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L <br /> Dane County Rezone & Application Date Petition Number <br /> 08/21/2014 DCPREZ-2014-10763 <br /> Conditional Use Permit Public Hearing Date C.U.P.Number <br /> 10/28/2014 <br /> OWNER INFORMATION AGENT INFORMATION <br /> OWNER NAME PHONE(with Area AGENT NAME PHONE(with Area <br /> RONALD J JOSEPHSON Code) KEVIN BAUMGARTHER Code) <br /> (608) 843-6179 (608) 832-1532 <br /> BILLING ADDRESS(Number&Street) ADDRESS(Number&Street) <br /> 9835 COUNTY HIGHWAY A 9976 COUNTY HIGHWAY A ( ,u —l t 2 '' 7� <br /> (City,State,Zip) (City,State,Zip) <br /> MT HOREB, WI 53572 MT HOREB, WI 53572 <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 /> 9835 COUNTY HIGHWAY A <br /> TOWNSHIP SECTION TOWNSHIP SECTION TOWNSHIP SECTION <br /> PERRY 23 <br /> PARCEL NUMBERS INVOLVED PARICOL NUMBE*$INVOLVED PARCEL NUMSMIRS INVOLVED <br /> 0506-234-8830-6 <br /> REASON FOR REZONE CUP DESCRIPTION <br /> SHIFTING OF PROPERTY LINES BETWEEN <br /> LAND OWNERS OrNci <br /> irl j ill toot ') TC1 iDie itiao 10, junta 1II:HeaAtNlrlf`ootot OIr Q � CR) iQlt 11C1t1E <br /> A-1 Ex Exclusive Ag A-2 Agriculture District 40.5 <br /> District <br /> A-1 Ex Exclusive Ag A-2 (8)Agriculture 8 <br /> District District <br /> A-1 Ex Exclusive Ag A-4 Agriculture District 28.5 <br /> 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 /> SSA1 <br /> Applicant Initials KG 0 Applicant Initials AG Q Applicant Initials /sG PRINT NAME: <br /> nFvrn' /3A0/++6--ARrdER <br /> DATE: <br /> KA <br /> Form Version 03.00.02 <br />