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01/17/23
CONDITIONAL USE PERMIT
STREET RIGHT-OF-WAY DEDICATION AGREEMENT
LOCATION/ADDRESS:
DATE:
- 3 - & v
r)nCKFTFI) FOR MEETING ON:
9
T_ Mw tik f4+ do hereby agr / disagree to dedicate to the
public any needed right-of-way as required by the an 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/o o her documents as necessary ng such right-of-way to the public.
C
APPLICANT/OWNS 01t 4 _ DATE `
(If the above signature represents an applicant, attachment of a letter is required authorizing this
person to act in behalf of the title-holder.)