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Dane County Rezone & Application Date Petition Number <br /> Conditional Use Permit 09/30/2019 DCPREZ-2019-11492 <br /> Public Hearing Date C.U.P.Number <br /> 11/26/2019 <br /> OWNER INFORMATION AGENT INFORMATION <br /> OWNER NAME PHONE(with Area AGENT NAME PHONE(with Area <br /> AARON L JACOB Code) DANA DOSKOCIL Code) <br /> (608) 576-7409 (608)235-6868 <br /> BILLING ADDRESS(Number&Street) ADDRESS(Number&Street) <br /> 3309 COUNTY HIGHWAY MN 1601 E MAIN ST <br /> (City,State,Zip) (City,State,Zip) <br /> MCFARLAND, WI 53558 STOUGHTON, WI 53589 <br /> E-MAIL ADDRESS E-MAIL ADDRESS <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 /> 2301 WILLIAM DRIVE <br /> TOWNSHIP SECTION TOWNSHIP SECTION TOWNSHIP SECTION <br /> PLEASANT SPRINGS 20 <br /> 0611-202-8310-0 <br /> REASON FOR REZONE CUP DESCRIPTION <br /> CREATING ONE RESIDENTIAL LOT AND ONE <br /> RECREATIONAL LOT <br /> T- 1 1.4 t <br /> B-1 Local Business RH-4 Rural Homes 4.38 <br /> District District <br /> RE-1 Recreational RH-4 Rural Homes 13.73 <br /> District District <br /> C.S.M REQUIRED? PLAT REQUIRED? DEED RESTRICTION INSPECTOR'S SIGNATURE:(Owner or Agent) <br /> REQUIRED? INITIALS <br /> ® Yes JJ No ❑ Yes ® No Yes ® No <br /> SSA1 <br /> Applicant Initials Applicant Initials Applicant Initials PRINT NAME: <br /> DATE: <br /> Form Version 03.00.03 <br />