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Dane County Rezone & Application Date Petition Number <br /> Conditional Use Permit 07/25/2016 DCPREZ-2016-11040 <br /> Public Hearing Date C.U.P.Number <br /> 09/27/2016 <br /> OWNER INFORMATION AGENT INFORMATION <br /> OWNER NAME PHONE(with Area AGENT NAME PHONE(with Area <br /> JOHN M HALVERSON Code) ❑ Code) <br /> (608)843-7498 <br /> BILLING ADDRESS(Number&Street) ADDRESS(Number&Street) <br /> 7599 STATE HIGHWAY 14 ❑ <br /> (City,State,Zip) (City,State,Zip) <br /> ARENA,WI 53503 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> johnhalversonsurveying.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 /> N of 5133 John Wilkinson Road <br /> TOWNSHIP TOWNSHIP SECTION TOWNSHIP SECTION <br /> BLACK EARTH 'SECTION <br /> 29 <br /> ,,,PARC I ERS INVOLVED z , ,PARCEL 1 ,. INVOLVED . IPAI„,,, AMBERS INVOL` E ,,AIN i <br /> 0806-291-9621-0 <br /> REASON FOR REZONE CUP DESCRIPTION <br /> CREATING ONE RESIDENTIAL LOT <br /> FROM;ElI31i7'RItYC 1E,3 3 '1'O DIS`I § ACRE , ttANL 1 1.0001tr F.s *fiACRES. <br /> A-1 Ex Exclusive Ag RH-2 Rural Homes 4.06 <br /> District District <br /> RH-3 Rural Homes RH-2 Rural Homes 5.24 <br /> District District <br /> RH-3 Rural Homes A-1 Ex Exclusive Ag 4.35 <br /> District District <br /> C.S.M REQUIRED? PLAT REQUIRED? DEED RESTRICTION INSPECTOR'S 711•TUR .(O ner or Agent) <br /> REQUIRED? INITIALS <br /> ` <br /> 0 Yes 0 No ❑ Yes 0 No 0 Yes 0 No <br /> �j�J, RLB / <br /> Applicant Initials ") Applicant Initia��(J9 Applicant Initia PRINT NAME: <br /> �Qi! JVhPI Pl./2/U-Prs2v. <br /> DATE: <br /> CSM/DOC: 0-Eit -y5 30 S 9 1 <br /> 7/zc/'/ C <br /> DEED RESTRICTION: S 30' o 1 t Form Version 03.00.03 <br /> DEED NOTICE: <br /> OTHER: <br />