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• _ Dane County Department of Planning & Development <br /> Application for Density Study Report <br /> Date: 5///7 <br /> Name: 4.57 1 O IC / 4 N do--C' G 0 Lk 4&c fc /•X <br /> Address:/O . City: Zip ode: s3� <br /> Daytime phone: <br /> Fax: E-mail: <br /> Applicant information (if diffe nt from Ia downer): <br /> Name: j 7/ f/fc-G� .� . /t!t ePtiat <br /> Address: C A City: _ Zip Code: Z3 <br /> Daytime phone: / Agg Z <br /> Fax: , • , Z iwr gorft w1_ a4sv w <br /> . Co t . <br /> Relationship to landowner: E.- 1 - ' <br /> Are you submitting this application as an authori ed agent for the landowner? Yes No_ <br /> Property information: <br /> Property address: 5e 'e- <br /> Parcel ID#: <br /> Legal description of property:1/4 of 1/4, Section , Town of 0411-4.57;}1/0 <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 0 0 <br /> Reg. of Deeds Doc.No. (if known) <br /> No <br /> Don't know <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 />