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RECEIVED <br /> Dane County Department of Planning & Development <br /> Application for Density Study Report NOV 2 2 2016 <br /> 1839, .= <br /> DANE COUNTY PLANNING&DEVELOPMENT <br /> Date: // - -, V / C. <br /> Landowner information: <br /> Name: /A v v I c e) c Y� <br /> Address: _ •. ,;ty: Zip Code: c135:z 7 <br /> Daytime phone: -9-77_? 6 ■ <br /> Fax: E-mail: e,s- z <br /> e C►''t c -v c a iviL h G CS <br /> Applicant information (if different from landowner): "C'fyrj <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 /> a'l ll-052- 8000- 5, of ll -05 95-01- 0 <br /> Property information: <br /> Property address: : - / /4GI2 E" dill-061-esoo-1 <br /> Parcel ID#: <br /> Legal description of property: <br /> 1/4 of 1/4, Section C-F( , Town of (co t+ U71- <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): E ti rye `C r'l C 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 iv <br /> Don't know 0 <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 />