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

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1OF3UPDATED12/28/2017

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VillageofBrooklyn

Variance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

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

 Pickupapplication.Readthroughexpectations.Ordinance(s)117‐621

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

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

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

setpublichearingdate. 

 ZoningAdministratortopreparewrittenreport.

 AttendBoardofAppealsmeetingatwhichapplicationwillbeconsidered.

 BoardofAppealspublichearingheld.Date:______________________________

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

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VillageOrdinance117‐621

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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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CurrentZoning:__________________________ProposedZoning:____________________________

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_______UseVarianceor_______AreaVariance

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2OF3UPDATED12/28/2017

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Submittals

LetterofIntent

LetterofIntentshoulddescribe,indetail,whatthevarianceis for.Includethepurposeforthe

request,constructionschedules,namesofpeopleinvolved(applicant,owner,contractor,architect,

landscaper,businessmanager).Includephysicalinformationonthesizeandlayoutofthesite,aswell

as

proximitytothestreetsandsurroundingbuildings.Includeexpectedconstructionschedule.

Includeanyadditionalinformationthatyouwishtosubmitinsupportoftherequestedaction.

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

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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.

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

investigatingthisrequest.

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

ofavarianceisimminentandguaranteed.



Iunderstandthatissuanceofavariancedoesnotqualifyas,norreplacethenecessityforproperpermittingfor

theproposedproject.

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

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

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

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:________________

OfficeUseOnly–MaterialsSentTo:

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

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

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

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

PublicWorks_________ ________________________

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

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

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

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

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

Approvals

BoardofAppealsmeetingdate:_________________________________

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

_____Ap provedwiththeseConditions:



click to sign

signature

click to edit

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3OF3UPDATED12/28/2017



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)



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

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