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,i0C/at e/V-,2f7/3 -000 i43 <br /> r , <br /> 0.: j <br /> 0' yrm.! Dane County Department of Planning & Development <br /> r. ire <br /> Application for Density Study Report <br /> Date: <br /> Ms. Ddrothea Kermicle <br /> Landowner information: 4261 Cleveland Rd. <br /> Name: Cross Plains,WI 53528 <br /> Address: .-_ d Code: <br /> Daytime phone: 6 C,f' 7/t- Zv 7 4 <br /> Fax: E-mail: _'k /44-t- <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: .414'v <br /> Parcel ID#: c -c - 132 — c)(30- } ! 0903- - - SYSO- 3 <br /> Legal description of property: <br /> 1/4 of 1/4, Section /3 , Town of _<' j t )f�:'' <br /> OR <br /> Certified Survey Map ID: Lot <br /> Sketch map provided? Yes 0 No 0 DEC 5 2013 <br /> Additional information (optional): <br /> Name of owner of original farm (if known): <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 0 Reg. of Deeds Doc.No. (if known) <br /> No <br /> Don't know <br /> Comments: <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 />