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Dane County Department of Planning & Development <br />Application for Determination of Parcel Status <br />ti 4 <br />0740 <br />Date: n1,a510-) <br />Landowner informatiRn: <br />Name: e 101.0 <br />Address: „. 1 q Lc 6 City: ©t'ppKl n Zip Code: 5-35 & <br />Daytime phone: L D� a -) : % Li On or (0 % 1 055 <br />• <br />Fax: E-mail: <br />j(,1 2 6 2007. <br />DANE COUNTY PLANNING & DEVELOPMENT <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 assspeciifi c as possible): <br />Property address: <br />Tax Parcel ID #: (10 9 — 3 3T e / ) ( 0 - 9 <br />Legal description of property: <br />5W 1/4 of 51.4 1/4, Section :33, Town of 0 re-9 0 f OR <br />Lot(s) , Block , Plat of <br />Sketch map provided? Yes )( No <br />Additional information (optional): Name(s) of previous owner(s) (if known): DO ► j� <br />�G De r rnoji <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 />