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Dane County Rezone & Application Date Petition Number <br /> 03/20/2014 DCPREZ-2014-10682 <br /> Conditional Use Permit Public Hearing Date C.U.P. Number <br /> 05/27/2014 <br /> OWNER INFORMATION AGENT INFORMATION <br /> OWNER NAME PHONE(with Area AGENT NAME PHONE(with Area <br /> STATZ BROS INC Code) BIRRENKOTT SURVEYING Code) <br /> (920) 988-6821 (608) 837-7463 <br /> BILLING ADDRESS(Number&Street) ADDRESS(Number&Street) <br /> 5707 COUNTY HIGHWAY W 1677 N. BRISTOL ST. <br /> (City,State.Zip) (City,State,Zip) <br /> MARSHALL, WI 53559 Sun Prairie, WI 53590 <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 /> 1151 berlin rd. <br /> TOWNSHIP TOWNSHIP SECTION TOWNSHIP SECTION <br /> MEDINA 1SECTION <br /> 5 <br /> PARCEL NUMBERS INVOLVED PARCEL NUMBERS INVOLVED PARCEL NUMBERS INVOLVED <br /> 0812-053-9000-8 <br /> REASON FOR REZONE CUP DESCRIPTION <br /> SEPARATION OF EXISTING RESIDENCE <br /> FROM DISTRICT: TO DISTRICT: I ACRES DANE COUNTY CODE OF ORDINANCE SECTION ACRES <br /> A-1 Ex Exclusive Ag RH-2 Rural Homes 7.43 <br /> District District <br /> A-1 Ex Exclusive Ag RH-3 Rural Homes 8.10 <br /> District District <br /> A-1 Ex Exclusive Ag RH-2 Rural Homes 4.19 <br /> District District <br /> C.S.M REQUIRED? PLAT REQUIRED? DEED RESTRICTION INSPECTOR'S INITIALS SIGNATURE:(Owner or Agent) <br /> REQUIRED? <br /> ® Yes ā‘ No ā‘ Yes ® No ā‘ Yes ® No <br /> DJE1 <br /> Applicant Initials/2/V Applicant Initialsr4/p Applicant Initials PRI T Nā€¢ E: <br /> DATE: <br /> Form Version 03.00.02 <br />