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Dane County Rezone & Application Date Petition Number <br /> Conditional Use Permit 09/18/2015 DCPREZ-2015-10920 <br /> Public Hearing Date C.U.P.Number <br /> 11/24/2015 <br /> OWNER INFORMATION AGENT INFORMATION <br /> OWNER NAME PHONE(with Area AGENT NAME PHONE(with Area <br /> JACOBSEN REV LIVING TR Code) TEMPLE BUILDERS Code) <br /> (608) 239-6585 <br /> BILLING ADDRESS(Number&Street) ADDRESS(Number&Street) <br /> 3159 SHADY OAK LN 2501 W BELTLINE HIGHWAYSUITE 113 <br /> (City,State,Zip) (City,State,Zip) <br /> VERONA, WI 53593 MADISON, WI 53713 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> PLJABDO42 @GMAIL.COM JTEMPLE @TEMPLEBUILDS.COM <br /> ADDRESS/LOCATION I 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 /> 3159 SHADY OAK LN 3159 SHADY OAK LN 3159 SHADY OAK LN <br /> TOWNSHIP SECTION TOWNSHIP TOWNSHIP <br /> VERONA 5 VERONA 'SECTION <br /> 5 VERONA 'SECTION <br /> 5 <br /> PARCEL NUMBERS INVOLVED PARCEL NUMBERS INVOLVED PARCEL NUMBERS INVOLVED <br /> 0608-052-8220-8 0608-052-8650-8 0608-052-9030-6 <br /> REASON FOR REZONE CUP DESCRIPTION <br /> CREATING <br /> 0 <br /> FROM DISTRICT: TO DISTRICT: ACRES DANE COUNTY CODE OF ORDINANCE SECTION I ACRES <br /> A-3 Agriculture District R-4 Residence District 51 <br /> RH-1 Rural Homes R-4 Residence District 2.1 <br /> District <br /> C.S.M REQUIRED? PLAT REQUIRED? DEED RESTRICTION INSPECTOR'S SIGNATURE:(Owner or Agent) <br /> REQUIRED? INITIALS <br /> ® Yes ❑No 0 Yes ❑ No El Yes ® No <br /> 3e <br /> +ter SJW3 <br /> Applicant Initials *RP Applicant Initials'RP Applicant Initials TT' PRINT NAME: <br /> COMMENTS: CREATE 1-53 ACRE PARCEL TO DEVELOP CONDOMINIUM ' ,k 4j jI$ <br /> DATE: <br /> 63-15- A015- <br /> CSM/DOC: <br /> DEED RESTRICTION: 5a50�O Form Version 03.00.03 <br /> DEED NOTICE: <br /> OTHER: <br />