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• <br /> r 13 Dane County Department of Planning & Development <br /> V , -. Application for S+4 di <br /> A DC()DEA 20 5 000 25 640 <br /> I <br /> Dat: : 7/S/5— Receipt # 72-2- (Po`, <br /> Lan. • ner information: <br /> Nam=: ,,�S-1.34-*-e O scc S v /e s <br /> Addr:s PO I City: alai/1/.%-e Zip Code: .SL sz 3 <br /> Dayti : phone: (Q (5 `I- Z 3 3 z <br /> Fax: ,c5' C/7_3 /$7o E-mail: iv1/'GliiviGe-Altv�t�'`3(,¢cc>. CQVvi • <br /> Appl c:nt information (if different from landowner): <br /> Name: <br /> Addr:s : City: Zip Code: <br /> Dayti : phone: <br /> Fax: E-mail: <br /> Relati• ship to landowner: <br /> Are y Iu submitting this application as an authorized agent for the landowner? Yes No <br /> Prop- information (be as specific as possible): <br /> Prope address: A e 5 u 7C0 4-6 <br /> Tax Pt r, el ID#: £ e e A (-Ee - - Zz.2-1coo- 6 <br /> Legal di scription of property: <br /> ) '7451- c-�t f 1C &) <br /> 1 4 of 1/4, Section , Town of 1A-421 -I (Z IC OR <br /> Lot(s , Block , Plat of <br /> Sketc, ap provided? Yes f// No <br /> Addi i•nal information (optional): <br /> Name s of previous owner(s) (if known): , d e ,(e 3 ` /e Lt -C441t i 4-7 - <br /> Comme ts: <br /> Impb tant Notice: A Dane County parcel status determination is preliminary in nature and <br /> only d:termines if a parcel of land was created in accordance with Dane County ordinance <br /> provisi s ns. Additional title history research conducted by a title company may be necessary to <br /> verify 'arcel status. Dane County and its staff are not responsible for any misrepresentation or <br /> mischa acterization of the information contained in the parcel status determination. <br /> Please Allow 1-3 weeks to process your request. A copy of the report will be mailed to the landowner, <br /> the appl cant(if different from the landowner) and the town clerk. <br /> http://dcne uploads/imservicerequest/scwl/Parcel_status_application.doc Page 2 of 2 Revision 1.20.2010 <br />