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„OA'. • Dane County Department of Planning & Development <br /> Application for Determination of Parcel Status <br /> 4 e <br /> oor <br /> Date: L' q,oe Receipt # <br /> Landowner information: II <br /> Name: id-, 11)t- 1 ��c.(cr J <br /> Address: /,, P I City: &I rut Le_ Zip Code: r33J"7? <br /> Daytime hone: S74 -G4 s <br /> Fax: (99-$001 9 E-mail: <br /> Applicant information (if different from landowner): <br /> Name: <br /> Address: City: Zip Code: <br /> Daytime phone: <br /> Fax: E-mail: <br /> Relationship to landowner: <br /> Are you submitting this application as an authorized agent for the landowner? Yes No <br /> Property information (be as specific as possible)/: / <br /> Property address: C. Yo)7 N y r/.r Ged 1.J4 e,k,4,, eal- <br /> Tax Parcel ID #: I 050 6 -3-5-41' 91/3s-- (o <br /> Legal description of property: <br /> S W 1/4 of SC 1/4, Section 3s—, Town of 6 OR <br /> Lot(s) , Block , Plat of <br /> Sketch map provided? Yes No <br /> Additional information (optional): <br /> Name(s)of previous owner(s) (if known): <br /> Comments: <br /> Important Notice:. A Dane County parcel status determination is preliminary in nature and <br /> only determines if a parcel of land was created in accordance with Dane County ordinance <br /> provisions. Additional title history research conducted by a title company may be necessary to <br /> verify parcel status. Dane County and its staff are not responsible for any misrepresentation or <br /> mischaracterization of the information contained in the parcel status determination. <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 /> H:\Zoning\Zoning Division Documentation\Form\Parcel status application.doc Page 2 of 2 Revision 11.26.2007 <br />