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01/17/19
CONDITIONAL USE PERMIT
STREET RIGHT-OF-WAY DEDICATION AGREEMENT
LOCATION/ADDRESS:
DATE:
DOCKETED FOR MEETING ON: y! " x '- 22--
� �v�..Mr-
I, a l� do hereby afire / disagree to dedicate to the
public any needed right-of-way as required by the Master Street Pt or a public street abutting property
owned by me adjacen to the pr pA erty requ�sted for a conditional use permit.
_ � V Gt�
I, s� oagr� / disagree to provide at my expense an
easement ee and/or other documents as necessary conveying such right-of-way to the public.
APPLICANT/OWNER 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.)