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DANE COUNTY Zoning Division <br /> PLANNING DEVELOPMENT Room 116, City-County Building <br /> 210 Martin Luther King Jr. Blvd. <br /> Madison,Wisconsin 53703-3342 Zoning Change Application Phone: (608) 266-4266 <br /> Fax: (608) 267-1540 <br /> I I <br /> Items that must be submitted with your application: <br /> o Written Legal Description of the proposed Zoning Boundaries <br /> Legal description of the land that is proposed to be changed. The description may be a lot in a plat, <br /> Certified Survey Map,or an exact metes and bounds description. A separate legal description is <br /> required for each zoning district proposed. The description shall include the area in acres or square <br /> feet. <br /> o Scaled Drawing of the location of the proposed Zoning Boundaries <br /> The drawing shall include the existing and proposed zoning boundaries of the property.All existing <br /> buildings shall be shown on the drawing. The drawing shall include�thee area in acres oor square feet. <br /> Owner's Name Ql„ (�Q 1 t�, f oat �` Agent's Name 0_1)14' of <br /> 1 ►`I( k <br /> '` `-off �l <br /> Address ■3 i3 l499,1C t rr RC/ Address 3 f e. E ri <br /> Phone 2 r1401I .L) S <br /> 3S'3/ Phone C(ge ?LOA) �/ <br /> (Q 0� 398 <br /> b - 0290 - S=.8 <br /> Email Email <br /> ZQ z7 f-ucti ts) •��oo. co <br /> Town- 4(81 0 n Parcel numbers affected: 057 7 cP 13 ( Stec) l <br /> Section: 01 Property address or location: /03 6 (n 9 40 1x14 l2C/ ecJ f/c iU C< <br /> Zoning District change: (To/From/#of acres) 'R- t j 4 �EX I a- g <br /> Soil classifications of area (percentages) Class I soils: % Class II soils: % Other:_ % <br /> Narrative: (reason for change, intended land use, size of farm, time schedule) <br /> Separation of buildings from farmland <br /> O Creation of a residential lot <br /> O Compliance for existing structures and/or land uses <br /> O Other: <br /> II <br /> I authorize that I am the owe r or have pe s on to act o behalf of the owner of the property. 4— /4/ c <br /> Submitted By: / Date: [ ` 7 <br />