Fill - Free fillable Conditional Use Permit Application PDF Fillable Approved 1-8-2018 (Village of Brooklyn) PDF form

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1of4Updated1/2/2018

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VillageofBrooklyn

ConditionalUsePermit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

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ContactInformation

Name:

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Co.Name(ifApplicable)

Address:

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City/State/Zip

WorkPhone

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HomeorCellPhone

Email Fax

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BestWaytoreachmeis:

PhoneEmail

Iamthe:

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

Procedure

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 Pickupapplication.Readthroughexpectations.Ordinances117‐352,117‐353,117‐355&117‐357.

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

 Completeapplicationandsubmittalsviapapercopyandapdfversionviaemailedtoclerk’soffice21

daysbeforePlanCommissionMeeting. 

 ClerktopublishClass1public notice,andnotifypropertyownerswithin300’andsetpublichearing

date.

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

 PlanCommissionpublichearingheld.Date:______________________________

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

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VillageOrdinances117‐352,117‐353,117‐355&117‐357

ZoningMap

LandscapeGuidelines

LightingPlanGuidelines

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PropertyInformation

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PropertyAddress:___________________________________________________________________

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LotorBlock#:____________________________Subdivision:_________________________________

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TaxParcel#:_____________________________TotalAcreage:_______________________________ 

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CurrentUseofProperty:______________________________________________________________

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ProposedUseofProperty:____________________________________________________________

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2of4Updated1/2/2018

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CurrentZoning:__________________________CurrentConditionalUsePermitinPlace?_ ________

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

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Non‐Residential:NumberofEmployees______NumberofParkingStalls______Handicapped_____

Hoursofoperation________

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Submittals

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Submit1copyandviaemailpdfversionofalldocumenttotheVillageClerk’sOfficeclerk@brooklynwi.gov

anddeputyclerk@brooklynwi.gov

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

SitePlan–Mustinclude:

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 easeme ntlines&dim ensions

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

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

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

AgreementforReimbursableService

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StormWaterManagementPlan



LandscapePlan



LightingPlan

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LetterofIntent:

Required

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,landscape r ,business manager).Giveadetaileddescriptionof thetypeofbusiness

proposed,thehoursofoperation,number

ofemployees,accessandparkingproperty.Ifresidential,

describehowman ydwellingunitsandexpectednumberofresidents,aswellasaccessandparkingon

property.

Includephysicalinformationonthesizeandlay outofthesite,aswellasanyfeaturesofthe

propertysuchaswetlands,

floodplain,woodlandsorotherenvironmentalfeatures.

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

thattheproposedconditionalusewillmeetthestandardsofthezoningcode.Includeanyadditional

informationthatyouwishtosubmitin supp ort oftherequested action.

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3of4Updated1/2/2018

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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issuance

ofaConditionalUse

Permitisimminentandguaranteed.



IunderstandthatissuanceofaConditionalUsePermitdoesnotqualityas,norreplacethenecessityforproper

permittingfortheproposedproject.



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

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



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

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



OfficeUseOnly

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

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

NotifyPropertyOwnerswithin300feet__________________Senton:___________By:________________

Publish/PostHearingNotice___________________________Senton:___________By:____ ____________

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OfficeUseOnly–MaterialsSentTo:

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

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

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

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

PoliceDepartment__________________________________

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

EMS__________________________________

Lawyer(asneeded)__________________________________

Engineer(asneeded)__________________________________

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Approvals

PlanCommissionmeetingdate:_________________________________

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

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

VillageBoardmeetingdate:____________________________________

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

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

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4of4Updated1/2/2018

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Agreement for Reimbursable Services

In the Review of Conditional Use Permit

Requests

Village of Brooklyn, Dane/Green County, WI

The cost of application review for all Conditional Use Permit shall be borne by the Applicant. The Applicant

shall pay all reasonable Village of Brooklyn incurred expenses relating to a particular Conditional Use Permit

request. This may include meeting charges, professional consultants, or other relevant Village expenses

incurred in connection to the Conditional Use Permit request. The Village reserves the right to apply the

charges for these services as well as for staff time, mileage, and Village equipment usage expended in the

administration, investigation and processing of applications to the Applicant.

The Applicant is required to provide the Village with an executed copy of this agreement as a prerequisite

to the processing of the Conditional Use Permit request application (Division 5 Conditional Uses -

Ordinances 117-352, 117-353, 117-355 & 117-357) requests. The submittal of a Conditional Use

Permit request application shall be construed as an agreement to pay for such professional review

services applicable to the proposal. Review fees which are applied to an Applicant, but which are not paid

within 30 days of the issuance of a bill by the Village will accrue interest at a rate of 1.5% per month until

the fee is paid in full. Failure to pay the fees in due time can result in further consequences, including disruption

of the project.

_________________________________________________________________________

Applicant and/or Property Owner(s)

for ______________________________________________________, agrees to reimburse the

Project Name

Village of Brooklyn all review costs associated with, but not limited to, the Village Engineer, Village Attorney

and any other consultants in connection with the Conditional Use Permit request and, further, agrees to

reimburse the Village for other administrative staff review if, in the judgment of the Village Board, such

reimbursement is warranted.

Dated this _____ day of , 20 .

____________________________________ _________________________________

Signature of Applicant Printed Name

____________________________________ _________________________________

Signature of Owner (if diff. than applicant) Printed Name

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Conditional Use Permit Application PDF Fillable Approved 1-8-2018 (Village of Brooklyn)

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