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11$11/16/2016 WED 11: 13 FAX 608 423 4570 RUMPF LAW CAMBRIDGE <br /> 001/001 <br /> Nov. 16. 2016 : 15AM�Lt(57D No, 1537 P. 1 <br /> toDB <br /> Dane County Rezone Vii. i._...APPIIcatlonPAtQ Petition NPmber <br /> 11/16/2016 DCPREZ-2016-11079 <br /> Conditional Use Permit <br /> Public Hearing Date c.U.P.Num6e► <br /> 01/24/2017 <br /> OWNER INFORMATION AGENT INFORMATION <br /> OWNER NAME PHONE(with Area AGENT NAME PHONE Nth Area <br /> MARY F NORDLAND Cole) MICHAEL RUMPF Cade) <br /> (608) 873-0708 (608)423-3254 <br /> BILLING ADDRESS(Number&Street) ADDRESS(Number&Street) <br /> 2022 KOSHKONONG RD PO BOX 1 <br /> (City,Slate,Zip) (City.Stale,Zip) <br /> COTTAGE GROVE, WI 53527 Cambridge, WI 53523 <br /> E-MIL ADDRESS E-MAiLADDRESS <br /> tjnsrm d>yahoo.cvm mrumpfcrumpflaw.com <br /> ADDRESS/LOCATION 1 ADDRESS/LOCATION 2 ADDRESS/LOCATION 3 <br /> ADDRESS OR LOCATION OF REZONE/CUP ADDRESS OR LOCATION OP REZONE/CUP ADDRESS OR LOCATION OF REZONEICUP <br /> N of 2022 Koshkonong Rd. <br /> TOWNSHIP SECTION TOWNSHIP SECTION TOWNSHIP SECTION <br /> PLEASANT SPRINGS 14 PLEASANT SPRINGS 13 <br /> 0611-142-8500-3 0611-113-9330-2 <br /> REASON FOR REZONE CUP DESCRIPTION <br /> SEPARATING EXISTING RESIDENCE FROM <br /> FARMLAND <br /> EX. . !S:{E.'9•' iTtit1P:.`i Mi:citt a _,i"Y'1,k.�.4�'! '�'^1; ag �µ�.�i.'j:ih M.H ONA-°R/iii °f I- , % 5:-.F;T=sue.,M4,- <br /> A-1 Ex Exclusive Ag RH-3 Rural Homes 9.6 <br /> District District <br /> C.S.M REQUIRED? - PLAT REQUIRED? DEED RESTRICTION INSPECTOR'S INITIALS SIGNATURE! • Agent) <br /> REQUIRED? / /% <br /> Q Yes ❑No ❑ Yes ® No ❑ Yes ® No /,1 / <br /> SCW1 i / 7, <br /> Applicant GIs Applicant Initials Applicard Initials PRINT NAME: <br /> OCillia j/PI <br /> DATE: <br /> If I V IA <br /> Form VerSIon 03.00.03 <br /> • <br />