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' Dane County Department of Planning & Development <br /> a. Application for Density Study Report <br /> Date: 3_1_41_0133m_ <br /> Landowner information: <br /> Name: 6\961- <br /> Address: ,16 kiix pa\g City: CQ,,,n `,SlQ Zip Code: 535 a3 <br /> Daytime phone:MO 57‘-8047 <br /> Fax: E-mail: :3 c is \1c tob't <br /> Applicant information (if different from landowner): <br /> Name: 5j4@%*& lo \50e\ <br /> Address: '.\3 Akktik sk. City: a„,„bc 0,c e Zip Code: 5-35a3 Daytime phone:C(o©�)5!(,, - 7151 J' �� <br /> Fax: E-mail: O\tl\A5CAN //W <br /> 0G CAvg.-itcvvtA <br /> Relationship to landowner: <br /> Are you submitting this application as an authorized agent for the landowner? Yes 0 No 0 <br /> Property information: <br /> Property address: aZTh5 <br /> Parcel ID #: <br /> Legal description of property: <br /> 1/4 of 1/4, Section a- , Town of ( VA-;qAck <br /> OR <br /> Certified Survey Map ID: Lot <br /> Sketch map provided? Yes 0 No e <br /> Additional information (optional): <br /> Name of owner of original farm (if known): Ro'tf)- `3-- \‘‘,4\1:4y-\ <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 /> rr <br /> Comments: - � � t • it' "=tom ■•• <br /> r .. �i,,. �� � .. ��'lsr►'J� �.►►L.�,! l lam►. � '�► !�FL�:L'P1�7 .I„ti <br /> 1► 1 1 <br /> 11�J <br /> 0 <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 />