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Dane County Rezone & Application Date Petition Number <br /> 10/07/2016 DCPREZ-2016-11062 <br /> Conditional Use Permit Public Nearing Date C.U.P.Number <br /> OWNER INFORMATION AGENT INFORMATION <br /> OWNER NAME PHONE(with Area AGENT NAME PHONE(with Area <br /> RUSSELL BALLWEG Code) ORION LAND SURVEYING Code) <br /> ((608) 235-8024 <br /> BILLING ADDRESS(Number&Street) ADDRESS(Number&Street) <br /> 6556 COUNTY HIGHWAY KP 290 5TH STREET <br /> (City,State,Zip) (City,State,Zip) <br /> MAZOMANIE, WI 53560 Prairie Du Sac, WI 53578 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> L <br /> ADDRESS/LOCATION 1 4DDPESS/LOCATION 2 ADDRESS/LOCATION 3 <br /> ADDRESS OR LOCATION OF REZONE/CUP ADDRESS ION OF REZONE/CUP ADDRESS OR LOCATION OF REZONE/CUP <br /> Northeast of 8799 Katzenbuechel <br /> Road <br /> TOWNSHIP SECTION T• IP SECTION TOWNSHIP SECTION <br /> ROXBURY 33 <br /> PARCEL NUMBERS INVOLVED PARCEL NUMB! - D PARCEL NUMNERS INVOLVED <br /> 0907-331-9001-0 <br /> REASON FOR REZONE CUP DESCRIPTION <br /> CREATING ONE RESIDENTIAL LOT <br /> 40:44 <br /> sr='' <br /> FROM DISTRICT: TO DISTRICT: ACRES DANE COUNTY CODE OP ORDINANCE SECTION I ACRES 1 <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 INITIALS SIGNATURE:(Owner or Agent) <br /> REQUIRED? <br /> ® Yes ❑ No ❑ Yes ® No El Yes ® No <br /> RWL1 <br /> Applicant Initials Applicant Initials Applicant Initials PRINT NAME: <br /> DATE: <br /> Form Version 03.00.03 <br />