Laserfiche WebLink
APP# .3 <br /> Date <br /> DWSMA WO <br /> (for office use only) <br /> CITY OF PEQUOT LADS <br /> LAND USE PERMIT APPLICATION <br /> l > E2F-Name of Applicant P�K�i+��/V t/G��/ Phone ko(� <br /> Mailing Address -7666 15 <br /> City,State,Zip <br /> r <br /> Applicant is: Title Holder of Property: <br /> mmdd"applicpt) <br /> Legal Owner `( L Le <br /> Contract Buyer () (N�e)a� <br /> Option Holder f4 <br /> Agent () (A r ass <br /> Other "/� <br /> (Ci State,Zip) <br /> Signature of Owner,authorizing application(require <br /> (By signing the owner is certifying that they have read and understood the instruc ons acco ying 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 roe involved in re uest: <br /> !6Sr 7 �7�r "r� . q <br /> Property Parcel ID (# on Tax Statement), 9 11-13 6613 C'�� 6,�,4O ` <br /> Zoning District /1 ,Lake Name / !q <br /> State nature of request in detail: (What are you proposing for the property? If a new dwelling,indicate <br /> ber of storiespd undation type.) <br /> ,Lim JC. 37� T cif" �i <br /> ' , , f <br /> sr ( <br /> �- <br /> G per; <br /> Approved by the Zoning Department` C F' id P �� Date: <br /> REV: DEC 2007 <br />