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APP# O, <br /> Date % - e <br /> (far office use onld <br /> CITY OF PEQUOT LASES <br /> CONDITIONAL USE APPLICATION <br /> Name of Applicant A r 4 14'-QCC NU T Phone 933- 77--79 <br /> Mailing Address Email rncd G r' /,;4 . ,-1,4 <br /> City,State,Zip t X r�-e auk <br /> Applicant is: Title Holder of Property: <br /> Legal Owner (� SAM:-- <br /> Contract Buyer () (Name) <br /> Option Holder () <br /> Agent () (Address) <br /> Other <br /> (City, , <br /> Signature of Owner,authorizing application(required): P6 <br /> (By signing the owner is certifying that they have read and underst Instructions accompanying this application.) <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 prop involved in this request: <br /> 417 erty GJa S �i Lo T- y f eumC s-r AbbI i,Dj To &aA-S <br /> P v T QF P46&k t <br /> Ci t .i 00 q oo 3 ato-1 <br /> Parcel ID No. -Z9 t d s pG tl pot j 0W j Zoning District <br /> State nature of request in detail:- (What are you proposing for the property?) <br /> &P A- c AVS oc KIITt.► -9,46LA L4 Jr'L ►�ay ZL ��.�rC <br /> J 1 4.12,-4 Frj s inJC, �.�1�f+'70.J —r�� 8C<T Q J Dc �E,ttSTi.71 <br /> What changes (if any) are you proposing to make to this site? <br /> Building. &PLAZVE /&JSS C IW ti-M 710,3 01-0;* G��icf <br /> Landscaping. REP -46- FriSr,,&& LA.)b5CALA JC' c'�,4 /5 C6.y,�'C <br /> Parking/Signs: io-464i Di jEt: 6A •�•:�iJ�F <br /> �t.Cd�3c>7 <br /> REV: JAN 2005 <br />