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Dane County Department of Planning & Development <br /> Application for Density Study Report <br /> Date: S / <br /> Name: t J a f S ',c //9/ / o N ,/oi 1 9X <br /> Address:/0 <br /> City: Zip ode: .S3S <br /> Daytime phone: <br /> Fax: E-mail: <br /> Applicant information (if diffeNnt from landowner): <br /> Name:W/ ' G- .� - /C�e2v,10". n <br /> Address: • C City: got i4(4/ .e.Zip Code: <br /> Daytime phone: / kart Z y <br /> Fax: . • , Z. �' l ' •. CD wt . <br /> Relationship to landowner: � r - <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: <br /> 1/4 of 1/4, Section , Town of C41/14.5771 <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 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 />