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01/17/19
CONDITIONAL USE PERMIT
STREET RIGHT-OF-WAY DEDICATION AGREEMENT
LOCATION/ADDRESS: !oo�
DATE:
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.
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APPLICANT/OWNER-
DATE
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(If the above signature represents an applicant, attachment of a letter is required authorizing this
person to act in behalf of the title-holder.)