State,Zip NI SSw>a, Mjy <� <br /> Applicant is: Title Holder of Property: <br /> Legal Owner () V i�,l F Iz:: a Z, -- <br /> Contract Buyer , � <br /> Option Holder () ��4 ��'�-1 <br /> ;Agent () (Ad Tess) <br /> Oder l J 5�+�+'4 j ✓i'j I°-1 j�-� <br /> (City,State, "Zip) <br /> Signature of Owner,authorizing application(required): <br /> (By signing the owner is certifying that they have read and understood d, ,tnietions a.company' is application.) <br /> Signature of Applicant(if different than owner): <br /> (By signing the applicvit is certifying that they have mad and understood the instaictions accompanying this application.) <br /> _ <br /> Location of ropp rty involved in this request: <br /> Parcel ID No. ZZ414(0 fi-M-t5o Zoning District <br /> State natyge of request in detail: (What are.,�ou oposing for die property?) <br /> — --��1' `'tom �t/Sf'i/v � f/ - /.�^ � Y�.s{�,�z�; <br /> � Cyi/ F Jt��lt <br /> What changes(if any)are you proposing to make to tliis site? <br /> Building 1 N5Tf'�t O/ DOOR- <br /> ;gt /N Fa 6^iF JF <br /> Landscaping: 17Av6-1-77,Mt= "6YA6,,r---14 !� 1'9X, VNb <br /> Parking/Signs: (..6/ANL!6 Sid/./ <br /> REV: JAN 2005 <br />