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Dane County �______� Application Fees I <br /> �: Department of Planning and Development <br /> General: $395 <br /> U,, t4 Farmland Preservation: $495 <br /> Zoning Division <br /> ,p`ry. - , ,( Room 116,City-County Building <br /> : Commercial: $545 <br /> p_ is.:v ,. , 210 Martin Luther King Jr. Blvd. _ <br /> S . . Madison,Wisconsin 53703 • PERMIT FEES DOUBLE FOR VIOLATIONS. <br /> Ct • 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: Scott and Sara Stoltenberg Agent Name: Williamson Surveying <br /> Address(Number&Street): 6924 Sam Road Address(Number&Street): 104 a West Main <br /> Address(city,State,Zip): Lodi, WI 53555 <br /> Address(City,State,Zip): Waunakee,WI 53597 <br /> Email Address: sstoltenberg @Iodivet.com Email Address: noa @williamsonsurveying.com <br /> ------- — — <br /> Phone*: 608-2190601 608-2190601 Phone#: ,608-255-5705 <br /> PROPERTY INFORMATION <br /> Township: Dane Parcel Number(s): 0908-034-8160-7 <br /> Section: 3 Property Address or Location: 6924 Sam Road <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 II <br /> Attached is the proposed certified survey map and rezone documents for the Scott and Sara Stoltenberg property in section <br /> 3. The family is requesting to be placed on the next available agenda for consideration. This proposed CSM is to create a <br /> new residential lot for their son. <br /> ^ Existing Zoning Proposed Zoning Acres <br /> District(s) District(s) <br /> RM-16 RR-1 2.0 acres incl. RNV <br /> 1.86 acres excl. R/W <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 /> I Scaled drawing of I9 Legal description ❑Information for ❑Pre-application U 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 h sh- .: the consent of the owner to file the application. <br /> Owner/Agent Signature ( - Date 7 /2-7/ZoZZ- <br />