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DC PpEN- aoi4-6003 q ( ci 8a <br /> r "'wit 1.094,1 ‘1 <br /> o�. is <br /> Dane County Department of Planning & Developme�@ECEIVED <br /> 4; <br /> ` c Application for Density Study Report I I v <br /> AUG 1 2016 <br /> Date: ii 11‘ <br /> DANE COUNTY PUNNING&DEVELOPMENT <br /> Landown r nformation: <br /> Name: . rife ` S17t S uc- <br /> Address: g63L OQ.L5eLs WIN City: 142o,04- Zip Code: 53973 <br /> Daytime phone: (,b$ 3513- 12-&7 <br /> Fax: host - 4i7 . #( E-mail: Art t 500 ho 1-01111 . at^ <br /> Applicant information (if different from landowner): <br /> Name: 'O/NI et Gk 54.1 S <br /> Address: City: Zip Code: <br /> Daytime phone: <br /> Fax: E-mail: <br /> Relationship to landowner: 14dn /115X . <br /> Are you submitting this application as an authorized agent for the landowner? Yes No <br /> Property information: 1`_ <br /> Property address: .CI 2-4f l IW C- 1 o . <br /> Parcel ID #: 4111= 391 - 8002-0 0711 -2-4 -- $5ob-O, olt(-tiet -4. -7� b?(( - Zo3 - gam)-a) <br /> oltt -ZO3 -$ ?-7� 0111 -703- 8‘,1 -2.. 07u( -laz-- ` 000-( 0 7/1 - Zot - 45'20 -L <br /> Legal description of property: ' � l <br /> 1/4 of 1/4, Section , Town of Coo ( ___ • L' '2.q 3, 21- <br /> OR <br /> Certified Survey Map ID: Lot <br /> Sketch map provided? Yes No <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 Y Reg. of Deeds Doc. No. (if known) <br /> No w 1(p Cog rmAcr bb- 5F-148 -41-0062-9 <br /> Don't know <br /> Comments: iitYlL RrS rbo 1 gad utA) f f444.1- l S k DOSS; `j,,LT 4- h Ids <br /> St C Mimi. o f((- Zo 3 Soon MI_ SE 1/e.. _ <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 />