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Dane County Rezone & Application Date Petition Number <br /> Conditional Use Permit 03/20/2015 DCPREZ-2015-10846 <br /> Public Hearing Date C.U.P.Number <br /> 05/26/2015 <br /> OWNER INFORMATION AGENT INFORMATION <br /> OWNER NAME PHONE(with Area AGENT NAME PHONE(with Area <br /> SIMPSON LE, HATTIE M Code) MARK RIESE Code) <br /> (608) 752-0035 (608)235-5458 <br /> BILLING ADDRESS(Number&Street) ADDRESS(Number&Street) <br /> 1645 HEMMINGWAY CT W420 STH 92 <br /> (City,State,Zip) (City,State,Zip) <br /> JANESVILLE, WI 53545 Brooklyn, WI 53521 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> ADDRESS/LOCATION 1 ADDRESS/LOCATION 2 ADDRESS/LOCATION 3 <br /> ADDRESS OR LOCATION OF REZONE/CUP ADDRESS OR LOCATION OF REZONE/CUP ADDRESS OR LOCATION OF REZONE/CUP <br /> West of Parkland Drive <br /> TOWNSHIP TOWNSHIP SECTION TOWNSHIP SECTION <br /> DUNN 'SECTION <br /> 17 <br /> wm w is <br /> 0610-174-8180-5 <br /> REASON FOR REZONE CUP DESCRIPTION <br /> CREATING TWO RESIDENTIAL LOTS <br /> A-1 Ex Exclusive Ag R-1A Residence District 1.3 <br /> District <br /> A-1 Ex Exclusive Ag RH-1 Rural Homes 2.0 <br /> District District <br /> C.S.M REQUIRED? PLAT REQUIRED? DEED RESTRICTION INSPECTOR'S INITIALS SIGNATURE:(Owner or Agent) <br /> REQUIRED? <br /> ® Yes ❑ No ❑ Yes ® No ❑ Yes ❑ No <br /> DJE1 <br /> Applicant Initials Applicant Initials Applicant Initials PRINT NAME: /� <br /> I �)1 rttL I�1 t3� <br /> DATE: <br /> CSM/DOC#: l Y()6(/5 Iz l 3/?-0 <br /> DEED RESTRICTION: 5s?1 (01 <br /> DEED NOT: Form Version 03.00.03 <br /> OTHER: <br />