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01/17/23
CONDITIONAL USE PERMIT
STREET RIGHT-OF-WAY DEDICATION AGREEMENT
LOCATION/ADDRESS:
DATE:
DOCKETED FOR MEETING ON:
1, do hereby agree disagree to dedicate to the,
pub is any needed right-of-way as required by the Master Stree lan for a public street abutting
property owned by me adjacent to the property requested for a conditional use permit.
1, agree / disagree to provide at my expense an
easement deed and/or other documents as necessary co ying such right-of-way to the public.
APPLICANT/OWNER DATE _. 4
(If the above signature represents an applicant, attachment of a letter is required authorizing this
person to act in behalf of the title-holder.)