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O <br /> `-� Dane County Department of Planning & Development <br /> 9 P <br /> _ii;4014 V Application for Density Study Report <br /> i�Cot4 <br /> Date: it 14) It <br /> Landowner information: <br /> Name: R► chard Tho irr i c d r) <br /> Address: aa-( $ pyre so ,n ga City: NA c Fax lair,d Zip Code: 5-3S 5 g <br /> Daytime phone: to o g - as S -5-to pa <br /> Fax: E-mail: fl■ and t o 10 <br /> Applicant information (if different from landowner): <br /> Name: RUN\ (x)i S Gn Coto v!U l anal,-c s u t,c c c S <br /> Address: ►'S 'f/ $n wS F■b9 c CA" City: Jc.r o n Zip Code: y'3 S9 3 <br /> Daytime phone: tp DX- I i¢ — (,1►f-7 <br /> Fax: &$ E-mail: p uw i Jen 4-cis . <br /> Relationship to landowner: R.c4 a r <br /> Are you submitting this application as an authorized agent for the landowner? Yes t/ No <br /> Property information: <br /> Property address: N 6V'u. t'A J a:j a.b I c <br /> Parcel ID#: 0 I - a 3 a- 9 310 -X <br /> Legal description of property: <br /> Ail) 1/4 of AM 1/4, Section a3 , Town of burl n <br /> OR <br /> Certified Survey Map ID: Lot <br /> Sketch map provided? Yes No X <br /> Additional information (optional): <br /> Name of owner of original farm (if known): Tirityylo S on <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 Reg. of Deeds Doc.No"(if known) <br /> No X !. <br /> Don't know <br /> Comments: <br /> NOV 9 1 2016 <br /> nr, <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 />