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be-rp -LJ Z01 -°"° <br /> t'' Dane County Department of Planning & Development <br /> Application for Density Study Report <br /> cat4 <br /> Date: �A, . tb4 401 7 <br /> Lane: £)o nform 3 E I <br /> Name: 1 0 <br /> Address: ('p , O o City: V1Jvt-vrJ r4 Kcc... Zip Code: 53, 7 <br /> Daytime phone: <br /> Fax: E-mail: <br /> Applicant information 1i.J(if different from landowner): tiG t <br /> Name: JILL AivtSv i 5v(\Ni C\i,1..1& <br /> Address: 104 $. t4)11,57-64144 66 City: VU ,,,,*$u►_ Zip Code: 53S-9 7 <br /> Daytime phone: (,c -,255-57 <br /> Fax: E-mail: v20e y/v16, <br /> Relationship to landowner: /}(,L.J <br /> Are you submitting this application as an authorized agent for the landowner? Yes 0 No 0 <br /> Property informati <br /> Property address: <br /> Parcel ID#: GS& ()WA ^0 I Q. - 5w --a 5 <br /> ega1description°Jf property: <br /> 1/4 of N W 1/4, Section ( ,Town of S?(Zr►S(2 f 1 <br /> OR <br /> Certified Survey Map ID: 1J ft 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 <br /> Comments: L„)n '�.D {..t AC To C ,t T- I 43 o r L b c AS6 '51 Tr-- C(/ft , <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 />