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<•,`' t� Dane County Department of Planning & Development <br />Application for Determination of Parcel Status <br />rl- <br />3'Ct7ii4s1 <br />Date: cam' J Li' c - ? <br />Landowner information: <br />Name: ©tek.. a (d L J <br />Address(02.2.Q / 4-1- 1 o IC City/114'2v I fe Zip Code: .c7j S---� 0 <br />Daytime phone: 6O4 —7 IS - Z 4154 <br />Fax: E-mail: <br />Applicant information (if different from landowner): <br />Name: <br />Address: City: <br />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 poi le): <br />Property address: /0Z2. �/ /144' 5oi !Z i /144 Ze��►'t-�n�'e L ����� <br />Tax Parcel ID#: 03 OnO6- 33 - q 7SCE-Z <br />Leal description of property: <br />S t 1/4 of S. ial 1/4, Section 3, Town of A 4 Zorn i e OR <br />Lot(s) , Block , Plat of <br />Sketch map provided? Yes No <br />Additional information (optional): <br />Name(s) of previous owner(s) (if known): <br />Comments: 'Tv y,'-t q e-J- Zoe r..i per VW,a 4- .to Ye(pu� <br />Hous f_ O .x. e 61'5^- <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 />