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01/17/19
CONDITIONAL USE PERMIT
STREET RIGHT-OF-WAY DEDICATION AGREEMENT
LOCATION/ADDRESS:_ �_ Z 3_ 1'r u a 1a) V J
DATE: f�.. 'r (o a Z- (�
DOCKETED FOR MEETING ON:
I, 4 To- a, PAT , do hereby e::e> 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,/-.- -m Do VAAf -�► gre / disagree to provide at my expense an
easement deed and/or other documents as necessary co-nVeTing such right-of-way to the public.
APPLICANTIOWNER Z DATE A 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.)