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. Dane County Application Fees <br /> t ;.,.. <br /> 1` a General $395 Department of Planning and Development <br /> s- Zoning Division Farmland Preservation: $495 <br /> ��cc�� <br /> t a Room 116,City-County Building Commercial: $345 ,a <br /> xt'r 210 Martin Luther King Jr.Blvd. . PERMIT FEES DOUBLE FOR vIOlAT10YS. <br /> 41'11-+ Madison,Wisconsin 53703 . ADDITIONAL FEES MAY APPLY.CONTACT DANE COUNTY i 5 <br /> LIO <br /> (608)266-4266 7 ZONING AT 608.26E-4266 FOR MORE INFORMATION. <br /> f c i-6-p ? ( REZONE APPLICATION <br /> APPLICANT INFORMATION <br /> Property Owner Name: Andy Grapa Agent Name: Williamson Surveying <br /> Address(Number&Street): 6468 Forest Park Drive Address(Number&Street): 104A W Main St <br /> Address(City,State,Zip): Deforest,WI 53532 Address(City,State,Zip): Waunakee, WI 53597 <br /> Email Address: apgrapa@uwalumni.com Email Address: noa@williamsonsurveying.com <br /> Phone#: 608-628-5466 Phone#: 608-255-5705 <br /> PROPERTY INFORMATION <br /> la .._� _ <br /> Township: T9N Parcel Number(s): 064/0909-164-9192-8 <br /> Section: 16 Property Address or Location: 5636 County Highway V <br /> REZONE DESCRIPTION <br /> Reason for the request.In the space below,please provide a brief but detailed explanation of the rezoning Is this application being <br /> request.Include both current and proposed land uses,number of parcels or lots to be created,and any other submitted to correct� a violation? <br /> relevant information.For more significant development proposals,attach additional pages as needed, Yes No(S <br /> Create a 4.13 acre lot and change zoning district to allow for a proposed veterinary clinic. <br /> Existing Zoning Proposed Zoning Acres <br /> District(s) District(s) <br /> '>. 35 GC <br /> IIIIIIIIIIIIIIIIIIIIIIIIIII <br /> IIIIIIIIIIIIIIIIIIIIIIIIIII <br /> Applications will not be accepted until the applicant has contacted the town and consulted with department staff <br /> to determine that all necessary information has been provided. Only complete applications will be accepted. All <br /> information from the checklist below must be included. Note that additional application submittal <br /> requirements apply for commercial development proposals, or as may be required by the Zoning Administrator. <br /> 8 Scaled drawing of B Legal description N Information for ®Pre-application N Application fee(non- <br /> proposed property of zoning commercial development consultation with town refundable), payable to <br /> boundaries boundaries (if applicable) and department staff the Dane County Treasurer <br /> I certify by my signature that all information provided with this application is true and correct to the best of my knowledge <br /> and understand that submittal of false or incorrect information may be grounds for denial. Permission is hereby granted for <br /> Department staff to access the property if necessary to collect information as part of the review of this application.Any <br /> agent signing below verifies that he/she has the consent of the owner to file the application. 217/21 <br /> Owner/Agent Signature /I— L-1thc----- Date <br />