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r,° <br /> tti <br /> Dane County Department of Planning & Development <br /> Application for Density Study Report <br /> •o <br /> Date: 6 - O- go ( (-( <br /> Landowner information: <br /> Name: G e, o <br /> Address: o�r,1g'1 A5 A � City: j`'lcc-Z0itt,ct1PZip Code: 5116-C,O <br /> Daytime phone:(6 O5' ,.c7,7 A o <br /> Fax: ^ ✓ E-mail: <br /> Applicant information (if different from landowner): <br /> Name: S tk, M 'Q <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 /> AlProperty address: C.� .5J A5 is e►'t r. _2.01.4.-t cam,t r P_ C%—� y Y Ci <br /> Parcel ID #: o`. C o h,f 519,/,,u5 • O YO 7-O&/ - rec,0 - l c4- k XO7-ex,/ - YFoci _ y <br /> Legal description of property: S w GI05e A x out S TO t- s <br /> 1/4 of 1/4, Section , Town of 8 es-c- y <br /> OR / <br /> Certified Survey Map ID: Lot <br /> Sketch map provided? Yes 0 No 0 <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) /143 16 cj/ - <br /> No 0 <br /> Don't know '® 5`33 veek <br /> Comments: r w o u l k t;l� �d''Cd,�fi(04,j 1 s�l c t5 t <br /> Cof‘,11-if b(>5 So t t wa� 1i b e a0/'ioJ p (v5 -1-lic �!t' <br /> IA o - �_i , N a w+v I . 't o o T' I w 71 o C.L. <br /> VagcL O.. c Srh,c..e AA: not a C..±Q(4.117 y '.1S (J To 5f T .1) <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 />