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01/17/19
CONDITIONAL USE PERMIT
STREET RIGHT-OF-WAY DEDICATION AGREEMENT
LOCATI
DATE:
DOCKETED FOR MEETING ON:
c�
�� , do hereby(a ee / disagree to dedicate to the
public any neede ght-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.
I, (�kA "R \ gree / disagree to provide at my expense an
easement deed a r other documents as necessary conveying such right-of-way to the public.
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APPLICANT/OWNE 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.)