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<br />Dane County Rezone & <br />Conditional Use Permit Application <br /> <br />Application Date Preliminary Application Number <br />12/28/09 RECU25663 <br />Public Hearing Date Petition Number C.U.P. Number <br />03/23/2010 10160 <br /> <br />OWNER INFORMATION I AGENT INFORMATION <br /> <br />OWNER NAME <br />THOMAS HANSEN <br /> <br />PHONE with Area Code <br /> <br />(608)437 -8183 <br /> <br />AGENT NAME <br />SAME AS OWNER <br /> <br />PHONE with Area Code <br /> <br />BilLING ADDRESS (Number, Street) <br />10295 BLUE ROCK RD <br />(City, State, Zip) <br />MT HOREB, WI 53572 <br />E-MAil ADDRESS <br /> <br />ADDRESS (Number, Street) <br /> <br />(City, State, Zip) <br /> <br />E-MAIL ADDRESS <br /> <br /> <br />WEST OF 10295 BLUE ROCK RD. <br /> <br />TOWNSHIP <br />BLUE MOUNDS <br /> <br />SECTION <br />33 <br /> <br />TOWNSHIP <br /> <br />SECTION <br /> <br />TOWNSHIP <br /> <br />SECTION <br /> <br />060633180010 <br /> <br />REASON FOR REZONE . CUP DESCRIPTION <br /> <br />CREATION OF ONE RESIDENTIAL LOT <br /> <br /> <br />A-1 EX <br /> <br />A-2(8) <br /> <br />15 <br /> <br /> <br />INSPECTOR'S SIGNATURE: (Owner or Agent) <br />INITIALS <br /> <br />[{)ves DNa <br /> <br />[}res DNa <br /> <br />[]ves DNa <br /> <br />DJE1 <br /> <br />PRINT NAME: <br /> <br />Applicant Initials <br /> <br />Applicant Initials <br /> <br />Applicant Initials <br /> <br />COMMENTS: <br /> <br />DATE: <br /> <br />545-113 (4/06) <br />