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CYliti <br /> 6 <br /> Dane County Department of Planning & Development <br /> J,. : - Application for Density Study Report <br /> pa9 <br /> scorls <br /> Date: - iy -f`1 <br /> Landowner information: <br /> Name: ,°i PN ek j ohA$0 Ai <br /> Address: 759( (Z ,vQ.rs'iclL&City: 00-rc)A� Zip Code: S3iS?3 <br /> Daytime phone: <br /> Fax: E-mail: <br /> Applicant information (if different from landowner): <br /> Name: G f Qk S c.,..co cc c <br /> Address: "7 ci 3s /f M er z r City: U e_(`c)r Zip Code: S 3 Sy 3 <br /> Daytime phone: (09; 7(, (9 l 3 fi <br /> Fax: E-mail: b redSpa\coo@ o I .CcM <br /> Relationship to landowner: 4c 0.Q c 1-C.._(1) 0- 4C)r 4 o (�u p r LC ce<e <br /> Are you submitting this application as an authorized agent for the landowner? Yes U No <br /> Property information: 1�e t lu� 53c7-) <br /> Property address: of 9 1 R i JQT Side 10 a <br /> Parcel ID#: (3€ 0Ss 3 i ).. `d50Li <br /> Legal description of property: <br /> /J k) 1/4 of N 14 1/4, Section 3 I ,Town of ve-POt,c. <br /> OR <br /> Certified Survey Map ID: Lot See_ Qh0pst Ste" )Qq <br /> Sketch map provided? Yes 0 No 0 <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 0 <br /> Don't know • <br /> l cu a- o A. o r- roc p 0 /4 04 cR S `� <br /> Comments: ,{- <br /> -4-- e 5 pcc) c,ndp LPcxelc.9 ( < k-� fc <br /> Knot,' Lo 1- 7 cam„ 5 p(s 4- o- ---F , SP 44 <br /> 'a red Sczglce,c,_ <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 />