TOWN OF FULTON PRELIMINARY LAND DIVISON – APPLICATION INFORMATION

Page 1 of 7

REVISED 6/2017

TOWN OF FULTON PRELIMINARY LAND DIVISON – APPLICATION INFORMATION

LAND DIVISION/SUBDIVISION
APPLICATION FORM
** PLEASE COMPLETE ALL PAGES OF THIS FORM
ANDINCLUDE A CSM OR PLAT, CONTAINING ALL INFORMATION AS REQUIRED.**
FEE SCHEDULE
ALL FEES ARE DUE AT THE TIME THE APPLICATION IS SUBMITTED, ALONG WITH A COPY OF THE SIGNED “AGREEMENT FOR REIMBURSABLE SERVICES”AT THE END OF THIS APPLICATION.
  1. CSM: $65.00 FOR UP TO TWO LOTS. $125.00 FOR OVER TWO LOTS PLUS $15.00/LOT.
  2. PRELIMINARY PLAT: $125.00 FOR UP TO, AND INCLUDING SIX LOTS. $125.00 FOR OVER SIX LOTS PLUS $15.00/LOT.
  3. FINAL PLAT: $35.00 MINIMUM PLUS $3.00 PER LOT
  4. Additional Reimbursable Services (if applicable) to be invoiced.

1.Application type (please check only one):
Preliminary Subdivision Plat Final Subdivision Plat Land Division/ Certified Survey Map (CSM)
2.Subdivision is consistent with Town’s Comprehensive Plan – Future Land Use Map: Yes No
3. Subdivision is in a State-certified Farmland Preservation zoning district: Yes No
4.Subdivision meets all Town Base Farm requirements: Yes No
5. The subdivision is adjacent to a Rock County highway, or in the Rock County Floodplain, Shoreland Overlay, or Airport Overlay zoning district: Yes No Unsure
If you answered Yes or Unsure and you plan to undertake any development activity (building construction/location or earth-moving activities), you will/may need to obtain a Rock County Building Site Permit. Please contact the Rock County Planning, Economic & Community Development Agency before completing and submitting this form to the Town. The Agency can be reached at 608.757.5587, , or 51 S. Main St., Janesville, WI 53545.
APPLICANT INFORMATION
6. LANDOWNER OR AUTHORIZED LANDOWNER REPRESENTATIVE
a. Name:
Telephone: / Email:
Address: / City: / State: / Zip:
b. Name: / Telephone:
Telephone: / Email:
Address: / City: / State: / Zip:
7. AGENT (SURVEYOR AND DEVELOPER)
a. Surveyor name:
Telephone: / Email:
Address: / City: / State: / Zip:
b. Developer name: / Telephone:
Telephone: / Email:
Address: / City: / State: / Zip:
8. Please identify the individual from 6. or 7. that will serve as the primary contact: 6a. 6b. 7a. 7b.
CERTIFIED SURVEY MAP (§ 380-19)
1.A CSM Should Include The Following:
Yes / No / Comment
  • CSM number

  • Surveyor’s statement

  • Scale/North Arrow

  • Date of preparation

  • Location by township and range

  • Location by metes and bounds

  • All corners monumented

  • Existing and proposed easements

  • All existing buildings, watercourses, drainage ditches and other features pertinent to proper division.

  • Setbacks or building lines required by the Town Board and Chapter 425 (Town of Fulton Zoning Code)

  • All lands reserved for future acquisition or public dedication

  • Name and address of the owner, subdivider and surveyor.

  • Square footage of each parcel

  • Present zoning for the parcels

  • Critical building locations dimensioned to the nearest 0.1 foot where the location of such building or structure will be critical in relation to proposed property boundaries or to the zoning yard requirements

2. Also attach the following information (* indicates requirement if public improvements are involved):
  • Preliminary certified survey map (20 copies)
  • Final certified survey map (20 copies)
  • If street dedication is required – owner’s certificate and mortgagee’s certificate in same form as required by §236.21(2)(a), Wis. Stats.
  • Site assessment checklist
  • *Contract with Town agreeing to install improvements
  • *Financial guarantee for proposed public improvements
  • *Improvement guarantee
  • *Survey monumentation
  • Erosion control plan
  • Deed restrictions
  • Copies of any special agreements, conveyances, restrictions, or covenants, which will govern the use, maintenance, and continued protection of the development and any of its common or public areas
  • Any other information deemed appropriate by the Town of Fulton representative for complete review of the application

PLATS (§ 380-17 & 18)
1.Preliminary and Final Plats Should Include the Following:
Yes / No / Comment
  • Name of subdivision

  • Existing contours extending to the center line of adjacent public streets. At least two permanent bench marks shall be located within the vicinity of the plat.

