Certified Survey Map (CSM) Application Date Submitted MM slash DD slash YYYY FeesPlease Check One 1-2 Lot CSM: $150 3-4 Lot CSM: $250 Each Additional Lot Over 4 Price: $16.00 Quantity: Fee Total $0.00 ContactsZoning and Planning Department Contact: Village Planner Phone: (262) 363-6420 Fax: (262) 363-6425 Email: planner@villageofmukwonago.comGuidelinesThe undersigned petition is to consider a request, as stated herein, for the specified parcel(s) of land and will be reviewed by the Plan Commission and Village Board of the Village of Mukwonago. The application packet must be filed with the Village Clerk at least 30 days prior to the meeting of the Planning Commission at which action is desired. Materials listed below must be provided to the Village of Mukwonago in accordance with Village Municipal Code Chapter 45 Article IV and other pertinent sections of Village ordinances, WI Stats. 236.34, and, as necessary, to permit review that is consistent with proper planning practice. The Village will strive to accommodate reasonable requests for informal preliminary staff review, however the Village shall not place any items on the agenda for Plan Commission consideration until such time as the application is complete in accordance with all requirements specified on this and other attached application forms. Complete, accurate and specific information must be entered.Applicant Information (Full Legal Name)Name Name Company Name Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Daytime PhoneFaxApplicant Email Applicant is Represented by (Full Legal Name)Name Name Company Name Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Daytime PhoneFaxEmail Property InformationOwner's Name Name (If different from applicant)Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Daytime PhoneFaxEmail Present Zoning Location Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Tax Key #(s)Present Use Intended Use Procedural Checklist for Certified Survey Map Review and ApprovalIn the case of a CSM, the submittal date, for the purposes of WI Stats. 236.34, is the date that the application is certified as complete by Village staff. The application packet must be filed with the Village Clerk at least 30 days prior to the meeting of the Planning Commission at which action is desired. Certified Survey Maps shall be prepared as provided in § 236.34 (1m) (c) Wis. Stats. and Article IV of the Land Division Ordinance. Submittals for review must include and be accompanied by the following: Application: Completed application form including the procedural checklist. Application fee: See page 1. Agreement for Reimbursable Services (separate application). Other Documents: Five(5) complete sets of Application and materials, in addition to the original, for Village of Mukwonago review. Project Summary: Please attach a statement detailing the reasons and background for this request including: details of proposal, services provided, wares sold, plans and hours of operation, number of employees, frequency of customer visits, frequency of deliveries to site, description of any interior/exterior modifications or additions to be made to property, any outside storage (dumpsters, trucks, materials…), number of parking stalls, screening/buffer type, any other information available. PLEASE EXPLAIN IN DETAIL. Electronic Submittals are required. Email (or CD ROM) with all plans and submittal materials in Adobe PDF to planner@villageofmukwonago.com. Any additional information as determined by Village staff. Upon receipt of a complete submittal, staff review will be conducted within ten business days. All Certified Survey Map requests require Plan Commission review and Village Board approval. All Certified Survey Map requests shall comply with Chapter 236 of the Wisconsin State Statutes. CertificationApplicant hereby certifies that: All of the above statements and other information submitted as part of this application are true and correct to the best of his or her knowledge. Affirms that no Village of Mukwonago elected or appointed official or employee has a proprietary interest in the above referenced property for which this applications being filed (except as stated below under “Exceptions”). None of the above referenced individuals has been promised or given any contract for consultation, planning or construction in relation to this project (except as stated below under “Exceptions”). Applicant has read and understands all information in this packet. Applicant further understands the policies of the Village regarding change of zonings and property development. Conditions of the resolution regarding all approvals are strictly followed. Certificates of Occupancy are not given until all conditions of approval have been met . By the execution of this application, applicant hereby authorizes the Village of Mukwonago or its agents to enter upon the property during the hours of 7:00 am to 7:00 pm daily for the purpose of inspection. Applicant grants this authorization to enter even if this land has been posted against trespassing pursuant to Section 943.13 WI Stats. (The applicant’s signature must be from a Managing Member if the business is an LLC, or from the President or Vice President if the business is a corporation. A signed applicant’s authorization letter may be provided in lieu of the applicant’s signature below, and a signed property owner’s authorization letter may be provided in lieu of the property owner’s signature[s] below. If more than one, all of the owners of the property must sign this Application).Property Owner SignatureProperty Owner Name First Last Title Applicant SignatureApplicant Name First Last Title
