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7Z/La* • 4 :f"rfr /72 <br /> ,) ow n �=T s r If/ <br /> OS/�.) <br /> 5 <br /> f"Li • /7cf"/�'-7 <br /> "Notice of Intent" <br /> TO REQUEST A ZONING CHANGE <br /> TOWN OF MAZOMANIE . <br /> ; <br /> 1 Name: C/4,51.S /7G/ / 0t? N 2 0 r I r <br /> Address: Ci j Phone: • <br /> 1. Purpose: ,r2e <br /> Zen E v o vr1 • X C i v 7 <br /> 2. Legal Description of parcel in question: <br /> 3 " <br /> 3. Attach map sketch of parcel (professional, scale drawing not necessary)/ <br /> Please show <br /> (a) Road cuts <br /> (b) Dimension of land (including proposed division, if applicable) <br /> (c) Location of structures <br /> 4. Type of action requested: <br /> 0 f (a) Zoning request <br /> (b) Other <br /> • <br /> 0 <br /> 5. Miscellaneous information: <br /> I (We) hereby acknowledge receipt of a copy of the Town of Mazomanie Land <br /> Use Plan, which is to be returned to the Town Clerk when the action is <br /> complete. <br /> I (We) agree to proceed in accordance with the Town's ordinances and plans. <br /> L.) <br /> Date: Signed <br /> Date filed: <br /> Town Clerk <br /> Plan Committee Action: Date: <br /> Board Action: Date: <br /> • <br /> • <br /> • <br />