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Dane County Rezone & Application Date Petition Number <br /> 02/01/2017 DCPREZ-2017-11108 <br /> Conditional Use Permit Public Hearing Date C.U.P.Number <br /> 04/25/2017 <br /> OWNER INFORMATION AGENT INFORMATION <br /> OWNER NAME PHONE(with Area AGENT NAME PHONE(with Area <br /> ANDREW E ANDERSON Code) Code) <br /> (608) 767-3953 <br /> BILLING ADDRESS(Number&Street) ADDRESS(Number&Street) <br /> 3757 RYAN RD 3787 RYAN RD <br /> (City,State,Zip) (City,State,Zip) <br /> BLUE MOUNDS, WI 53517 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> andymidplains @yahoo.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 /> West of 3825 SHOWER RD <br /> TOWNSHIP SECTION TOWNSHIP SECTION TOWNSHIP SECTION <br /> VERMONT 19 <br /> PARCEL NUMBERS INVOLVED PARCEL NUMBERS INVOLVED PARCEL NUMBERS INVOLVED <br /> 0706-193-8040-8 <br /> REASON FOR REZONE CUP DESCRIPTION <br /> CREATING ONE RESIDENTIAL LOT <br /> FROM DISTRICT: TO DISTRICT: ACRES ? DANE COUNTY CODE OF ORDINANCE'SECTION ACRES <br /> A-1 Ex Exclusive Ag A-2 (8)Agriculture 11.3 <br /> District District <br /> C.S.M REQUIRED? PLAT REQUIRED? DEED RESTRICTION INSPECTOR'S INITIALS SIGNATURE:(Owner or Agent) <br /> REQUIRED? <br /> • <br /> '_I Yes 'No ❑ Yes ® No ❑ Yes ® No aAr/‘W Z'Q)\)V411A1141- <br /> SSA1 <br /> Applicant Initials`R-Ck Applicant Initials(At Applicant Initials <br /> PRINT NAME: <br /> /VNo1�cw L, AN Deilt,C <br /> DATE: <br /> lF>:e, (1 <br /> Form Version 03.00.03 <br />