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• <br /> ..0 .-b REcFivED <br /> � ,i `,1-`�"� Dane County Department of Planning & Developmen <br /> T,n,, . Application for Density Study Report • <br /> cosv JUL Z32013 1 <br /> 1 <br /> DANE COUMY PlANNING&DEVELOPMENT <br /> Date: 7- 2 3 - "'% 3 <br /> Landowner informa 'on:I- <br /> Name: Q o r,rt- .2,J1 r i "1,`? Q r <br /> Address: /b zz S I/w■ /'/ ' City: {y,r20,14,,,,,.„. Zip Code: g3 5 4. b <br /> Daytime phone: 6 .., 2:2-,c- z1 2 Z <br /> Fax: E-mail: • , ,. r; h . , n • , 0/14 <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: /i IN L/ /1/ <br /> Parcel I D#: 'p g06 --/k! , 9 -7a -O <br /> Legal description of property: : <br /> 3 E 1/4 of N f:::1/4, Section ) (0, Town of II &2 c h') 0\ e_ <br /> OR <br /> Certified Survey Map ID: Lot <br /> Sketch map provided? Yes tV No 0 <br /> Additional information (optional): <br /> Name of owner of original farm (if known): S:ct t�i e -Po Y YIA <br /> Are there any recorded agreements, liens, deed restrictions, easements or dher 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: G4e.c if j,Aq -to S9 c? ► C 1- Katie. 2 bLJ,:., 1 0k.iU, 5i14S <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 />