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APP# O,°- <br /> Date /)-OS' <br /> DWSMA�CZZ - <br /> (for office se only) <br /> CITY OF PEQUOT LAKES <br /> LAND USE PERMIT APPLICATION <br /> Name of Applicant �lAirt� y.4B .cs Phone <br /> Mailing Address 3 ' t C1 E t f`'" E.0 <br /> City,State,Zipe f c cv�- f�✓" !" ��'rjL/ Z-- <br /> Applicant is: Title Holder of Property: <br /> (if not applicant) <br /> Legal Owner l.i�Ai,01, G- %Stu'r <br /> Contract Buyer () (Name) / <br /> Option Holder () _MRS ShAFFEA-,s - t--'jV' PO4 <br /> Agent g () ( ddress) <br /> Other if kr- $4oi+�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 the instructions 6c mpanying this applica <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 /> Property Parcel ID (#on Tax Statement) <br /> Zoning District )�?1 L _ ,Lake Name A, <br /> State nature of request in detail: (What are you proposing for the property? If a new dwelling,indicate <br /> number of stories and foundation type.) <br /> 1A p'V� fig u .e 1C STi� o <br /> � �J , c vtZ acs/ LIZ 8 12 0 Lt rw PS 0-1� <br /> SZ-f'-2__t-2 �,,,,c�% i y►fir 1 c C oL t� <br /> Approved by the Zoning Department: Date: <br /> REV: DEC 2007 <br />