Laserfiche WebLink
05/15/03 THU 08:05 FAX 6082881877 <br />WIS,DOT LAND DIVISION REVIEW REQUEST <br />DT1636 9r2002 <br />MOORE SURVEYING' <br />tJ002 <br />Wisconsin Department of Transportation <br />Land Division Name <br />agRT/F/. 0 sc4R4).y .,'I?,11. <br />_ <br />a Conceptual <br />County <br />•D.4n/ <br />Higf,way <br />0.5. <br />1. <br />5/ <br />D Preliminary <br />secpoNTownlRange <br />• ac, .' , '7r5 AA/ , R // <br />- <br />4 Final <br />Municipatrty or Township <br />7"0rr.'N OF Da,,/, ,RK <br />Submitter Name, Company and Address. <br />r�v V/.V(,, 1LLI <br />41.4 R1� 7-PLdC' OR, 57e IOS <br />_.494PiS0 'f Iel/ .537/4 <br />Area Ccde- Telephone <br />/4. 21z) ; " / qz. 0 <br />FAX Number <br />p,K) .2s5 - �ff77 <br />E-Mail Address <br />oarqcc: Vu_ R ,40L cfr, <br />Land Divider Name and Address <br />Ro,5p- 11t FR <br />30o/ CrX 8 <br />STo(la firc,_24. /1)1 j3s$7 <br />Area Code - Telephone <br />-5/55 <br />FAX Number <br />E-Mail Address <br />Buyer Name and Address <br />Required Enclosures - Legal Document (Check one) <br />1. ❑ Subdivision Plat <br />®' Certified Survey Map <br />❑ Warranty Deed <br />❑ Plat of Survey & Deed <br />❑ County Plat <br />❑ Condominium Plat <br />❑ Other <br />Required Additional Information <br />2. a $ketch (per TRANS 233.04) <br />3. ❑ Fee: $110.00 check attached <br />4. ❑ Special Exception Request! <br />❑ Access ❑ Setback ❑ Other <br />5 ❑ Drainage Plans/Calculations' <br />6. ❑ Last Deed of Record & Tax <br />Parcel Numbers <br />(Include contiguous parcels of current land owner) <br />7. ❑ Driveway PerinitlApplication Submitted <br />(If requesting additional driveway) <br />or copy of Existing Permit Attached <br />Required Notes on survey map or deed <br />Fr- Hwy Setback (TRANS 233.08) <br />[R' Access (TRANS 233.05 & 233.06) <br />❑ Noise (TRANS 233.105-1) <br />❑ Vision Comer' (TRANS 233.105-2) <br />'if applicable <br />All existing driveways & connections to the State Highway System must have an approved special exception: driveways <br />are not grandfathered. <br />Current Land Owner of Record <br />f'a5 �5CHA0O"-C1z, <br />Ctorxit Zoning and Land Use <br />Address <br />Sot, / GT/% 3 5.70OCNroM , W/ <br />PropasAd Zoning and Land Use <br />Area Code - Telephone Number <br />(60 ) S73 - .5/55" <br />Potential Additional Land DiviSion5 <br />DOT INTERNAL USE ONLY <br />Submittal Complete- <br />❑ Yes ❑ No <br />Date Received <br />Date Time Limit Fires <br />Tirne Extension <br />00T Reviewer <br />Central Office <br />Receipt # <br />DOT Certification ff <br />"Receipt of COMPLETE submittal starts 20 day review period. Incomplete submittals may be returned. <br />