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Ua/s0i4UU0 IU:2s kAA 21.5 '66 58UU CITY OF FEQUOT LAKES W002 <br /> APP - <br /> Dale. a <br /> ;:�:. - <br /> /', ` � <br /> CITY OF PEQUOT LAKES <br /> COMMON"UE AEW-CATION <br /> Nuae of Apphowt LO "Id <br /> � - <br /> V ( Phone � c <br /> M ffingAddress 9Dl (0 -�Ki �-halcr-D,ir ^„ Emsd We5rl u <br /> City,state,zipbw,Z4 Po 5(y 41 A <br /> Applicant is: 'Tide Holder of Property. <br /> Legal Owner () b <br /> contract Buyer () (N2n <br /> Option Hoklec <br /> Agent () (Address) <br /> Other <br /> (City,State, Grp) <br /> Signature of Owner,authorizingappLcatim(mquttec)_ _ <br /> (by sib the owner is tern ft that they have x"d and the iastructiom ac this appkatioa) <br /> Sigaature of Applicant(if different than owner). <br /> (BT the V is c d2c d >"e read the msmxcdaas aecompmft dis qTfimfioam) <br /> Location of propertlr ivaoked in this r t <br /> { ,---)k- <br /> K c c , <br /> a- <br /> Zoning District c'F f <br /> State nature of request in&,bA (What are you proposing for the property?) <br /> 4th (e- once t? <br /> What changes(if any)am you proposing to make to this site. <br /> Budding: naJ w al <br /> 7_axidsrap�i,�g i'Yl+!1 t` tr�C �J�?�'LL ✓t �p d <br /> Paddrjg/signs: + r Kd G n f owt of 0Af ri--vv _yDwid"l <br /> REV-. JAN 2005,- <br />