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Dane County Rezone & Application Date Petition Number <br /> 02/16/2016 DCPREZ-2016-10967 <br /> Conditional Use Permit Public Hearing Date C.U.P.Number <br /> 5/1 o//6 <br /> OWNER INFORMATION AGENT INFORMATION <br /> OWNER NAME PHONE(with Area AGENT NAME PHONE(with Area <br /> DONALD A HOFFMAN Code) Code) <br /> (608) 849-7119 <br /> BILLING ADDRESS(Number&Street) ADDRESS(Number&Street) <br /> 6718 STATE HIGHWAY 19 <br /> (City,State,Zip) (City,State,Zip) <br /> WAUNAKEE, WI 53597-9202 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> MMLHOFFMAN @YAHOO.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 /> 6718 STATE HIGHWAY 19 6718 STATE HIGHWAY 19 <br /> TOWNSHIP SECTION TOWNSHIP SECTION TOWNSHIP SECTION <br /> SPRINGFIELD 11 SPRINGFIELD 2 <br /> 0808-111-8500-3 0808-024-9000-2 <br /> REASON FOR REZONE CUP DESCRIPTION <br /> CREATING ONE RESIDENTIAL LOT <br /> ►! i.n,,< . T * W, a:01 1±109), " E. "4 * .•. BAR ;? <br /> A-1 Ex Exclusive Ag R-1A Residence District .65 <br /> District <br /> A-B Ag-Business District R-1A Residence District .47 <br /> A-B Ag-Business District A-1 Ex Exclusive Ag 1.18 <br /> District <br /> C.S.M REQUIRED? PLAT REQUIRED? DEED RESTRICTION INSPECTOR'S INITIALS SI :(Owner or nt) <br /> REQUIRED? <br /> • <br /> Yes ❑ No ❑ Yes ® No ❑ Yes ® No <br /> HJH3 <br /> Applicant Initials 14 L 7 Applicant Initials- -)7 ' Applicant Initials !-7-0 PRINT NAME: <br /> P <br /> r:7' 14 /41< <br /> CSM/DOC#: 'i a.13g15 DATE: <br /> DEED RESTRICTION: —/6 <br /> DEED NOTICE: <br /> OTHER: Form Version 03.00.03 <br />