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01/17/19
CONDITIONAL USE PERMIT
STREET RIGHT-OF-WAY DEDICATION AGREEMENT
LOCATION/ADDRESS: 2 2, Pa 4 St - '{ , 7Z f
DATE: ? ! s / 2-7-
DOCKETED FOR MEETING ON:
I, If4w tiCypr� do hereby agrc / 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.
I, ✓r y 4-4 �"l ®redisagree to provide at my expense an
easement deed and/or other documents as necessary conveying such right-of-way to the public.
APPLICANTIO W NER DATE ��IS / 0'2
(If the above signature represents an applicant, attachment of a letter is required authorizing this
person to act in behalf of the title-holder.)