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CONDITIONAL USE PERMIT
STREET RIGHT-OF-WAY DEDICATION AGREEMENT
LOCATION/ADDRESS:(
DATE:
DOCKETED FOR MEETING ON:
I, PAd IC , do hereby agree / disagree to dedicate to the
public any needed righ -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, 1 �0 $e CL LA& C fL C , agree / disagree to provide at my expense an
documents easement deed an or other as necessary conveying such right-of-way to the public.
APPLICANTIOWNSR ��v 4, ' DATE I2-'n-2-0
(If the above signature represents an applicant, attachment of a letter is required authorizing this
person to act in behalf of the title-holder.)