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• //6"/ ' / <br /> TOWN OF VERONA <br /> APPLICATION FOR LAND.USE CHANGE 7/7 76 <br /> Please review the Town of Verona Comprehensive Land Use Plan and Subdivision and Development Ordinance 05-04 <br /> (found on the Town website: www.town.verona.wi.us)and Dane County Ordinances Chapter 10-Zoning, Chapter 11 — <br /> Shore land, Shorland-Wetland and Inland-Wetland Regulations and Chapter 75—Land Division and Subdivision <br /> Regulations prior to application. <br /> APPLICATION IS MADE to the Town of Verona Board for a land use change for: <br /> Property address/legal description <br /> • <br /> Please check all that apply: <br /> ❑ comprehensive plan amendment • <br /> 7(rezone petition <br /> current zoning category — f • <br /> new zoning category requested z <br /> ❑ conditional use permit <br /> conditional use requested • <br /> ❑ certified survey map • <br /> ❑ preliminary plat <br /> ❑ final certified survey map <br /> ❑ concept plan <br /> ❑ site plan <br /> ❑ request for Town road ces a <br /> :1" Property Owner: 1 G '�' : <br /> Phone# (0(3 2 -� S <br /> Address: (0 S -[ 3 j-t°Sbl * E-Mail I tR i�– l - Co)t✓ <br /> Applicant: Owner Agent )c <br /> Applicant's Phone# 668--a,/a—/36'6" CCU!/) E-Mail SCO/V-turfy i'agn at/Olt), <br /> If the applicant is different from property owner,please include documentation authorizing application on behalf of property owner <br /> •I hereb authorize, 5:Orr/1 e'rre ov n <br /> to act a -g- t n t e ap. g ation process for the abov dicated land use change. <br /> /a.i6— <br /> Signa - e Date <br /> • <br /> Description of Land Use Change requested:(use reverse side if additional space is needed) <br /> • <br /> • <br /> • <br /> I certify that all .. ••� �..,.:. ,.�,:_• .nderstand that failure to provide all required Information will be.ALgunds for denial of my request <br /> Jar /6 <br /> Applicant Signature` Date <br /> Print Name 4, C•6).4, C•6). /(/f A'CPW�1 ,1 <br /> ( <br /> • <br /> RETURN COMPLETED APPLICATION PRE-APPLICATION MEETING:.. <br /> AND.12 COPIES OF MAP/PLAN TO: <br /> Amanda Arnold, Planner/Administrator A pre application meeting or initial review.may <br /> • Town of Verona be scheduled with Town Staff and/or Plan <br /> 335 N. Nine Mound Rd Commission Chair <br /> Verona.WI 53593-1035 608-845-7187/608-845-7143 Fax <br /> • <br />