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Dane County Department of Planning & Development <br />Application for Determination of Parcel Status <br />Date: 7-/c - 0 7 <br />Landownermform 'on: <br />Name: /f �� / -ec/'e— <br />Address: 17 er el.._ City: -/ -' Zip Code: 5353/ <br />Daytime phone: 6 or- Vim`/ 6- <br />Fax: 6" S Cr( SC Y 3 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 pos�s,�e�le)/ 7 <br />Property address: ?��/b.'q� , l%y ra., <br />Tax Parcel ID #: -) 2/6 5/ — 02 /% - r,SOU - <br />Leal description of property: <br />Leal <br />1/4 ofi/L4) 1/4, Section <br />, Town of /1�61vn 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 />S:\PlanDev\Zoning\ZLR\Forms, Applications & Informational Materials\Parcel status application.doc <br />