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01/17/23
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USE PERMIT
STREET RIGHT-OF-WAY DEDICATION AGREEMENT
LOCATION/ADDRESS: 70 f A e W ? J/
DATE: r— V-2 q
DOCKETED FOR MEETING ON:
I, ( r ( f �U 11 _ , do hereby a �r / 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, ( r e— 0 4o 6)4 -0 agre disagree to provide at my expense an
easement deed and/or other documents as necessary co ing such right -of --way to the public.
�SYV 2! Z'
APPLICANT/OWNER - DATE_ _
(If the above signature represents an applicant, attachment of a letter is required authorizing this
person to actin behalf of the title-holder.)