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03/10/2008 11:00 608-267-1540 DANE CO PLANNING DEV <br />PAGE 03/03 <br />Dane County Department of Planning & Development <br />Application for Determination of Parcel Status <br />Date: 3— I p - v F Receipt # <br />Landowne information: <br />Name: c 4 L. '1 s.-, L d-e <br />Address: 7 Y PA '9,,, t� g_ A J City: - c J Zip. Code: ,S- 3 J-cP3 <br />Daytime phone: 6.a P- 6 'i 3_ 3 32 / - c X /CP ci.- 6`o. - c 3 - 22q 7 <br />Fax: 6d J -- 6 y3 - 3.2_9 H E-mail: <br />ocp <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 p ssible' ): <br />�$ ®/ Property address: 2y vim e�,,f <br />Tax Parcel ID #: _L� 1 7 0 7 0 73 - M o f <br />Legal description of property: <br />1/4 of 1/4, Section , Town of .OR,RECEIVED <br />Lot(s) , Block , Plat of <br />MAR 1 1 2008 <br />Sketch map provided? Yes No <br />Additional information (optional): OANECOUNTYp,,AIVh;NO&DEI�ELOPMENT <br />Name(s) of previous owner(s) (if known): . ,- - o eh/ , •� <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 w 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 <br />Page 2 of 2 Revision 11.26.2007 <br />