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•fir- " !) <br /> Dane County Department of Planning & Development <br /> Application for Density Study Repo, <br /> iElf ' <br /> . 4 l / 10 <br /> OUVtvelOt <br /> C • <br /> Date: cb. t 7 016 14 <br /> Landowner informatio • n M <br /> Name: .166. £i1.9. moo f e -h �e A. Moore <br /> Address: 394/5 5140.cc14 T 'rai l City: Mi ff Zip Code: s356 o z <br /> Daytime phone: (Q jy-a(7-A,12 5 <br /> Fax: 7- 65 - ro Q4 E-mail: dujimano re a f',hP r�Yl. (�I GC,edLt, <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 0 <br /> Property information: <br /> Property address: <br /> Parcel ID#: o8d 7- 75m - <br /> Legal description of property: <br /> N'\ 1/4 of $E 1/4, SectionaM Town of -3errc� <br /> OR (l <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 © O Reg. of Deeds Doc.No. (if known) <br /> No <br /> Don't know <br /> Comments: ( <br /> Der Wave S .tQ MIffe■� D a c.y, lica_ BllS 1S -Poi- <br /> -/ I. - . • O8O <br /> , 2.% .11* - <br /> �� ecims; bJe cxxvia. (f Clatc ft, be, CO CO OS idere24. iltQEte?C'• <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 />