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APP# " Z/ <br /> Date <br /> (for office use only) <br /> CITY OF PEQUOT LAKES <br /> CONDITIONAL USE APPLICATION <br /> Name of Applicant f 9D - Phone�j A - 93q-1&17'Y <br /> Mailing Address Ld7Q �t�c�bey-�/'y 4/1. Email r'krciso/d <br /> City,State,Zip 12 4 L 4 A S MA) y7 <br /> Applicant is: Title Holder of Property: <br /> Legal Owner 5a n&Q, as Q_h©o e' <br /> Contract Buyer () (Name) <br /> Option Holder () <br /> Agent () (Address') <br /> Other <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 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 /> `.. <br /> Location of Prrro erty involved n this x est: <br /> e k s V 7 <br /> Parcel ID No.':AgOQ� /41®,? � �9 Zoning District � ) <br /> S to nature of request in detail (What are you proposing for the property?) <br /> o eLmzk t.'s Li <br /> r i \ <br /> s 4- in. v <br /> I t-s Far <br /> What changes (if any) are you proposing to make to this site? <br /> Building NO C. . n o <br /> Landscaping. <br /> Parking/Signs <br /> REV: JAN 2005 <br />