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DANE COUNTY <br /> APPLICATION FUR A CONDITIONAL USE PERMIT No. 3 3 <br /> the undersigned heretby applies for a conditional use permit <br /> to construct a sing_ c <br /> family residence in the A-2 Agriculture <br /> District as provided for in ss 10.126 (2) (i) of the ?.oning ordinance. The <br /> property is located at 9495 CTH Y in the Town of ' <br /> Roxbury , more fully described as follows: <br /> Part of the NW 1/4 NW 1/4 of said Section 19, Town of Roxbury described as Lot #1 <br /> Certified Survey Map #3581 as recorded in Volume 14 Page 204 Register of Deeds. <br /> / 7/972 /77-8y I4 • <br /> Respectfully submitted on ! — 195yby: <br /> Agent: Owner: <br /> Name Name V �✓ <br /> l�dr.5!2 G-$ 1p`' C <br /> lo`' <br /> Street Street ./172—,0 4,67p k g'� (/ <br /> Post Office J /i <br /> Office Office (J <br /> 1 <br /> Telephone Zip Telephone4S3- '—Fea aip Ao9S7 <br /> 545-59(11/79) c� O <br />