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<br />Dane County Rezone & <br />Conditional Use Permit Application <br /> <br />Application Date Preliminary Application Number <br />12/29/09 RECU25669 <br />Public Hearing Date Petition Number C.U.P. Number <br />03/23/2010 10166 <br /> <br />OWNER INFORMATION I AGENT INFORMATION <br /> <br />OWNER NAME <br />GARY KARLS <br /> <br />PHONE with Area Code <br /> <br />(608 )437 -6942 <br /> <br />AGENT NAME <br />SAME AS OWNER <br /> <br />PHONE with Area Code <br /> <br /> <br />BILLING ADDRESS (Number, Street) <br />7748 MINeRAL rOI~JT 110 <br />(City, State, Zip) <br />VERONA, 'NI 636~3 <br />E-MAIL ADDRESS <br /> <br />ADDRESS (Number, Street) <br /> <br />10795 N PERRY RD., <br /> <br />TOWNSHIP <br /> <br />PERRY <br /> <br />SECTION <br />05 <br /> <br />TOWNSHIP <br /> <br />SECTION <br /> <br />TOWNSHIP <br /> <br />SECTION <br /> <br />050605285005 <br />050605280000 <br /> <br />REASON FOR REZONE CUP DESCRIPTION <br /> <br />SEPERATE THE RESIDENCE FROM THE FARM <br /> <br /> <br /> <br /> <br />A-1 EX <br /> <br />RH-2 <br /> <br />4.5 <br /> <br /> <br />INSPECTOR'S SIGNATURE: (Owner or Agent) <br />INITIALS <br /> <br />[Z]ves DNo <br /> <br />[)yes [{]NO <br /> <br />[]Yes [{]NO <br /> <br />SCW1 <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 />