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Dane County Rezone & Application Date Petition Number <br /> 01/28/2016 DCPREZ-2015-10942 <br /> Conditional Use Permit Public Hearing Date C.U.P.Number <br /> 02/23/2016 <br /> OWNER INFORMATION AGENT INFORMATION <br /> OWNER NAME 1 PHONE(with Area AGENT NAME PHONE(with Area <br /> DALE R PUISTO Code) ISTHMUS .SURVEYING LLC Code) <br /> (608) 838-4750 pct 2 09 _ a 3 0 L (608)244-1090 <br /> BILLING ADDRESS(Number&Street) ADDRESS(Number&Street) <br /> 3274 LEE SOUTH CT 450 N BALDWIN ST. <br /> (City,State,Zip) (City,State,Zip) <br /> MCFARLAND, WI 53558 Madison, WI 53703 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> c.puisto2@gmail.com isthmussurveying@sbcglobal.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 /> 3274 S. Lee Court <br /> TOWNSHIP SECTION TOWNSHIP SECTION TOWNSHIP SECTION <br /> BLOOMING GROVE 36 <br /> 0710-363-8390-0 <br /> REASON FOR REZONE CUP DESCRIPTION <br /> CREATING A LOT FOR AND EXISTING RESIDENCE <br /> AND ONE NEW RESIDENTIAL LOT <br /> A-1 Ex Exclusive Ag RH-1 Rural Homes 2.5 <br /> District District <br /> A-1 Ex Exclusive Ag A-2 (8)Agriculture 13.63 <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 Applicant Initials PRINT NAME: <br /> DATE: <br /> CSM/DOC# (y aa9/5aa906 <br /> DEED RESTRICTION: <br /> DEED NOTICE: <br /> OTHER: Form Version 03.00.03 <br /> ) 1)-16\ •• <br />