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01/17/19
CONDITIONAL USE PERNUT
STREET RIGHT-OF-WAY DEDICATION AGREEMENT
LOCATION/ADDRESS: 2 �- Cori Sri t n DY U l I koCtcl—P 72 Z1
DATE: -7I 1 J 1 2�
DOCKETED FOR MEETING ON:
1,4.. , 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,.` , agree / disagree to provide at my expense an
easement deed and/or other documents as necessary conveying such right-of-way to the public.
APPLICANVOWNERIS DATE-7�52
(If the above signature represents an applicant, attachment of a letter is required authorizing this
person to act in behalf of the title-holder.)