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vc*pt iv -2o1c -Oooyo <br /> Dane County Department of Planning & Developmen <br /> ,' Application for Density Study Report R CEIVED <br /> SEP 2 6 2016 <br /> Date: qj - 2,( - .2'016 <br /> DANE COUNTY PLANNING&DEVELOPMENT <br /> Landowner 'nformation: <br /> Name: ' ref%1 e h 0.2 <br /> Address: S-�,.2 f ee lIi a Q, '�1 City:W:0 L(.4 Code: 3 4' <br /> Daytime phone: If q .- g 4e - oZ8 a,cf -- c (( 1$ - (3y <br /> Fax: E-mail: 4 c, c I tel./ ctd I• a-r''^t <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 <br /> Property information: nn <br /> Property address: 5,5-00 n „As KQ oete y1, 5.(357C <br /> Parcel ID#: (� <br /> Legal description of property: <br /> 1/4 of 1/4, Section , Town of <br /> OR <br /> Certified Survey Map ID: 711 5 Lot <br /> Sketch map provided? Yes 0 No ® <br /> Additional information (optional): ', / <br /> Name of owner of original farm (if known): Oe Ago s. <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 O Reg. of Deeds Doc. No. (if known) <br /> No <br /> Don't know • <br /> Comments: / ede �Ol O " ( 41''" 1 �` <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 />