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Is there a house or building on this parcel now? ®Yes ❑No <br /> Have you previously submitted an application for rezone <br /> on this parcel? ❑Yes 8 No <br /> Is this the original tract of land from 1979? ®Yes ❑No <br /> Has the property been previously rezoned? ❑Yes ®No <br /> If yes,how many times? ❑1 0 2 ❑3 <br /> Are there any deed restrictions on this property? ❑Yes ®No <br /> Explain land divisions,provide dates and attach documentation. <br /> N/A <br /> Please provide us with a list of names and addressed of landowners within IA mile of your <br /> property and whose land is adjacent. See Attached. <br /> Have you filled out an application with Dane County? ®Yes ❑No <br /> Are you requesting a conditional use permit? ®Yes ❑No <br /> Will you be requesting a variance from the Town Board? ❑Yes al No <br /> SECTION C SITE VISIT <br /> Do you have any objection to a site visit by Plan Commission or Town Board members with <br /> reasonable notice? ❑Yes in No <br /> SEdrION APPI,ICANT'SSTATEMENT <br /> All the information on this form is accurate. <br /> May 11.2016 //e0./ Ji i' ..4rf` 4 <br /> Date Si a i ature of applicant , <br />