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Is there a house or building on this parcel now? ®Yes 0 No <br /> Have you previously submitted an application for rezone <br /> on this parcel? El Yes 0 No <br /> Is this the original tract of land from 1979? ©Yes 0 No <br /> Has the property been previously rezoned? 0 Yes ®No <br /> If yes,how many times? 01 0 2 0 3 <br /> Are there any deed restrictions on this property? 0 Yes 0 No <br /> Explain land divisions, provide dates and attach documentation. <br /> See Exhibit A attached hereto and incorporated herein. <br /> Please provide us with a list of names and addressed of landowners within 'A mile of your <br /> property and whose land is adjacent. <br /> Have you filled out an application with Dane County? ®Yes 0 No <br /> Are you requesting a conditional use permit? 0 Yes 0 No <br /> Will you be requesting a variance from the Town Board? 0 Yes ©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? 0 Yes El No <br /> SECTION D-APPLICANT'S STATEMENT <br /> All the information on this form is accurate. <br /> Date Signature of applicant <br />