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1,; is of i <br /> _ Dane County Department o� Planning & Development <br /> ,', -.? Application for Density Study Report <br /> f4' <br /> i t , 1` 1 <br /> Date: 4 -/----4-) <br /> Landowner information: / <br /> Name: Dcrwa-c_D .?&i U5ori/ <br /> Address: I t,05 i'al)� Zip Code: �p 7 <br /> l�7� G��ur N�it1 City:�� <br /> Daytime phone: 6 n e 0 7 5 S. 6 '0 <br /> Fax: E-mail: <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 No <br /> Property information: <br /> Property address: <br /> Parcel ID : OS[a.— o7Z. - 961( _ S <br /> �Lregal description of property: <br /> .JW 1/4 of NW 1/4, Section 7 , Town of Az-570A) <br /> OR <br /> Certified Survey Map ID: Lot <br /> Sketch map provided? Yes No <br /> Additional information (optional): 1 <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 • Reg. of Deeds Doc. No. (if known) <br /> No <br /> on't know <br /> Comments: <br /> F <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 />