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Application Date C.U.P Number <br /> Dane County 03/15/2016 DCPCUP-2016-02340 <br /> Conditional Use Permit Public Hearing Date <br /> Application 05/24/2016 <br /> OWNER INFORMATION AGENT INFORMATION <br /> OWNER NAME Phone with Area AGENT NAME Phone with Area Code <br /> PATRICIA A FISCHBECK Code HEATHER ALSTON-SHANNON (760) 533-8880 <br /> (608) 244-9368 <br /> BILLING ADDRESS(Number,Street) ADDRESS(Number,Street) <br /> 5525 PORTAGE RD <br /> (City,State,Zip) (City,State,Zip) <br /> MADISON, WI 53704 San Marcos, CA 92069 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> innkeeper @speckledheninn.com hrshannon @cox.net <br /> ADDRESS/LOCATION 1 ADDRESS/LOCATION 2 ADDRESS/LOCATION 3 <br /> ADDRESS OR LOCATION OF CUP ADDRESS OR LOCATION OF CUP ADDRESS OR LOCATION OF CUP <br /> 5523 Portage Road <br /> TOWNSHIP SECTION TOWNSHIP TOWNSHIP <br /> BURKE 21 1SECTION 1SECTION <br /> PARCEL NUMBERS INVOLVED PARCEL NUMBERS INVOLVED PARCEL NUMBERS INVOLVED <br /> 0810-211-8000-2 --- --- <br /> CUP DESCRIPTION <br /> Limited Family Business <br /> DANE COUNTY CODE OF ORDINANCE SECTION ACRES <br /> 10.12(3)(p) 18.52 <br /> DEED RESTRICTION Inspectors SIGNATURE:(Owner or Agent) <br /> REQUIRED? Initials <br /> ❑ � <br /> Yes No <br /> Applicant Initials PRINT NAME: <br /> -7.) p fic,c`.A U l: CltVJ��� <br /> DATE: <br /> (93- /457,;?0/4) <br /> • <br /> Form Version 01.00.03 <br />