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01/17/23
CONDITIONAL USE PERMIT
STREET RIGHT-OF-WAY DEDICATION AGREEMENT
LOCATION/ADDRESS: ' q I c, lam_ 9 -5;PL1
DATE: +Cr-� — Z c)C,`/ r
DOCKETED FOR MEETING ON:
do hate agree disagree to dedicate to the
public any needed right-of-w y as required by the Master Stree an for a public street abutting
property owned 1by me adjacent to the property requested for a conditional use permit.
,(Agz=�4 disagree to provide at my expense an
easement deed and/or other currents as necessary conveying such right-of-way to the public.
APPLICANTIOWNER DATE
(If the above signature rep esents a applicant, attachment of a letter is required authorizing this
person to act in behalf of the title-holder.)