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TOWN OF MAZOMANIE <br /> NOTICE OF INTENT TO REQUEST A ZONING CHANGE <br /> NAME: , j <br /> ADDRESS: OS- . / . i/ irr �. ; a, ' ' 16 <br /> PHONE: 60cp-- )9 V69:2 (Box vt 6e <br /> 1. PURPOSE: <br /> 2'0n a Q/l Cpl of Ga4cic <br /> 2. LEGAL DES pN �f `l0/Yr�° on . <br /> OF PAR IN QUESTION: <br /> l/ Oc10b aBa 8010 .2. oLD 0 /7 ..ag- 52.9. I <br /> 3: ATTACH: (A) Map or sketch of parcel to scale <br /> (B) Land dimensions toe cti;qh /.t- l v w i le /7.�q0 <br /> (C) Location of structures 5p�_ ZdC,wo en, <br /> 4. TYPE OF ACTION tz�� ��`�`��G�-'�zcG cry` <br /> ` STED I.E., ZONING REQUE T, O L(.7 w . <br /> f-ki o 6 �t - ( 4 ic( C 1cz <br /> 5. MISCELLANEOUS INFORMATION: <br /> I (We) agree to proceed in accordance with the Town's ordinances and plans. <br /> Date: L1- 'IL__ Signed <br /> Date Filed: '- 1 <br /> Town Clerk <br /> Plan Committee Action: Date: <br /> Board Action: <br /> Date: <br /> Manual Received: Manual Returned: <br /> A refundable deposit of$10.00 is required for land use plan manual. <br /> Revised 1/93 <br /> A-5 <br />