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TOWN OF COTTAGE GROVE <br /> Notice of Intent for Change of Land Use <br /> 1. APPLICANT 2. OWNER(if different than Applicant) • <br /> Name: David C. Pappas Name: <br /> Addr.: 1787 Strawberry Road Addr.: <br /> Deerfield, WI <br /> (608) 256-7900 <br /> ZIP: 53531 Phone: (60 8) 764-8458 ZIP: Phone: <br /> 3. LOCATION&DESCRIPTION OF LAND <br /> Parcel No.: 09-12-278. 3 Parcel Size: 5 . 5 Acres <br /> Parcel Addr.: 1787 Strawberry Rd. , Deerfield, WI 53531 <br /> Description: The subject property consists of 5 . 5 Acres- of moods _ <br /> with a residence and separate garage. <br /> 4. ACTION REQUESTED (circle requested change &complete the information.) <br /> �y) <br /> (,7Zone Change from A-1 to A-1 for s, $ acres. <br /> 0 Conditional Use Permit for 5 . 5 acres. <br /> C. Variance to Town Ordinance Number <br /> 5. ADDRESSES OF NEIGHBORING LANDOWNERS (Use additional sheet if needed.) <br /> Name: Gary Chamberlain Name: Harold Dorn <br /> Addr.: 1783 Strawberry Rd. Addr 1796 Strawberry Rd. <br /> Deerfield, WI 53531 Deerfield, WI 53531 <br /> Name: Leslie V. Arndt Name: Daniel G. Lampman <br /> Addr.: 1801 Cottage Grove Rd. Addr.: 4294 Ridge Road <br /> Deerfield, WI 53531 Deerfield, WI 53531 <br /> I hereby certify that the information provided on this notice is true and correct. I understand that failure to <br /> provide all required information shall be grounds for denial of my request. I also certify that no other change <br /> has been requested on this/these parcel(s) in the last twelve(12)months. <br /> -`�_ /— /I' 9.3 Instructions for completion of this form <br /> '�° // Date are on the back of this form. <br />