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Dane County Rezone & Application Date Petition Number <br /> 12/18/2014 DCPREZ-2014-10805 <br /> Conditional Use Permit Public Hearing Date C.U.P. Number <br /> 02/24/2015 <br /> OWNER INFORMATION AGENT INFORMATION <br /> OWNER NAME PHONE(with Area AGENT NAME PHONE(with Area <br /> ROBERT T ROEVEN Code) Code) <br /> (608) 770-9367 <br /> BILLING ADDRESS(Number&Street) ADDRESS(Number&Street) <br /> 324 LOWELL ST <br /> (City,State,Zip) (City,State,Zip) <br /> STOUGHTON, WL53598- 3 5 g9 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> robert.roeven@tds.net <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 /> 845 State Highway 138 north of 845 State Highway 138 <br /> TOWNSHIP TOWNSHIP (SECTION TOWNSHIP SECTION <br /> DUNKIRK 'SECTION <br /> 18 DUNKIRK 18 <br /> PARCEL NUMBERS INVOLVED PARCEL NUMBERS INVOLVED PARCEL NUMBERS INVOLVED <br /> 0511-184-9831-3 0511-184-9521-8 <br /> REASON FOR REZONE CUP DESCRIPTION <br /> C- p - p • <br /> 'tl�,]rc�mot.w� l�� f��t!N�✓�S <br /> FROM DISTRICT: TO DISTRICT: I ACRES DANE COUNTY CODE OF ORDINANCE SECTION , ACRES <br /> A-1 Ex Exclusive Ag RH-2 Rural Homes 1.879 <br /> District District <br /> RH-1 Rural Homes RH-2 Rural Homes 3.033 <br /> District 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 /> _ SCW1 <br /> Applicant Initials Applicant Initials eg g Applicant Initials PRINT NAME: <br /> Rc-6Egr. 2cev�,ti. <br /> DATE: <br /> X91/E /ge'f <br /> Form Version 03.00.02 <br /> 4 <br />