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01/17/IV
CONDITIONAL USE PERMIT
STREET RIGHT-OF-WAY DEDICATION AGREEMENT
LOCATION/ADDRESS: �sZo .So�s`G� �Ti�ldr�e/S,rl`I
DATE:
DOCKETED FOR MEETING ON:Z-
I, U�t�raA�I .ijn 1le,S�/YI Pn� � D • do hereby �``�' / 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,
easement
It .A"e�s 0 gree / disagree to provide at my expense an
and/or other documents as necessary conveying such right -of --way to the public.
(If the above signature represents an applicant, attachment of a letter is required authorizing this
person to act in behalf of the title-holder.)