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01117/2019
CASE NO. Z- a L
DATE
DOCKETED FOR MEETING ON
STREET RIGHT-OF-WAY
AGREEMENT
LOCATION/ADDRESS V 10 � � F-cAo
[] [ a2L
I, f , 4r 5 f 1�-► ��r, do hereh agree sagree to dedicate to the public
any needed right-of-way as r quired by the Master Street Plan for a public street abutting property on
which I am requesting Planned Zoning District.
are isagree to provide at my expense an
easement deed and/or other doculnents as necessary conveying such right-of-way to the public.
APPLICANT WNER DATE
(IF THE ABOVE SIGNATURE REPRESENTS AN APPLICANT OTHER THAN THE TITLE
HOLDER, ATTACHMENT OF A LETTER IS REQUIRED AUTHORIZING THIS PERSON TO ACT
IN BEHALF OF THE TITLE-HOLDER.)