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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 ;5'2je ;L/1"21:1.--- Name <br /> Addr. /J lL%7'7- Ctl°c',/..--,f- Addr. <br /> %dad/f Ze is <br /> ZIP 11'7,0-Phone 25:1,-/7 ,Z Fz_ ZIP Phone <br /> 3 . DESCRIPTION <br /> 'pAND LOCATION OF LAND <br /> /l - ' -� -� <br /> Parcel No. ��- , � Parcel Size �{ ��_ii-ee; <br /> `4� <br /> 5q7,21-522.2 09-142380837837 SCHOOL 3675 <br /> 0711-212-8340-G SEW FR 0TH <br /> G9 EDNA E & MILO W LOT <br /> , 3MBU tiLK AC : 2.015 <br /> 40z1 ONYAWATHA TR R901/173 E 810716/17-10/16/87 <br /> 4740N WI LOT 1 CSM 2666 CS10/30Zc303 DE <br /> SC <br /> 53716 �/4 �S SAC 21-7-11 f�!?T NP 1/4N4 <br /> 4 . ACTION REQUESTED (Circle requested change and complete line. ) <br /> a. Zone Change from (� � to -2. 7 for ,�t_ 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 ��� �a r Name /r/(6-1/ (/'z77e_ ;"4.tk°/41 <br /> Addr. /9� ,.f/.7 4/ Addr. 1.4. /777S � <br /> 7**/ Y ///i 3) 7 21-t//Y1r'i��7 Si las Z , / <br /> Name ,r/de, Q / /CAD 2 Name <br /> Addr. a-, 25-G7-44-e7 Addr. <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 /> I 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 fe of $20 . 00 must accompany each application. <br /> -� 7- 0' Signed:� `��Signed: �� /� <br /> Applicant Date Town Clerk <br />