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APP#67- 7 <br /> (for office use cnW <br /> CITY OF PEQUOT LASES <br /> CONDITIONAL-USE APPLICATION <br /> Name of Applicant �--�' a►^" . Qo. fS . LLS. Phone <br /> Mailing Address ?0 k x EmaII �ti�i..c�v�(c� /w QSo v"Q- ro c* <br /> G�SVt <br /> City,State,Zip TZ:.c;vmod-- L s_ 1111Y 50472, <br /> Applicant is: Title Holder of Property: <br /> Legal owner <br /> Contract Buyer () (Name) <br /> Option Holder () <br /> Agent () (Address) <br /> Other <br /> (City,State,Zip)�. <br /> Signature of Owner,authorizing application r C- --� <br /> (By ssgmng the owner is certifying that they have read and understood the instmctions 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 instnxaons accompanying this application.) <br /> `.. Location of roperty involved in this request <br /> Parcel ID No. ,-;;�&,fk-,, 1 T�� ���� / Zoning District �--1 <br /> State nature of request in detail: (That are you proposing for the property?) <br /> v.re. bv,Ic� G� ,w.� 3 O�co It <br /> What changes (if any)are you proposing to make to this site? <br /> Building: 30,000 FF� CgC7 3q x 1 ` s�rtww�� <br /> Landscaping. w y ri w� i.,C.A CL-A i� <br /> Parldng/Signs: #10 i�l o►'�. Sc <br /> REV: JAN 2005 <br />