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APP# � <br /> Date <br /> (for office use only) <br /> `— CITY OF PEQUOT LAKES <br /> CONDITIONAL USE APPLICATION <br /> Name of Applicant ^� �e-2 <br /> Mailing Address c 619 O NV G Email <br /> c� <br /> City,State,Zip 07S- <br /> Applicant <br /> Applicant is: Title Holder of Property: <br /> Legal Owner 30"'4 boee.� <br /> Contract Buyer () (Name) <br /> Option Holder r Z7 4"Z-3 Csr RA. 10-4 <br /> Agent () (Address) <br /> Other r'kdr 1 ,"i <br /> (City,State, Zip) <br /> Signature of Owner,authorizing application (required): L 1 C <br /> (By signing the owner is certifying that they have read and understo the struc' s mp this a ' a on) <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 property involved in this request: <br /> Parcel ID No. Zoning District <br /> State nature of request in detail: (What are you proposing for the property?) <br /> 2a., i^a,r,,- L--:,.-&LA_ `f--- �-k_f r e Ce 2� 4 T�V' <br /> What changes (if any)are you proposing to make to this site? <br /> Building. <br /> Landscaping. Aro 5��. , ���Qr o�4:)r <br /> Parking/Signs: <br /> REV: JAN 2005 <br />