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1 <br /> Dane County Department of Planning & DevelopmentRECE1VED <br /> Application for Density Study Report <br /> OCT 242016 <br /> Date: f o/?jA,o/ DANE couNT1PL4NNlNG <br /> &DEVI:La:MENT <br /> Landown information: <br /> Name: goN A L S /2� DT -- ,i4Arl(G✓S /T <br /> ?'1ie- <br /> Address: / 9 71e S,4,i T All 126 City: 476.1 Zip Code: 3 S-89 <br /> Daytime phone: (0012 Z. 9 -7' 6 9 <br /> Fax: E-mail: f ZNA-1454aft-4.Q �4Aao . co/in <br /> Applicant information (if different from landowner): d <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: 1 <br /> Property address: /99" treAs, Wr /A/b ee 5Toc�g�T tJ, 5-.5,521 <br /> Parcel ID #: on - c St I - 022, -Q2.0D -le <br /> Legal description of property: <br /> 5 t4.1 1/4 of N W 1/4, Section 2 , Town of bk.IN lc/ <br /> tik-- <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): (here—. <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 <br /> Comments: , /L''., 1S-Oo I jrt.4CiT 6o7S <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 />