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Dane County Department of Planning & Development <br />Application for Determination of Parcel Status <br />Date: (L` // y/G/ <br />Landowner information: ,n <br />Address: <br />Daytime phone: <br />Fax: <br />City: ne1 u <br />3 03 <br />ti JI.• c k <br />ht 11 Zip Code: C 3 5-5-9 <br />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 po ible):1 <br />Property address: 117 C-0 kS /C O p, of <br />Tax Parcel ID #: 0 3 C/ 0 F J Z 3 4'3 — 'eye - <br />Legal description of property: <br />S W' 1/4 of S W 1/4, Section 3 b , Town of <br />r. <br />Lot(s) , Block , Plat of <br />Sketch map provided? Yes V No <br />OR <br />Additional information (optional): � � /+�,r�'� //_ /(fir <br />Name(s) of previous owner(s) (if known): L a Po >~ (r //c [ b <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 />