  • Location, right-of-way width and names of all existing streets, alleys, easements, railroad and utility rights-of-way

  • Adjacent land use and zoning

  • Surveyor’s statement

  • Scale/north arrow

  • Location by township and range

  • Date of preparation

  • Total area

  • Exact length and bearing of exterior boundaries referenced to a corner established in the US Public Land Survey

  • Location and names of adjacent subdivisions, parks, cemeteries, and owners of abutting unplatted lands

  • Type, width and elevation of existing street pavements within or adjacent to plat, including any legally established center-line elevations

  • Location, size and invert elevation of existing sanitary or storm sewers, culverts and drain pipes, the location of manholes, catch basins, hydrants, and electric and communication facilities, and the location and size of existing gas and water mains within or adjacent to plat. If no sewers or water mains are within or adjacent to plat, indicate the direction and distance of the nearest mains.

  • Corporate limit lines

  • Existing zoning of plat and of adjacent parcels

  • High water elevations within plat or within 100 feet therefrom

  • Water elevation of all ponds, streams, lakes, flowages and wetlands within the exterior boundaries of the plat or located within 100 feet therefrom

  • Floodland and shoreland boundaries with contour lines

  • Location, width and names of proposed streets, public rights-of-way, alleys, pedestrianways and utility easements

  • Approximate radii of all curves

  • Any proposed lake and stream access

  • Any proposed lake and stream improvement or relocation and notice of application for approval by the WDNR, when applicable

  • Soil tests (if required by Town)

  • Layout numbers and preliminary acreages and dimensions of lots and blocks

  • Minimum front, rear, side and street yard building setback lines

  • Proposed contours within plat extending to center line of adjacent public streets

  • Location, size and grade of proposed sanitary sewer mains

  • Gradients of proposed streets, including center-line profiles

  • Areas other than streets, alleys pedestrianways and utility easements intended to be dedicated to public use, including the size of such areas

  • Location and description of survey monuments

  • An identification system for the consecutive numbers of all blocks and lots within subdivision

  • Sites, if any, to be reserved for parks or other public uses

  • Sites, if any, for multifamily dwellings, shopping centers, churches, industry or other nonpublic uses exclusive of single-family dwellings

  • Drainage flows

  • Potential resubdivision and use of excessively deep (over 200 feet) or oversized lots must be indicated in a satisfactory manner

  • Wetlands, floodplains, or environmentally sensitive areas

  • Exact length and bearing of the center line of all streets

  • Exact street width along the line of any obliquely intersecting street

  • Exact location and description of utility and drainage easements

  • Railroad rights-of-way within and abutting the plat

  • All lands reserved for future public acquisition or reserved for the common use of property owners within the plat

  • Special restrictions required by Town Board relating to access control along public ways or to the provision of planting strips.

  • Groundwater presence

  • Dimensions of lot lines shown in feet and hundreths

2. Also attach the following information: (* indicates requirement if public improvements are involved)
  1. Preliminary Plats
  • Preliminary plat and application
  • Site assessment checklist
  • Concept report addressing sewer and water service, drainage facilities and approximate center-line grades for streets in the subdivision
  • Draft of legal instruments and rules for proposed property owners’ associations
  • Affidavit certifying plat is a correct representation of all existing land divisions and features and that he has fully complied with the provisions of this chapter
  • Use statement: proposed use of lots stating type of residential buildings with number of proposed dwelling units and types of business or industry to reveal the effect of the development on traffic, fire hazards and congestion of population
  • Any proposed zoning changes
  • Area plan if subdivider owns property adjacent to what is being proposed for subdivision
  • Preliminary street profiles showing existing ground surface
  • Soil testing (if required by Planning and Zoning Committee)
  • Any other information deemed appropriate by the Town of Fulton representative for complete review of the application
  1. Final Plats
  • Final plat and application
  • Certifications showing all taxes and special assessments due on property have been paid in full
  • Deed restrictions
  • Legal instruments creating a property owners’ association
  • Certificates as required by §236.21, Wis. Stats.
  • *Contract with Town agreeing to install improvements
  • *Financial guarantee for proposed public improvements
  • *Improvement guarantee
  • *Survey monumentation
  • Final erosion control plans
  • Any other information deemed appropriate by the Town of Fulton representative for complete review of the application

