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(.7' ` Dane County Department of Planning & Development <br /> Application for Density Study Report <br /> J0 .1 <br /> ,Co <br /> Date: 7, / /J <br /> Landowner f rm tion,� <br /> Name: �r v1P4 --�- / — <br /> l U 'E- G C( /. /j1 e5 <br /> Address: 41/ • . 1 , ity: ! Zip Code: • <br /> Daytime phone: � , `f i '04// <br /> Fax: E-mail: ///zr a c a aces N2aA ' Coh7 <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: 4,0 Ge 6I e reeoti <br /> Parcel ID#: <br /> Legal description of property: LL <br /> 1/4 of 1/4, Section , Town of 5,e6 4714Aeei /✓/175 <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 © Reg. of Deeds Doc. No. (if known) <br /> No 0 <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 />