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APP# D.�- %/ <br /> Dater° -ej5 <br /> (for office use ally) <br /> CITY OF PEQUOT LAKES <br /> LAND US PERMIT APPLICATION <br /> Name of Applicant LL4 &,4 Phone SLO% S) <br /> Mailing Address PO Vy-� --1 3(.o Email l'e i oJ'5 ttd5 - <br /> City,State,Zip T-90 U A lit�5 IV I o <br /> Applicant is: Title Holder of property: <br /> s <br /> l egal Owner () )Vn kae ✓ <br /> Contract Buyer () (Name)Option Holder () )po&-t <br /> Agent () (Ad s i t o <br /> Other '��'-,� CQ l-a , I�l ti q Z <br /> (City,State,Zip) <br /> 4 authorizing application(required): e- <br /> (BY wgcring the owner is certifying that they have read and understood the ins )". I %Signature of Applicant(if different than own <br /> (BY s'gni8 the appficant is cer fying that they have read and the instnrctions accowpanying this application.) <br /> Location of property involved in this <br /> request <br /> O <br /> �.. <br /> -12- <br /> Property Parcel ID(#on Tax Statement)_ <br /> Zoning District l! ,Lake Name <br /> State nature of request in detail• (What are you proposing for the property? If a new dwelling,indicate <br /> number of stories and fo dation type.) <br /> Approved by the Zoning Department: Date: <br /> REV: JAN 2005 <br />