SUBDIVISION INFORMATION (FOR CSMs, Preliminary and Final Plats)
9. Current zoning of property:
10. Current use of property:
11. Proposed use of property:
12. Current water service on property: Municipal Private
13. Current sewer service on property: Municipal Private
14.If proposed residential use, identify (if applicable): Number of Dwelling Units: Number of Parking Stalls:
Number of Employees: Number of Parking Stalls:
15.If proposed commercial use, identify (if applicable): Hours of Operation: Floor Area:
Number of Employees: Number of Parking Stalls:
16.Proposed development timeline (if applicable):
17. Property location: / T4 R12E / 1/4 of 1/4
Section / Tax parcel number(s) -
18. Subdivision area is located adjacent to (check all that apply):
Local/Town road RockCounty highway State highway U.S. highway
19. Landowner’s contiguous property area (Square feet or acres):
/
20. Zoning/land use change area (Square feet or acres):
21. Please attach a list oflandowners within five hundred (500) or one thousand (1,000) feet of subdivision area, where applicable. A notice of the date and time of the public hearing will be mailed to all property owners within 500’ of the land identified in the application.
APPLICANT STATEMENT AND SIGNATURE
I, as the undersigned, am a landowner applying for a zoning/land use change in the Town of Fulton in unincorporated Rock County, or am serving as the primary contact for said landowner. I do hereby verify that I have reviewed the TOWN OFFULTONZONINGOR LAND USE CHANGE – APPLICATION FORM INFORMATION, reviewed and completed this application form, and submitted all information as required per said documents, and that all information is correct, accurate, and true to the best of my knowledge and belief, with all information accessible to me. These statements are being made to induce official action on the part of the Town of Fulton, its agents, employees, and officials.I, as the undersigned, further understand that the Town of Fulton may require additional information, not identified herein, to supplement this application.
LANDOWNER/PRIMARY CONTACT SIGNATURE: ______/ DATE: ______
TOWN ACTION:
_____Approve ______Deny
Town action rationale and findings of fact:
______
______
______
______
Town Official Signature______
Title______
Date:______
TOWN OF FULTON
Application
Agreement for Reimbursable Services
by Petitioner/Applicant/Property Owner
The Town may retain the services of professional consultants (including planners, engineers, architects, attorneys, environmental specialists, recreation specialists, and other experts) to assist in its review of a proposal coming before the Planning & Zoning Commission. The Town reserves the right to apply the charges for these services as well as for staff time expended in the administration, investigation and processing of applications to the Petitioner.
The Petitioner is required to provide the Town with an executed copy of this agreement as a prerequisite to the processing of the application. The submittal of an application or petition shall be construed as an agreement to pay for such professional review services applicable to the proposal. The Town may delay acceptance of the application or petition as complete, or may delay final approval of the proposal, until the Petitioner pays such fees. Review fees which are applied to a Petitioner, but which are not paid, may be assigned by the Town as a special assessment to the subject property.
______, the applicant/petitioner/property owner(s) for
[Name(s)]
______, dated ______, 20______, agrees,
(Nature of application/petition)
to reimburse the Town of Fulton for all consultant services (e.g. engineering, planning, surveying, legal) required to process this application in addition to those normal costs payable by an applicant/petitioner (e.g. filing or permit fees, publication expenses, recording fees, impact fees, etc.), and, further, agrees to reimburse the Town for other administrative staff review if, in the judgment of the Town Board, such reimbursement is warranted. If costs exceed the initial fee, the Town will invoice applicant/petitioner for the services provided for the professional consultants.
Dated this ______day of ______, 20_____.
______
(Signature of Applicant/Petitioner)
______
(Signature of Property Owner, if Different from Applicant/Petitioner

THANK YOU FOR COMPLETING THETOWN OF FULTONSUBDIVISION – APPLICATION FORM.

