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Dane County Department of Planning & Development <br />Application for Determination of Parcel Status <br />00140 <br />Date ;i 0 o 7 <br />Landowner in#orma ion: <br />Name: /CAft 1I /2 /CC/Z_— _ <br />Address: ,5 ,SC Q&D(F J-hJ City: -� Ut�Z.r41/-04yZip Code: 35 <br />Daytime phone: &0,1 k -3.51-6 <br />Fax: 60 t L '73 6 E-mail: Q - sisz is %2 IV/ 5111, CO kg <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 swcific as possible): <br />Property address: 6,2 6 N /4 6 5 17 <br />Tax Parcel ID #: �O ��(� a — 3 Sze{— 993/5-- <br />Legal description of property: <br />1/4 of Si, 1/4, Section 35/ , Town of J B/0 &`.. OR <br />Lot(s) , Block , Plat of . <br />Sketch map provided? Yes X No <br />Additional information (optional): <br />Name(s) of previous owner(s) (if known) 0 %� Pl elS(m o k,D - . <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 />