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Dane County Rezone & Application Date Petition Number <br /> 11/18/2015 DCPREZ-2015-10930 <br /> Conditional Use Permit Public Hearing Date C.U.P.Number <br /> 01/26/2016 <br /> OWNER INFORMATION AGENT INFORMATION <br /> OWNER NAME PHONE(with Area AGENT NAME PHONE(with Area <br /> AUDREY W KORITZINSKY Code) DAVID HAUG Code) <br /> (608)445-3500 <br /> BILLING ADDRESS(Number&Street) ADDRESS(Number&Street) <br /> 4110 TIMBER LN 2916 MARKETPLACE DR <br /> (City,State,Zip) (City,State,Zip) <br /> CROSS PLAINS, WI 53528 MADISON, WI 53719 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> dhaug @lighthousecre.com <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 /> 4110 TIMBER LANE <br /> TOWNSHIP SECTION TOWNSHIP SECTION TOWNSHIP SECTION <br /> MIDDLETON 18 <br /> PARCEL " 1$VOLVED PARCEL NUMBERS'INVOLVED PARCEL,thiiiillifts INVOLVED; <br /> 0708-183-8691-9 <br /> REASON FOR REZONE CUP DESCRIPTION <br /> CREATING TWO RESIDENTIAL LOTS <br /> FROM DISTRICTt TO DISTRICT;;` ACRES DANE COUNTY CODE OF'ORDINANCE SECTION ACRES <br /> RH-1 Rural Homes A-1 Agriculture District 1.y <br /> District , 3 31 <br /> C.S.M REQUIRED? PLAT REQUIRED? DEED RESTRICTION INSPECTOR'S INITIALS SIGNATURE:(Owner or Agent) <br /> REQUIRED? <br /> ® Yes ❑ No ❑ Yes ® No ❑ Yes 0 No <br /> SSA1 1 <br /> Applicant Initials t/V Applicant Initials 1>// Applicant Initials 1W PRINT NAME: <br /> 11)41/1. ki/grt6 <br /> DATE: <br /> CSM/DOC# 1 y aoq fsaa351$ <br /> DEED RESTRICTION: Form Version 03.00.03 <br /> DEED NOTICE: <br /> OTHER: <br />