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Dane County Department of Planning & Development <br />Application for Density Study Report <br />Date: S 1\s\v-\ <br />Landowner information: <br />Name: <br />Address: City: Zip Code: <br />Daytime phone: <br />Fax: E-mail: <br />Applicant information (if different from landowner): <br />Name: .\,\,,\ (No.c.kN\5 <br />Address: "IRO r1\etgNe «e1 A City: b-cit„n Zip Code: 53-11cl <br />� Daytime phone: b- au- a`n 6 <br />Fax: bC1k -3.q\ -aoq.0 E-mail: .\,.\,,c,c-kc\% c4N,,,,,•\c• . vIe <br />Relationship to landowner: 1,3r ,Aixv&� >4., pputiN\c.,<r \\ ,L1,0\ tL-3 `.,-,\c c, \Novc5e <br />Are you submitting this application as an autliorized agent for the landowner? Yes No ✓ <br />Property information: <br />Property address: e15Fs C �,.r\� H;y�,, rh'\,N" \oA,z;,,N e. ecjor' <br />Parcel ID #: c_mal 0S(Sk\3 a,\� <br />Legal description of property: <br />ME. 1/4 of 5E 1/4, Section k3-`"D-1, Town of <br />OR <br />Certified Survey Map ID: Lot <br />Sketch map provided? Yes No <br />Additional information (optional): <br />Name of owner of original farm (if known): <br />Are there any recorded agreements, liens, deed restrictions, easements or other legally binding <br />documents that would affect the number or distribution of potential building sites on the property? <br />Yes Reg. of Deeds Doc. No. (if known) <br />No <br />Don't know r/ <br />Comments: TR5 \c,aNc & - \();.,_\ o \N>vse . So t �N-k`' <br />�O r�\ !� r,p� �I'%1\cs t\,\ AS (iSC flv-� k \cc�c�e\. \ �n <br />-\V,,^rt COS'N \O.N.A \ Lk..^ VX73,4 04\ v�C� <br />v <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 />