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v11 G <br /> i! V.�� Dane County Application Fees <br /> A-.. • ,. General: $395 <br /> ,`rr w Department of Planning and Development <br /> -4 - Zoning Division Farmland Preservation: $495 <br /> ' 'i,• Room 116,City-County Building <br /> commercial: $545 <br /> f}11,) ..L. 210 Martin Luther King Jr.Blvd. • PERMIT FEES DOUBLE FOR VIOLATIONS. <br /> Madison,Wisconsin 53703 , • ADDITIONAL FEES MAY APPLY.CONTACT DANE COUNTY <br /> (608)266-4266 ZONING AT 608-266-4266 FOR MORE INFORMATION. <br /> REZONE APPLICATION <br /> APPLICANT INFORMATION <br /> Property Owner Name: Sharon Hein Agent Name: Tim Coulson <br /> Address(Number&Street): 7215 Tri County Road Address(Number&Street): <br /> Address(City,State,Zip): Waterloo,Wi Address(City,State,Zip): <br /> Email Address: Email Address: Tim.Coulson@novolex.com <br /> Phone": Phones: 715-505-1810 <br /> PROPERTY INFORMATION <br /> Township: York Parcel Number(s):0912-134-8000-0 <br /> Section: 13 Property Address or Location:7215 In County Rd <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 su.,,. +-._d to correct a violation? <br /> relevant Information.For more significant development proposals,attach additional pages as needed. Yes N No 0 <br /> Create seperate parcel for owner around existing home <br /> Existing Zoning Proposed Zoning Acres <br /> Oiatrkt(s) off) <br /> FP-35 RR-1 1.2 <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 /> NI Scaled drawing of II Legal description O InformatIon for B Pre-application (0 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. <br /> Owner/Agent Signature>1-4‘1\1..e.)--A--. <br /> Date I))AVAAO <br />