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O - 0 <br /> Dane County Department of Planning & DeveioCE1N/ <br /> .' y Application for Density Study Report <br /> NCO, <br /> FEB 1 0 2017 <br /> Date: Cb . 2W* PANE coin PUNNING&DEVELOPMENT <br /> Landowner information: <br /> Name: <br /> Address: 1033 +-k-tASP\ City: nr\t� wAr\LACE. Zip Code: W t S3 b <br /> Daytime phone: joo$ - 'c S-44t 9 �- <br /> Fax: E-mail: /NA-P1-12..`C 6n I3 SG D <br /> Applicant Information (if different from landowner): <br /> Name: <br /> Address: City: Zip Code: <br /> Daytime phone: <br /> Fax: E-mail: <br /> Relationship to landowner: <br /> Are you submitting this application as an authorized agent for the landowner? Yes 0 No <br /> Property information: <br /> Property address: (,323 . iY1��Z �v��-1 r�1 I,.� S 3 5( c <br /> Parcel ID#: 03o-1- - O b Z <br /> Legal description of property: <br /> (\f 4■ 1/4 of N in.‘.) 1/4, Section Ob ,Town of Be:R l?�t <br /> OR _ <br /> Certified Survey Map ID: Lot Ls3 RR )OJJO) 1$ <br /> �r°v�].�S MEt LL�� 1��> <br /> Sketch map provided? Yes 0 No ® � ' <br /> P-kuL_ CAE r ILL 'S (1 3 <br /> Additional information (optional): L+ 5wrJ mgt LLt. (NJ <br /> Name of owner of original farm(if known): T kk ZRGE NaE Oc-A6-G) <br /> Are there any recorded agreements, liens, deed restrictions, easements or other legally binding <br /> documents that would affect the number or distribution of potential building sites on the property? <br /> Yes • Reg. of Deeds Doc. No. (if known) <br /> No • <br /> Don't know 0 <br /> Comments: M 42,E $ 1 u C. SE 1, 15.2. E Piz L corms <br /> J 2.1 oN Sic PT, �t , Ivly�r R�c�R c �t�P i_ \ <br /> IZeCc-I R bs , FA C. �P'i � - k 1 50 <br /> PkF-N1 t -1--iE A-►J r Cj-N P kc v <br /> Please allow 3-6 weeks to process your request. A copy of the report will be mailed to the landowner, <br /> the applicant(if different from the landowner) and the town clerk. <br /> c-9h5ov 2ot -- 00010 �� r�2 <br />