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o <br /> k Dane County Department of Planning & Development <br /> Application for Density Study Report <br /> 4C <br /> Date: 5///7 <br /> Landowner information: // / Q LA-L4 Name: tJ7 a,it o,' /it 4o N Cie ct o-- G 0 •�. <br /> Address:%O , 74. City: Zip ode: ,S-X,S” <br /> Daytime phone: <br /> Fax: E-mail: <br /> Applicant information (if diffeRnt from landowner): <br /> Name:p7/c ett,,oP" <br /> Address: • e City:P, 44,4a te Zip Code: Z.3 <br /> Daytime phone: e , Z.3 3 Z Spy <br /> Fax: r Z (� E-mail: /'- i Nti' 14441. Co Nit . <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 `e- <br /> Parcel ID#: <br /> Legal description of property: <br /> 1/4 of 1/4, Section , Town of Ci411,s729t)t1rt <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 Reg. of Deeds Doc. No. (if known) <br /> No <br /> Don't know kV <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 />