City of Portage Fee: $200.00
115 W Pleasant Street Plus $30.00
Portage, WI 53901 Date:
(608)742-2176 Phone Receipt #
(608)742-8623 Fax Revised: 7/22/20
Receipting Code: 1518
Permit #
APPLICATION FOR LAND USE
Applicant Name: ______________________________ Owner Name: __________________________________
Applicant Address: ____________________________ Owner Address: ________________________________
Applicant City/State/Zip: _______________________ Owner City/State/Zip: ___________________________
Applicant Phone #: ____________________________ Owner Phone #: ________________________________
Applicant Email: ______________________________ Owner Email: __________________________________
Owner Relationship to Applicant: __________________
Signature of Applicant: _________________________ Owner Signature: _______________________________
_____________________________________________________________________________________________
Application Type: (complete detailed section below and on reverse side)
__Conditional Use Permit (+$30 recording fee made out to Columbia County - Receipting Code:2404)
__Temporary Use Permit __Zoning Amendment __Zoning Variance (+30.00 recording fee)
_____________________________________________________________________________________________
FOR CONDITIONAL USE PERMIT: (Reviewed by Plan Commission) __Site Plan Attached
Current use of property and type of business (if applicable): ____________________________________________
Proposed use of property and type of business (if applicable): ___________________________________________
Proposed Hours of Operation: _____________________________ # of Employees: ____________________
Daily # Customers/Visitors: ____________ Weekly Truck Traffic: ____________ Outside Storage? ______
Outside Machinery/Mechanicals? _______ Exceeds 40,000 sq. ft.? ____ If yes, constitutes a large group
development. See ordinance 90-64.
For Office Use Only: Public Hearing Notice to all within 300 feet. Mailing Date: _______________
Publish Public Hearing Notice twice; one week apart, at least ten days prior to public hearing - Record at county.
______________________________________________________________________________________________
FOR VARIANCE: (Reviewed by Board of Zoning Appeals)
__Site Plan Attached __Statement of Justification Attached
For Office Use Only: Public Hearing Notice to all within 100 feet. Publish Public Hearing Notice 10 days before Board of
Zoning Appeals Meeting.
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