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Dane County Department of Planning & Development <br />Application for Determination of Parcel Status, - <br />Date: tI-Z8-Zoo2-- <br />Landowner information: <br />Name: OE oeq Ctt E. C 2_41..YLEl?( <br />Address: `{ 19 U coocA30 City: >• 1 to c 1 S a p Code: t 5 53 i 1 <br />Daytime phone: �� 1c1� ` <br />Faxes" <br />Email: <br />Applicant information (if different from landowner): <br />Name: 1L 1 3 S C A C t _i C A <br />Address: City: Zip Code: <br />Daytime phone: 0' - 9 U84 <br />Fax: E-mail: SCh t.t 4 ( G) • d cz ;.ti t <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: 4119 00 v LA ,`, , 2 lap <br />Tax Parcel ID #: O 1 D' O E3 Z- Cv 317 7 <br />Legal description of property: <br />61/4 of tip= ' 1/4, Section , Town of D u 1 ti OR <br />Lot(s) <br />PAk <br />, Block `? , Plat of /-\ S S S S n r .5 PAT *( <br />Sketch map provided? Yes No <br />L�ci/tir" <br />Additional information (optional): <br />Name(s) of previous owner(s) (if known): i c c t e ((E. b e 1. Pi - o <br />Comments: [ Ao p.£-4 c_ 4- 3I S-g e {- 'ct <br />d oc.Gt ea <br />Price: $100 <br />(Effective: 1-1-08) <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 />