Request for Plat Review DOA – Shipping Address: 101 E Wilson St FL 9 Land Subdivision Plat Review Madison WI 53703 Mailing Address: PO Box 1645 Madison WI 53701 Phone: 608-266-3200 Department of Administration Email: Web: Subdivision Name: Surveyor's Seal County: Surveyor, Company & Shipping Address: Name: Company: Shipping Address: Phone: Email: _______________________ Surveyor's Signature Date Complete: 1-7 for FINAL Plats; 3-7 for PRELIMINARY Plats; 6 for ASSESSOR'S Plats; or 3 & 6 for CSMs I certify that, as the Wisc. Professional Land Surveyor responsible for the field survey & preparation of this plat: 1. All monuments have been set per s. 236.15 (1), Wis. Stats. OR All exterior boundary monuments have been set, but the town, village or city has temporarily waived placing interior monuments per s. 236.15 (1)(h), Wis. Stats. 2. Preliminary plat name: 3. Subdivider's name, address, and email: 4. PDF (no scans) OR paper drawing from surveyor. Number of sheets □ 5. Is this plat served by public sewer? Yes No □ 6. Include check or money order covering Department of Administration, Plat Review fee □ 7. DOT: Not abutting a S.T.H., U.S.H. or I.H. OR DOT form enclosed. □ Shaded Area for Office Use Only & Transmittal Record Surveyor’s Receipt Date Received: Date Time Limit Expires: Preliminary Date Copies Sent: Final DOT: County: By: Plat Review Officer Assessor CSM DD-326 (Rev 02/2019) o:\forms\wi_plat_review_form.docx
Request for Land Subdivision Plat Review Department of Administration Plat Review – DOA Shipping Address: 101 E Wilson St FL 9 Madison WI 53703 Mailing Address: PO Box 1645 Madison WI 53701 Phone: 608-266-3200 Email: Web: Subdivision Name: County: Surveyor's Seal Name: Surveyor, Company & Shipping Address: Company: Shipping Address: Phone: Email: _______________________ Surveyor's Signature Date Complete: 1-7 for FINAL Plats; 3-7 for PRELIMINARY Plats; 6 for ASSESSOR'S Plats; or 3 & 6 for CSMs I certify that, as the Wisc. Professional Land Surveyor responsible for the field survey & preparation of this plat: 1. All monuments have been set per s. 236.15 (1), Wis. Stats. OR All exterior boundary monuments have been set, but the town, village or city has temporarily waived placing interior monuments per s. 236.15 (1)(h), Wis. Stats. 2. Preliminary plat name: 3. Subdivider's name, address, and email: 4. PDF (no scans) OR paper drawing from surveyor. Number of sheets 5. Is this plat served by public sewer? Yes No 6. Include check or money order covering Department of Administration, Plat Review fee 7. DOT: Not abutting a S.T.H., U.S.H. or I.H. OR DOT form enclosed. □ □ □ □ Surveyor’s Receipt & Transmittal Record Shaded Area for Office Use Only Date Received: Date Time Limit Expires: Preliminary Date Copies Sent: DOT: County: Final By: Plat Review Officer Assessor CSM DD-326 (Rev 02/2019) o:\forms\wi_plat_review_form.docx
WIPlatReviewForm.docx