Fill - Free fillable CSM-Application-PDF-Fillable-Approved-1-8-2018 - Final Approved Version 1-8-2018 Village of Brooklyn CSM Application PDF form

 

1OF4UPDATED1/2/2018



VillageofBrooklyn

CertifiedSurveyMap(CSM)Application

210CommercialStreet,P.O.Box189

Brooklyn,WI53521

608‐455‐4201/fax455‐1385

clerk@brooklynwi.govordeputyclerk@br ooklynwi.gov



ContactInformation

PropertyOwnerName



SurveyorNameandCompany

Ownerphone



SurveyorPhone

Address



City,State,Zip

Email Fax



BestWaytoreachmeis:

PhoneEmail

Iamthe:

OwnerTenantRepresentative

Procedure

 Pickupapplication.Readthroughexpectationsinordinances111 ‐54,111‐85&111‐202,WIStates.,

Sec.236.34.

 MeetwithVillageofficials(zoninginspector)todiscussplanneduseandnecessarysubmittals.

 Completedapplication‐papercopyandapdfversionemailedtoclerk’soffice21daysbeforePlan

CommissionMeeting.

 AttendPlanCommissionmeetingatwhichapplicationwillbeconsidered.

 PlanCommissionmustactwithin90daysofthedateofthereceiptbytheClerk’sOffice

 PlanCommissionmeetingheld.Date:______________________________

ReferenceMaterials–www.brooklynwi.gov

VillageOrdinanceChapter111‐54,111‐85,111‐202

ZoningMap

WisStats.236.34

PropertyInformation



PropertyAddress:___________________________________________________________________

LotorBlock#:____________________________Subdivision:____________ _____________________

TaxParcel#:_____________________________TotalAcreage:_______________________________



CurrentUseofProperty:______________________________________________________________



ProposedUseofProperty:____________________________________________________________



CurrentZoning:__________________________Current ConditionalUsePermitinPlace?_________



IfResidential:NumberofDwellingUnits_____



2OF4UPDATED1/2/2018



Submittals

Allapplicableitems/documentsmustbesubmittedviaemailinpdfformatand1papercopytotheclerk’s

officeatclerk@brooklynwi.govanddeputyclerk@brooklynwi.gov



Map–Mustinclude:

Lots:location,size,shape&proposeduse,preparedinaccordancewith236.34Wi.Stats

Titleplanwithname&addressofcurrentpropertyowner

Dateoftheoriginalplan&latestrevisionoftheplan

Northarrow,dimensionswithbearing&distance



Allpropertylines&existing&proposedright‐of‐waylines

Allexisting&proposedeasementlines&dimensions

Proposedlocationofstructures,pavedareas,parking&loadingareas

Allrequiredbuildingsetbacklines

Locationofallaccesspoints

Locationofalloutdoorstorageareas



Environmental

AssessmentChecklist(Ordinance111‐202)ifover5acres



LetterofIntent

LetterofIntentshoulddescribe,indetail,whatthepropertywillbeusedfor.Includethe 

purposefortherequest,constructionschedules,namesofpeopleinvolved(applicant,owner,

contractor,architect,landscaper, businessmanager

ThePlanCommission

isrequiredtobaseitsdecisiononwhethertheapplicantdemonstrated

thattheproposedCSMwillmeetthestandardsofVillageofBrooklynOrdinanceChapter111and

Wis.Stats.Chapter236.34.Includeanyadditionalinformationthatyouwishtosubmitinsupportof

therequestedaction.



Owner’sSignature–StatementofUnderstanding



Bysigningbelow,I__________________________,certifythattheinformationcontainedinthisapplicationis

trueandaccuratetothebestofmyknowledge,andunderstandthatadeliberatemisrepresentationof

informationmaybegroundsfordenialorreversalofthisapplication,and/orrevocationofanyapprovalalready

awardedbasedon

thisapplication.



IalsoauthorizetheVillageofBrooklynstaffpermissiontoviewandenterthesubjectpropertyforthepurpose

ofreviewingandinvestigatingthisrequest.



