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01/17/23
CONDITIONAL USE PERMIT
STREET RIGHT-OF-WAY DEDICATION AGREEMENT
(� �4 F
LOCATION/ADDRESS'.-r [6L y
DATE: U I` a_. I A O�A5
DOCKETED FOR MEETING ON: VD ba
I, 6� Z(Ja C h 5 GYl do hereby 6;)/ disagree to dedicate to the
public any 6eided 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, (� oe / disagree to provide at my expense an
easement dgkd and/or other documents as necessary conveying such right-of-way to the public.
APPLICANT/OWNER -AT-W LC ' DATE 2 ) �' , 5
V
(If the above signature represents an applicant, attachment of a letter is required authorizing this
person to act in behalf of the title-holder.)