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o <br /> v} Dane County Department of Planning & Development <br /> 1 <br /> Application for Density Study Report <br /> Date: L i k, <br /> Landowner information: <br /> Name: �C -� 11— 1�� �y� 1tiJ,e;Sr.an <br /> Address: 1 -12 ANN A sck City: ('A,,,.,,,,,` S Zip Code: S39255 <br /> Daytime phone: q-la2qu•cx 2c) <br /> Fax: E-mail: <br /> Applicant information (if different from landowner): <br /> Name: T v d k Er:4A E We,Sc n <br /> Address: N 111\ ex),vve_ City: C�.,1,,,,, \c s Zip Code: S 2 V <br /> Daytime phone: eciev. 'j20 29 I. ?_��q- N/ ci 1223 4q06 <br /> Fax: E-mail: rL-we_.scvatNL h a\ .com <br /> Relationship to landowner: Z <br /> Are you submitting this application as an authorized agent for the landowner? Yes 0 No <br /> Property information:, <br /> Property address: 3C-,n'+ have_ an akkrfx,s, h-4 ;c, 0A �L't c ��r�l,,�•u �S� <br /> Parcel ID#: 0-10 � o�1�- ►2. u000 <br /> Legal description of property: <br /> NE 1/4 of i J 1/4, Section l2 , Town of '(,Dr <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). 1[ASS (1 J kwif\i Y <br /> Are there any recorded agreements, liens, deed restrictions, easements or other legally binding t <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: - I be 1.t e Ni e, Ay-01w- yACCMCt(I (1 eO etas-1, <br /> • - - ..: . • : - • - , -- any <br /> • <br /> of-lan4 •eeci, --the bu - c-- elo-ca - .o (-(D-�- 04er livc- <br /> Please allow 3-6 weeks to process your request. A copy of the report wi I be maile to the 1.ndowner, <br /> the applicant(if different from the landowner) and the town clerk. <br /> IO- ►one_; Aitt\I \ E ZSq Vsper Ra, 1c4, <br /> Di o Cci 12-1 tie--(B was -i-1 le-r-4-tevz. S` capAL <br />