Iunderstandthatthesubmittalofthisapplicationandpaymentoftheproperfeesdoesnotmeanthatapproval

oftheCSMis

imminentandguaranteed.



IunderstandthatapprovalofaCSMdoesnotqualityas,norreplacethenecessityforproperpermitting forthe

proposedproject.



____________________________________________________________________

SignatureofApplicantDate



____________________________________________________________________

PrintedNameTitle

click to sign

signature

click to edit

3OF4UPDATED1/2/2018



VILLAGEOFBROOKLYN

ENVINROMENTALASSESSMENTCHECKLIST

ProjectOwnerName



EnvironmentalAssessmentChecklist

Ifchecked,pleaseexplainindetailbyattachingmapsandsupportingdocumentationdescribingtheimpacts

oftheproposeddevelopment.Ordinance111‐202





LandResources

 Changesinreliefanddrainagepatterns(attachatopographicmapshowing,ataminimum,two‐foot

contourintervals)

 Afloodplain.(ifyes,attachtwocopiesofatypicalstreamvalleycross‐sectionshowingthechannelof

thestream,the100‐yearfloodplainslimitsandthefloodwaylimits(ifofficially adopted),ofeachsideof

thechannelandacross‐sectionofareatobedeveloped).

 Anareaofsoilinstability–greaterthan20%slopeand/ororganicsoils,peats,ormucksatornearthe

surface.

 Primeagriculturalland(ClassI,IIorIIIsoils).

 Wetlandsandmappedenvironmentalcorridors.





WaterResources

 Alocationwithinanareatraversedbyanavigablestreamordryrun.

 Lakefrontage.



HumanandScientificInterest

 Anareaofarcheologicalorgeologicalinterest.

 Anareaofhistoricalinterest.

 Anareaofbuildingsormonumentswithuniquearchitecture.



Energy,TransportationandC ommunications

 DoesthedevelopmentencompassanyfuturestreetappearingontheVillage ofBrooklynOfficialMap?

 Isthedevelopmenttraversedbyandexistingorplannedutilitycorridor(gas,electricity,water,sewer

interceptor,communications,stormsewer)?



Comments:



4OF4UPDATED1/2/2018



OfficeUseOnly

DateReceived:_________________By:____________________Parcel#:_____________________________

Referredto:________________________________________Fee:____________Check#_______________

PostHearingNotice___________________________ By:_____________________________________ ____

CSMRecordedatCounty.Senton_______________By:______________________Returned:____________



OfficeUseOnly–MaterialsSentTo:

DateSent:ReturnBy:Response:

ZoningAdministrator_________________________________

BuildingInspector_________________________________

PublicWorks_________________________________

PoliceDepartment_____________ _____________________

FireInspector__________________________________

EMS________ __________________________

VillageEngineer__________________________________

VillageAttorney(asneeded)__________________________________



Approvals



PlanCommissionmeetingdate:_________________________________



Yourrequesthasbeen:_____Approved_____NotApproved

_____ApprovedwiththeseConditions:



VillageBoardmeetingdate:____________________________________ 



Yourrequesthasbeen:_____Approved_____NotApproved

_____ApprovedwiththeseConditions:



Download
Save PDF to desktop

Email
Email completed PDF

Send for Signing
Email for others to sign

Print
Print document

NAME

CSM-Application-PDF-Fillable-Approved-1-8-2018 - Final Approved Version 1-8-2018 Village of Brooklyn CSM Application

View Audit Log
Print With Audit Log
Duplicate Document

Fill Online, Printable, Fillable, Blank CSM-Application-PDF-Fillable-Approved-1-8-2018 - Final Approved Version 1-8-2018 Village of Brooklyn CSM Application Form

Related forms

Fillable CSM-Application-PDF-Fillable-Approved-1-8-2018 - Final Approved Version 1-8-2018 Village of Brooklyn CSM Application

Fill Online, Printable, Fillable, Blank CSM-Application-PDF-Fillable-Approved-1-8-2018 - Final Approved Version 1-8-2018 Village of Brooklyn CSM Application Form

Related forms

First 20 documents completely FREE!