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Dane County Rezone & Application Date Petition Number <br /> 01/08/2016 DCPREZ-2015-10928 <br /> Conditional Use Permit Public Nearing 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 /> GRUNDAHL REV TR, JEFFREY A& Code) WYSER ENGINEERING Code) <br /> MARY L (608) 576-7850 (608) 843-3388 <br /> BILLING ADDRESS(Number&Street) ADDRESS(Number&Street) <br /> 10964 COUNTY HIGHWAY A 201 1/2 EAST MAIN STREET <br /> (City,State,Zip) (City,State,Zip) <br /> HOLLANDALE, WI 53544 Mt Hored, WI 53572 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> jeff @jgdevelopment.com wade.wyse @wyserengineering.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 /> s of 10102 Barton Road S of 10102 Barton Road <br /> TOWNSHIP SECTION TOWNSHIP SECTION TOWNSHIP SECTION <br /> BLUE MOUNDS 27 BLUE MOUNDS 27 <br /> P A:1 1 PAlk <br /> ::ate. � .��-� .� <br /> 0606-271-8670-0 0606-271-8600-0 <br /> REASON FOR REZONE CUP DESCRIPTION <br /> CREATING AN AGRICULTURAL LOT AS PART OF AN <br /> EXISTING RESIDENTIAL LOT <br /> _73101111*:,' ooktok.,000140010r006.440041 ,, 40041* <br /> A-1 Ex Exclusive Ag A-4 Agriculture District 8.45 <br /> District <br /> C.S.M REQUIRED? PLAT REQUIRED? DEED RESTRICTION INSPECTOR'S INITIALS SIGNATURE:(Owner or Agent) <br /> REQUIRED? <br /> ® Yes El No ❑ Yes ® No El Yes ® No <br /> RLB <br /> Applicant Initials Applicant Initials Applicant Initials PRINT NAME: <br /> CSM/DOC#: ty)Lica370a3 DATE: <br /> l/ <br /> DEED RESTRICTION: <br /> DEED NOTICE: <br /> OTHER: Form Version 03.00.03 <br />