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01/17/19
CONDITIONAL USE PERMIT
STREET RIGHT-OF
n-WAY DEDICATION AGREEMENT
LOCATION/ADDRESS: `Ll f `l 1� I �a
DATE: ` I 17 W I I
DOCKETED FOR MEETING ON:
1, , do hereby agree / disagree to dedicate to the
public any needed right-of-way as required by the Master Street Plan for a public street abutting property
owned by me adjacent to the property requested for a conditional use permit.
1, , agree / disagree to provide at my expense an
easement deed and/or other documents as necessary conveying such right-of-way to the public.
APPLICANTIOWNER _ DATE
(If the above signature represents an applicant, attachment of a letter is required authorizing this
person to act in behalf of the title-holder.)