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Q ' Dane County Department of Planning & Development <br /> Application for Density Study Report <br /> LIP r <br /> aCeli <br /> Date: /0 17- 1 <br /> Landowner information: <br /> Name: a Z j <br /> Address: d` City: Zip Code: S.–3 c6 <br /> Daytime phone: I d -O 3s- <br /> Fax: 1 c, , <br /> E-mail �j a� ,�,� i{�,jZ j,rd'e�;rLW • ''"��y', ( <br /> Applicant�infor�mation (if different from landowner): <br /> Name: `: r..c ^( �IJY <br /> Address: ag 7 O �1 4 /1 City: /S Zip Code:_-35 7-L <br /> Daytime phone: ��`j—, _ t <br /> Fax: E-mail: �5S,,veyu-,✓ hcf�t.b u v Y 1'44, S • C <br /> Relationship to landowner: <br /> Are you submitting this application as an authorized agent for the landowner? Ye No d <br /> Property information: <br /> Property address: 1155 /-/ ' 9 1' -vat tr- <br /> Parcel ID#: 0 bO 2 3 / 9600 -4 <br /> Legal description of property: <br /> 1/4 of 1/4, Section , Town of V -o.if <br /> OR <br /> Certified Survey Map ID: Lot <br /> Sketch map provided? Yes p 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 O Reg. of Deeds Doc. No. (if known) <br /> No <br /> Don't know Q <br /> Comments: <br /> I <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 />