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' ` h Dane County Department of Planning & Development <br /> RECEIVED <br /> Application for Density Study Report <br /> SEP 1 2 2016 <br /> Date: 'WC <br /> DINE COUNTY PLANNING&DEVELOPMENT <br /> Landowner information: <br /> Name: T J Rc G�- <br /> Address: I a L-(7( 4.6,11-4_ Si-, City: -(`y,,,,,„f„#L._ Zip Code: 5 1-i8 17 <br /> Daytime phone: <br /> Fax: E-mail: <br /> Applicant information (if different from landowner): <br /> Name: A-c-e.•( ,ck, z i e. <br /> Address: Si 1 „k,,.,4 Lam. City: ti-er .)et, Zip Code: .Code: 4p S s s93 <br /> Daytime phone: Cog 9%t7 ?at( <br /> Fax: Gob 8K8 Coi3 E-mail: . 7f-t. cfz.T -ca-, <br /> Relationship to landowner: <<�K� ,,( Kau-- Coe t4 <br /> Are you submitting this application as an authorized agent for the landowner? Yes 0 No <br /> Property information: <br /> Property address: `t )o 8 Gretel w€Id Rol. Ott 1-[ors b Li..)J- <br /> Parcel lD#: o %704-a 3 N - 1000 <br /> Legal description of property: <br /> 1/4 of 1/4, Section ,Town of <br /> OR <br /> Certified Survey Map ID: Lot <br /> Sketch map provided? Yes 0 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 0 Reg. of Deeds Doc. No. (if known) <br /> No <br /> Don't know L' <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 />