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City of <br /> Department of Planning and Development <br /> Madison Planning Unit <br /> rMadison Municipal Building <br /> 215 Martin Luther King Jr.Blvd <br /> �_ Madison,Wi 53701 266-4635/FAX267-8739 <br /> InI Extraterritorial Plat and Land Division Application <br /> Type of application: <br /> Date: <br /> ❑ Preliminary plat (name ) <br /> ❑ Final plat (name ) <br /> ❑ Certified Survey <br /> ❑ Moving a lot line <br /> Address of property: <br /> Legal Description of Property (township, range, section, 1/4 section): <br /> • Number of lots: current proposed <br /> Size (in acres): <br /> Existing Zoning: <br /> Proposed Zoning: <br /> Proposed land use (list for each lot): <br /> Date approved by County: Date approved by Town: <br /> Owner of Property and address: <br /> Applicant is: <br /> ❑ owner of property <br /> ❑ contractor, builder <br /> ❑ other, please explain <br /> Applicant's phone number: <br /> Signature: <br /> 1 <br /> Date accepted staffperson <br />