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Dane County Rezone & Application Date Petition Number <br /> Conditional Use Permit 06/19/2019 DCPREZ-2019-11455 <br /> Public Hearing Date C.U.P.Number <br /> 08/27/2019 <br /> OWNER INFORMATION AGENT INFORMATION <br /> OWNER NAME PHONE(with Area AGENT NAME PHONE(with Area <br /> DAKOTA J GRAY Code) 247-1041 COMBS &ASSOCIATES INC. Code) <br /> (608)BILLING ADDRESS(Number&Street) ADDRESS(Number&Street) <br /> 724 WASHINGTON RD 109 W MILWAUKEE ST., <br /> (City,State,Zip) (City,State,Zip) <br /> EDGERTON, WI 53534 Janesville„ WI 53546 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> c.gray2012 @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 /> 724 Washington Rd., south of 724 Washington Rd., <br /> TOWNSHIP SECTION TOWNSHIP SECTION TOWNSHIP SECTION <br /> ALBION 19 ALBION 19 <br /> 0512-192-9110-3 0512-192-9000-6 <br /> REASON FOR REZONE CUP DESCRIPTION <br /> SHIFTING OF PROPERTY LINES BETWEEN ADJACENT <br /> LAND OWNERS <br /> SFR-08 (Single Family RR-8 (Rural .72 <br /> Residential, small lots) Residential, 8 to 16 <br /> District acres) District <br /> FP-35 (General RR-8 (Rural 8.65 <br /> Farmland Preservation) Residential, 8 to 16 <br /> District acres) 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 ® No /^ <br /> SCW1 `J�-•-�_ <br /> Applicant Initials Applicant Initials/?J L Applicant Initials R'JC PRINT NAME: <br /> Ro,td .J. Go"-4L5 <br /> DATE: <br /> a// Y/zoiq <br /> Form Version 03.00.03 <br />