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01/17/23
CONDITIONAL USE PERMIT
STREET RIGHT-OF-WAY DEDICATION AGREEMENT
LOCATION/ADDRESS: -3rC! 7
DATE: -fl— 1d
DOCKETED FOR MEETING ON:
I, d„ • _ do hereby agree / isagree to dedicate to the
public any n right-of-way reams quired by the Master 4lrcfor a public street abutting
property owned by me adjacent to the property requested for a conditional use permit.
I, , agree / disagree to provide at my expense an
easement deed and/or other documents as necessary conveying such right-of-way to the public.
4Z�APPLICANTIOWNER DATE --1�7—
(If the above signature represents an applicant, attachment of a letter is required authorizing this
person to act in behalf of the title-holder.)