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r. Dane County Department of Planning & Development ti Application for Density Study Report sCOA Date: l- Landowner information: Name:P ,A n)e Zip Code: 635 7y Address: uT T City: Y ld-e p o a : Z Daytime p one: ,vr6-�l3-7 - 3/ & 1--1- S h e_• E-mail: - fib Fax: Applicant information (if different from landowner): Name' City: Zip Code: Address: Daytime phone: E-mail: Fax: Relationship to landowner: Are you submitting this application as an authorized agent for the landowner? Yes No Property information: Property address: / - s. �7��vc6 c�75 �-3S7Z - w , Pd Parcel ID#: _>5-6 o to • -4030 - Legal description of property: of �'' �o �J 1/4 of N g 1/4, Section Town, 'I D� OR Lot Certified Survey Map ID: Sketch map provided? Yes No Additional information (optional): Name of owner of original farm (if known): !^ n o, Are there any recorded agreements,liens,deed restrictions,oten al bu'lldi g sites on the property? y binding documents that would affect the number Reg. of Deeds distribution Doc.No. (if known) Yes No � Don't know Comments: Please allow 3-6 weeks to process your request. A copy of the report will be mailed to the landowner, the applicant(if different from the landowner) and the town clerk.