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Dane County Rezone & Application Date Petition Number <br /> 10/18/2016 DCPREZ-2016-11062 <br /> Conditional Use Permit Public Nearing Date C.U.P.Number <br /> 12/13/2016 <br /> OWNER INFORMATION AGENT INFORMATION <br /> OWNER NAME PHONE(with Area AGENT NAME PHONE(with Area <br /> RUSSELL BALLWEG ■ Code) ORION LAND SURVEYIj Code) <br /> (,o&) g�3 _I ((608)235-8024 <br /> BILLING ADDRESS(Number&Street) `' ADDRESS(Number&Street) <br /> 6556 COUNTY HIGHWAY KP °�5'T 290 5TH STREET <br /> 4,04,4 <br /> (City,State,Zip) (City,State,Zip) <br /> MAZOMANIE, WI 53560 Prairie Du Sac,WI 53578 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <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 /> Northeast of 8799 Katzenbuechel Roa• <br /> TOWNSHIP SECTION TOWNSHIP TOWNSHIP [SECTION S <br /> ROXBURY 33 !SECTION <br /> ,u ll#040.E JNVC1LVE , PPARCEL Ni,t Q x <br /> s 1� <br /> 0907-331-9001-0 <br /> REASON FOR REZONE CUP DESCRIPTION <br /> CREATING ONE RESIDENTIAL LOT <br /> faii**** 16.4 ,s'!! A r t r Yr, , V'<e r ' ` '•,;y sg 3' —' <br /> A-1 Ex Exclusive Ag RH-3 Rural Homes 8.1 <br /> District District <br /> C.S.M REQUIRED? PLAT REQUIRED? DEED RESTRICTION INSPECTOR'S SIGNATURE:(Owner or Agent) <br /> REQUIRED? INITIALS <br /> Yes ❑No ❑ Yes ® No ❑ Yes El No <br /> RWL1 <br /> Applicant Initials Applicant Initials Applicant Initials PRINT NAME: <br /> DATE: <br /> Form Version 03.00.03 <br />