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s � <br /> •r <br /> Dane County Department of Planning & Development <br /> Application for Density Study Report <br /> s <br /> Date: S / /f <br /> Name: i 3 a.fL' OIC ffrt /Lo N /moo dam ' G 0 /,vi AvAL4 c 1 i <br /> Address:/O City: Zip ode: <br /> Daytime phone: <br /> Fax: E-mail: <br /> Applicant information (if diffe nt from landowner): <br /> Name: /n/ .b n410/ <br /> Address: - C City: gof !7 L Zip Code: z3 <br /> Daytime phone: <br /> Fax: r , Z IM9X4r /J.' ! '' 1444). Co `v► . <br /> Relationship to landowner: � ' <br /> Are you submitting this application as an authori ed agent for the landowner? Yes No= <br /> Property information: <br /> Property address: 5e J <br /> Parcel ID#: <br /> Legal description of property: .� <br /> 1/4 of 1/4, Section , Town of 0-111-1.5//J <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): <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 <br /> Don't know tti <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 />