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01 /17119
STREET RIGHT-OF-WAY
AGREEMENT
CASE NO.Z- LOCATiONJADDRESS aa5t Capi4 I Avo
DATE
DOCKETED FOR MERUNG ON *Ai ntt. C `z , ZG 2
I, T'ar ).4 =-�� , da hereby � disagree to dedicate to the public
any needed right -of --way as required by the Master Street Plan far a public street abutting property on
which I am requesting zoning.
.I P . v , (OJdisagree to provide at my expense an
easement deed and/or other documents as necessary conveying such right-of-way to the public.
(IE THE ABOVE SIGNATURE REPRESENTS AN APPLICAIiT OTHER THAN TI-IEr TITLE-
HOLDER, ATTACHMENT OF A LETTER IS REQUIRED AUTHORIZING THIS PERSON TO ACT
IN BEHALF OF THE TITLE-HOLDER.)