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TOWN OF COTTAGE GROVE <br /> Notice of Intent for Change of Land Use <br /> 1. APPLICANT 2 . OWNER (if diff. the Applicant) <br /> Walter J. Olson, Agent For: DonaldE. & Ruth H. Schimelpfonig <br /> Name Name <br /> Addr. 217 North Main St Addr. 4090 Oak Park Road <br /> Deerfield, Wisconsi 53531 Deerfield, Wisconsin 53531 <br /> ZIP 53531 Phone 764-5564 ZIP53531 Phone 754-5°93 <br /> 3 . DESCRIPTION AND LOCATION OF LAND <br /> 9-0711-241- ,�e n acres • <br /> Parcel No. -9 - Je n Parcel Size 3 :7 acres <br /> Parcel Addr. Deerfield Road & Sheimelpfenig and N. Jargo and one unnamed Tn Rd. <br /> Description S. 1/2, SE 4, NE'.., Ecx pt N. of Deerfield Rd & Exc. pt. CSM 3974 <br /> N?J',;,SE ,, Exc. pt CSM 3974 <br /> SW ,,NE4 Exc. pt CSM 3974 all three are inSect 24,T7N, R11E <br /> 4 . ACTION REQUESTED (Circle requested change and complete line. ) <br /> a. Zone Change from Ex Ag to Rh-2 and Rh-4 for 92.4 acres. <br /> b. Conditional Use Permit for acres. <br /> c. Variance to Town Ordinance # <br /> d. Other (desc. ) <br /> 5. ADDRESSES OF NEIGHBORING LANDOWNERS <br /> Name Richard Kapral Name Vernon Krueger <br /> Addr. 1629 N. Jargo Rd Addr. Rt. 1, Susan Lane <br /> Cottage Grove, Wis Cottage Grove, Wisc 53527 <br /> Name Daniel f3ruenig Name James Valeria <br /> Addr. 152 Union St Addr. 1600 Susan Lane <br /> Sun Praire, Wisc Cottage Grove, WI <br /> 6. Please attach a sketch or map of the parcel showing existing and <br /> proposed structures, existing and proposed roadbeds, tillable land, <br /> sewage disposal systems, and description of proposed land use. <br /> 7 . The Town will notify surrounding landowners of the requested land use <br /> change. Your request for change will NOT be considered until this form <br /> is satisfactorily completed. <br /> 8 . A fee of $20. 0 / must . company each application. <br /> /.! I •//7 37V/s/ <br /> Signed: 1p , �j Signed: <br /> 1App ica / Date Town Clerk <br />