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A <br />Dane County Department of Planning & Development <br />Application for Determination of Parcel Status <br />cos <br />1 <br />Date:ccevi- /7 07 <br />Landowner information: <br />Name: S'1 V tV . 61 /1/ <br />Address: 619 8 (. City: «. "000-c b Zip Code: S35 7 a <br />Daytime phone: 4G <br />Fax: 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 possible): <br />Property address: 89ig[�- <br />Tax Parcel ID #: ( SO-7 / J 9 % Q !' Z <br />- I ( <br />Legal description of property: <br />SE 1/4 of 5F' 1/4, Section J$ , Town o 1Ve:'cnCo SS OR <br />Lot(s) <br />, Block , Plat of <br />Sketch map provided? Yes No <br />,O AC <br />Additional information (optional): <br />Name(s) of previous owner(s) (if known): <br />CAmments: Jv o. T <br />61e4,1.4 70 <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 />