
1of5Updated1/3/2018
VillageofBrooklyn
FinalPlatApplication
210CommercialStreet,P.O.Box189
Brooklyn,WI53521
6084554201/fax4551385
clerk@brooklynwi.govordeputyclerk@br ooklynwi.gov
ContactInformation
PropertyOwner/DeveloperName
CompanyName(ifapplicable)
Workphone
HomeorCellPhone
Address
City,State,Zip
Email Fax
BestWaytoreachmeis:
PhoneEmail
Iamthe:
OwnerTenantRepresentative
Procedure
Pickupapplication.Readthroughexpectations.Ordinances11153&11184,111204,111122.
Submitwithin36monthsoflastPreliminaryPlatapproval,includinganyconditions
Completeapplicationandsubmittalsviapapercopyandemailapdfversiontotheclerk’soffice21
daysbeforePlanCommissionMeeting.
Clerktonotifyapprovingauthoritieswithin2days(Developertoprovidelist)
AttendPlanCommissionmeetingatwhichapplicationwillbeconsidered.
PlanCommissionmustactwithin60days.DeadlinetoAct:___________
PlanCommissionmeetingheld.Date:______________________________
Clerkmustgiveatleast10days’noticepriortoVillageBoardmeetingtoclerksofallmunicipalities
with1000’oftheplat
Villageboardmustactwithin60days.DeadlinetoAct:______________
Villageboardmeetingheld.Date:________________________________
ReferenceMaterialswww.brooklynwi.gov
VillageOrdinanceChapter11153,11184,111122,111204
WIStats.236
ZoningMap
PropertyInformation
PlatName:_______________________________________________________________
CurrentParcel#:___________________________________________________________
GeneralDescriptionofPlatArea:_____________________________________________

2of5Updated1/3/2018
Submittals
Submit1papercopyandalsosubmitdocumentsviaemailinpdfformattotheclerk’sofficeat
clerk@brooklynwi.govanddeputyclerk@ brooklynwi.gov

FinalPlat

ResolutionofallconditionsfromPreliminaryPlatapprovalprocess

ListofauthoritiestowhichtheplatmustbesubmittedWis.Stats.236.10
AgreementforReimbursableServices
Owner’sSignatureStatementofUnderstanding
Bysigningbelow,I__________________________,certifythattheinformationcontainedinthisapplicationis
trueandaccuratetothebestofmyknowledge,andunderstandthatadeliberatemisrepresentationof
informationmaybegroundsfordenialorreversalofthisapplication,and/orrevocationofanyapprovalalready
awardedbasedon
thisapplication.
Iunderstandthatthesubmittalofthisapplicationandpaymentoftheproperfeesdoesnotmeanthatapproval
oftheplatisimminentandguaranteed.
Iunderstandthatapprovalofafinalplatdoesnotqualityas,norreplacethenecessityforproperpermittingfor
theproposed
project.
____________________________________________________________________
SignatureofApplicantDate
____________________________________________________________________
PrintedNameTitle
click to sign
signature
click to edit

3of5Updated1/3/2018
AGREEMENT FOR REIMBURSABLE SERVICES
INCURRED BY THE VILLAGE OF BROOKLYN
The cost of application review for all land division, site plan, conditional use, zoning and other applications
required to come before the Planning Commission shall be borne by the Applicant. The Applicant shall pay all
reasonable Village of Brooklyn incurred expenses relating to a particular project review. This may include
meeting charges, professional consultants, or other relevant Village expenses incurred in connection to the
review of the project in question. 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 project application. The submittal of the project 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 the 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
(Project Name)
reimburse the Village of Brooklyn for all review costs associated with, but not limited to, Village Engineer,
Village Attorney and consultants as appropriate, relating to the review costs associated with the project review
request and, further, agrees to reimburse the Village for other administrative staff review if, in the judgment of
the Village of Brooklyn Board such reimbursement is warranted.
Dated this _____________day of_________________, 20___.
____________________________ _________________________
Signature of Applicant Printed Name
____________________________ _________________________
Signature of Property Owner Printed Name
(if different from applicant)

4of5Updated1/3/2018
FinalPlatChecklist
OfficeUseOnly
DateReceived:_________________By:____ ________________Parcel#:_____________________________
DateSent:ReturnBy:Response:
ZoningAdministrator_________________________________
VillageEngineer__________________________________
DatePreliminaryPlatApprovedbyPlanning&ZoningCommission:________________________
DateStormWaterApproved:____________________
DateDOAPlatReviewReceived:__________________
DateofDOAApproval:__________________________
NameofPlat:
_________________________________
FinalPlatmustbesubmittedwith12copies,21dayspriortothePlanning &ZoningCommissionMeeting.

MustbesubmittedwithinsixmonthsofPreliminaryPlatApproval.
Owner:_____________________________________Subdivider:__________________________________
Address:____________________________________Address:____________________________________
Phone#:____________________________________Phone#:____________________________________
Number&TypeofLots
created:______________________________________________________________
Developer’sEngineer/Surveyor:______________________________________________________________
Address:_________________________________________________________________________________
VillageEngineerRecomm endations:

5of5Updated1/3/2018
Commission’sRecommendations:
PublicWorksDirectorRecommendations:
OtherComments:
Approvals
DateImpactFeesPaid:_______________________
PlanCommissionmeetingdate:_________________________________
Yourrequesthasbeen:_____Approved_____NotApproved
_____ApprovedwiththeseConditions:
VillageBoardmeetingdate:____________________________________
Yourrequesthasbeen:_____Approved_____NotApproved
_____ApprovedwiththeseConditions:
