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'APP# <br /> Date <br /> (for office use only <br /> CITY OF PEQUOT LAKES <br /> LAND USE PERMIT APPLI"hon7M2?6-07?C <br /> Name of A beam •>Y'i s <br /> PP �—� <br /> Mailing Address,?�-" Yz,1,x"t01,AVe— Email <br /> City,State,Zip <br /> Applicant is: Title Holder of Property. <br /> (if not applicant) <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(required): ,z-- <br /> (By sigoing the owner is certifying that they have read and understood accompanying this application.) <br /> Signature of Applicant(if different than owner): <br /> (By signing the ap*sm is certifying that they have read and understood the msti�accompanying this application.) <br /> Location of property volved in this request: <br /> SL 31, L <br /> Property Parcel ID (#on Tax Statement) 1 <br /> Zoning District oS /C ,Lake Name —(el, <br /> State nature of request in detail: (What are you proposing for the property? If a new dwelling,indicate <br /> n ber of stories and foundation type.) / <br /> Ar+� a 1 S r I r c:, o r 4L4 <br /> Z4al 120CX--r x*— 5tckr&kj <br /> tier �^,�S b re✓iu o c , ter• /s c> <br /> r a ti eL <br /> Orr- U S cO f knd vr,q <br /> MYo t v o <br /> Approved by the Zoning Depm1ment, �C� 17-) Date: -17- 6 7 <br /> REV: JAN 2006 <br />