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r <br />Dane County Department of Planning & Development <br />Application for Determination of Parcel Status <br />cos <br />Date;/' / /O 7 <br />Landowner int9rmaion: <br />Name: S( Jc R!Aila 1� <br />Address: <br />Daytime phone:. 7 t <br />Fax: 60 ,5? ,3 9136 <br />Si ckeiz, <br />City:Zip Code: •- 3s — <br />E-mail: CPI- 572 is %2 e e <br />y115jv, C0Wl <br />Applicant information (if different from landowner): <br />Name: <br />Address: City: <br />Daytime phone: <br />Zip Code: <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 spg.cific as possible): <br />Property address: ( FS -D <br />Tax Parcel ID #: nD P,!'.S/a - 3 93✓5-- <br />Legal description of property: <br />1/4 of 5� 1/4, Section 3 5/ , Town of A i 3/0 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): <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 />