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01/17/19
CONDITIONAL, USE PERMIT
STREET RIGHT-OF-WAY DEDICATION AGREEMENT
T.nC.ATTnN/ADDRRSS- 12 6 0 5, C. le ,? fA,J 177 L OI X
DATE: i Z /1G�0 2d22
DOCKETED FOR MEETING ON: � & e,
i, W , 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.
I, �1.4f " A 4h/ , agree / disagree to provide at my expense an
easement deed atid/or other documents as necessary conveying such light -of -way to the public.
APPLICANTIOWNE DATE I �GTG i
(If the above signature represen �san applicant, attachment of a letter is required authorizing this
person to act in behalf of the title-holder.)