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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 /> Name Km4,.m L . spUIJT�-e Name . 61.1 AAA) 0.4t.mELP FEl ( <br /> Addr. .512J 0 L 6,/i, fE hD • Addr. P_OU I - Li 0q0 Cy*. .P JJ,' <br /> TA1)0oA 1 km- T E-R \t U) I Wt <br /> i <br /> ZIP 537O'1 Phone ( off) 24a- II $-1 ZIP 5353) Phone (6/00 7694--- 509 3 <br /> lUok.+< 04020 `.L:.,/ --114, <br /> 3 . DESCRIPTION AND LOCATION OF LAND <br /> Parcel No. O./11 (9 'II- q(p`jO- o Parcel Size 1'7• .l A 5 <br /> Parcel Addr. DEL VC-10A) !?O/A () 0(Z �Ct-+►►'vtl��L1)Cum) ,, ion <br /> Description lL of SE Ala Cr NE f4- E>ctt`-pi Per ED 11644 wh`l <br /> 4 . ACTION REQUESTED (Circle requested change and complete line. ) <br /> Zone Change from 6(C . 144- to AN-2- for I q• P.. 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 .j r ' 4ALI✓12I A Name C\ 4 6 OP QA't <br /> Addr. /(v00 .USAT) LI4JE Addr. )V19 M , •IMC6O 12of i) <br /> E 2FteLl A ei) <br /> Name VEktoM 6ZUE6Ee_- Name ) 4 ( x{50 M <br /> Addr. )19w1 `yt,Al, 1- Addr. VI f1 • .9\12-1,0 P .0 <br /> T 4 t_ VC 3lTl <br /> I(at 1 L-ArJC, DEI VE==tLL,l) <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. 00 must accompany each application. <br /> Signed: Wt -� • Cipil' (0-19-9) Signed: <br /> Applicant , Date Town Clerk <br />