Page 1 of 2 Rev. 2017
115 W. Pleasant St.
Portage, WI 53901
608-742-2176
City of Portage
Land Use Application
All Land Use Applications should be filed at City Hall, 115 W. Pleasant St.
The following information is required for all applications to be reviewed.
This form may also be completed online at: www.portagewi.gov, click on
“Public Works: Forms & Applications” in the Quick Links Box.
FOR OFFICE USE ONLY:
RECEIPT NO:
AMT PAID:
DATE REC’D:
PARCEL NO:
PROPERTY
ADDRESS:
ZONING:
REVIEW REQUIRED BY:
PLAN COMMISSION
BOARD OF ZONING APPEALS
COMMON COUNCIL
ZONING ADMINISTRATOR
STATEMENT OF JUSTIFICATION
YES
NO
PRECONFERENCE
MEETING
PUBLIC
HEARING(S)
Application Type (complete detailed section on reverse side)
Conditional Use Permit
$200 + $30 Rec. Fee
Zoning Amendment
$200
Temporary Use Permit
$200
Zoning Variance
$200
APPLICANT/CONTACT INFORMATION
APPLICANT INFORMATION
CONTACT INFORMATION ( SAME AS APPLICANT)
Applicant Name:
Contact Name:
Address:
Address:
City, State, Zip
City, State, Zip
Telephone:
Telephone:
Fax:
Fax:
Email:
Email:
Relationship to
Applicant:
OWNERSHIP INFORMATION
Owner Signature:
Date:
PROPERTY OWNER 1 ( SAME AS APPLICANT)
PROPERTY OWNER 2 (IF NEEDED)
Owner’s Name:
Owner’s Name:
Address:
Address:
City, State, Zip
City, State, Zip
Telephone:
Telephone:
Fax:
Fax:
Email:
Email:
Signature of
Applicant:
Date:
click to sign
signature
click to edit
Page 2 of 2 Rev. 2017
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:
No. of
Employees:
No. of Parking
Stalls:
Daily No.
Customers/Visitors
Weekly Truck
Traffic:
Outside
Storage?
Yes
No
Outside Machinery/
Mechanicals?
Yes
No
Exceeds 40,000 sq. ft.?
Yes No
If yes, constitutes a large or group development. See Questionnaire.
FOR
OFFICE
USE:
PUBLIC HEARING NOTICE TO ALL WITHIN 300 FT
PUBLISH PUBLIC HEARING NOTICE TWICE, ONE WEEK APART, AT LEAST 10 DAYS PRIOR TO PUBLIC HEARING
RECORD AT COUNTY
MAILING
DATE:_________________________
TEMPORARY USE PERMIT (Reviewed by Zoning Administrator)
SITE PLAN ATTACHED
Current Use of Property and
Type of Business (if applicable):
Proposed Use of Property and Type
of Business (if applicable):
Dates of Temporary Use:
Start Date:
End Date:
Proposed Hours of
Operation:
No. of
Employees:
No. of Parking
Stalls:
Daily No.
Customers/Visitors
Weekly Truck
Traffic:
Outside
Storage?
Yes
No
Outside Machinery/
Mechanicals?
Yes
No
FOR
OFFICE
USE:
NO PUBLIC HEARING REQUIRED
IF OVER 6 MONTHS, RECORD AT COUNTY
ZONING AMENDMENT (Reviewed by Plan Commission & Common Council)
SITE PLAN/MAP ATTACHED
STATEMENT OF JUSTIFICATION ATTACHED
Proposed Use of
Property:
Proposed
Zoning:
Proposed Hours
of Operation:
No. of
Employees:
No. of Parking
Stalls:
Property contains
wetlands and/or
floodplain?
Yes No
If yes, explain:
Overlay District?
Yes
No
If zoning is changed, do you need a Conditional Use Permit
for the proposed use?
Yes
No
FOR
OFFICE
USE:
PUBLIC HEARING NOTICE TO ALL WITHIN 300 FT
PUBLISH PUBLIC HEARING NOTICE TWICE, ONE WEEK APART, AT LEAST 10 DAYS PRIOR TO PUBLIC HEARING
RECORD AT COUNTY
MAILING
DATE:_________________________
VARIANCE (Reviewed by Board of Zoning Appeals)
SITE PLAN ATTACHED
STATEMENT OF JUSTIFICATION ATTACHED
FOR
OFFICE
USE:
PUBLIC HEARING NOTICE TO ALL WITHIN 100 FT
PUBLISH PUBLIC HEARING NOTICE 10 DAYS BEFORE BOARD OF ZONING APPEALS MEETING
MAILING
DATE:_________________________
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