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TOWN OF COTTAGE GROVE <br /> NOTICE OF INTENT FOR CHANGE OF LAND USE <br /> (Instructions for completion of this form are listed on reverse side) <br /> 1. APPLICANT 2. LANDOWNER <br /> Name• Mark Dupre Name: County of Dane. Attn: Gaylord Plummer <br /> Address.: 3190 County N Adkvm: Bnom 425 <br /> Cottage Grove, WI City-County Building, Madison, WI <br /> ZW: 53527 Phone: (608) 839-8555 ZW:53709 PSaoe: (608) 266-4172 <br /> 3. LOCATION&DESCRIPTION OF LAND <br /> per}No,: 09-0711-334-90002-2 pst+od Size: One Acre <br /> PmodAddrea: 3190 County N, Cottage Grave. WI <br /> Dom: See Attached Exhibit A <br /> 4. ACTION REQUESTED <br /> IA] Variance from Town Ordinance No. <br /> [Bl Zone Change harm P-1 (f l.) to C-1 for_ One (1 ) saes <br /> fCJ awaked Use P+eemit for am= Zaoed <br /> [D) Sue Approval for <br /> * This is a resubmission of a prior notice (see attached explanation) • <br /> S. trammmusE Petitioner owns land located directly west of and,adj acent to <br /> subject land. Petitioner intends to expand his current septic field on to part <br /> of subject land, which land petitioner is purchasing fran Dane County. <br /> 6. NAILES IL ADDRESSES OF ADJOINING IL ADIACE:NT LANDOWNERS <br /> [me addidiosd meet.if•_r1 <br /> Nam Timothy Connery Nms= County of Dane <br /> Ad 3702 Crestview Drive Adam= Roan 425 <br /> Cottage Grove, WI 53527 City-County Building, Madison, WI 53709 <br /> Nam Helen Link _ Nam= Loraine Jermstad <br /> Address: 3196 County N Adams= 3136 County N <br /> Cottage Grove, WI 53527 Cottage Grove, WI 53527 <br /> 1 haehr =it' d= tare iaforaraaon prurided on this smile:filon is are am come= 1 mdat>,sad that fi'i <br /> o pruiide ail required adatmman WWI be grounds for denial of this raw= I Rather certify that no otber ewe <br /> of land use has been rapeseed for thisttbae paMsl wbbia the/ 12 nraedts. <br /> 3664. c <br /> ow._ D0a■A, <br /> ii►► 5-S'n <br /> Applicant Signature �p Da .•1! ? Signature Signare Date <br /> (R5-94] r.-+ ' T ek ick., • <br />