PLEASE SEND VIA POSTAL MAIL, OR HAND-DELIVER,THE REQUIRED NUMBER OF COPIES OF THISAPPLICATION FORM,

CSM/PRELIMINARY PLAT/FINAL PLAT,THE APPLICATION FEE AND THE RETAINER TO:

TOWN OF FULTON

2738 W. FULTON CENTER DR.

EDGERTON, WI 53534

TOWN OF FULTON
SITE ASSESSMENT CHECKLIST – (to be used for subdivisions)
(To be prepared by applicant)
Town of Fulton Comprehensive Plan:
Rock County Comprehensive Plan:
INFORMATION REQUESTED / YES / NO
I. Land Resources. Does the proposed development site include or is it adjacent to:
A. Steep slopes of20% - 30%? (See comprehensive plan Map 3.2 or complete on-site survey)
C. A floodplain, as designated by FEMA? (If yes, attach map of the 100-year floodplain limits)
E. Bedrock within 40 in. of surface? (See County Comprehensive Plan Map3.8 or based on on-site soil borings)
F. Groundwater within 3 ft of surface? (See County Comprehensive Plan Map 3.8 or based on on-site soil borings)
G. Soils not suitable for private on-site waste treatment (septic) systems or soils suitable for alternative (above-ground) systems? (See comprehensive plan Map 6.2 or based on on-site perc tests)
H. A brownfield/contaminated site? (DNR Contaminated Lands Web Database or site assessment)
I. Mineral rights owned by someone aside from the lot owner? (If yes, provide more info)
J. JJ. A mineral extraction operation or asphalt batch plant, whether approved, in operation or both?
K K . A Land Evaluation Score between 85-100? Higher scores represent soil types more conducive to agricultural utilization. (See comprehensive plan Map 3.1 or County Soil Survey)
List soil types on property:______
L. Development adjacent to an existing farm operation? (If yes, setbacks, bufferyards and/or covenants may be required over the new subdivisions)
M. Wetlands? (see WisDNR Wisconsin Wetland Inventory or based on on-site survey)
O. Open space/Public Recreation or a Lowland or HighlandConservancy Overlay District? (See Maps 2.1, 2.2 of comp plan)
Q. Existing or planned trails? (see Rock County Parks, Outdoor Recreation and Open Space Plan)
R. Existing trails for motorized vehicles, such as snowmobile routes? (see Rock County Parks, Outdoor Recreation and Open Space Plan)
II. Water Resources. Does the proposed development site include or is it adjacent to:
A. An area traversed by a navigable creek or stream, intermittent stream, or dry run?
B. Within 300 feet of a river or stream or 1,000 feet of lake, pond, or flowage?
F. An existing stormwater storage or transmittal system, either natural or human-made?
I. Use of a private group waste treatment system, holding tanks, or other non-traditional means of sanitary waste treatment and disposal?
J. A high-capacity well? (defined by as a well with withdrawal > 100,000 gallons per day)
III. Biological Resources. Does the development site include or is it adjacent to:
A. A section of land that the WisDNR Wisconsin Natural Heritage Inventory identifies as containing endangered or rare plant or animal species? (see WisDNR Natural Heritage Inventory Public Portal, you must submit an Endangered Species (NHI) Review Request Form (Form 1700-047) )
B. Trees with a diameter of 12 or more inches at breast height?
C. Areas with a continuous woodland canopy of 5 acres or greater?
IV. Human and Scientific Interest. Does the project site include or is it adjacent to:
A. An archeological site, such as a Native American site? (See State Historical Society Archeological Site Inventory database)
B. A historic site or building, including those listed or eligible for listing on the State or National Register of Historic Places? (see State Historical Society American Heritage Inventory)
C. An area or structures that reflect the agricultural heritage of the Town, such as stone rows, fence lines, tree lines, or agricultural buildings such as farmsteads, barns, and silos?
V. Energy, Transportation and Communications. Is the development site:
A. Abutting or traversed by an existing or planned roadway corridor, as shown on the town, county, or adjacent city comprehensive plan; an official map; or a state, county, adjacent city, or town highway plan?
B. Within a highway noise impacted area (within 500 feet of a state or federal highway)?
C. Traversed by or abutting an existing or planned utility corridor or structure, including but not limited to gas, electrical, water, sewer, storm, and telecommunications?

Yes answers must be explained in detail by attaching maps and supportive documentation on the type, location, and extent of the identified feature, and the impact that the subdivision or land division is expected to have on that feature.

The completed site assessment checklist and the attached information will be used by the Town as a basis for determining the suitability of the land for subdivision or land division, and for evaluating whether the project meets other requirements of the Town’s subdivision ordinance and comprehensive plan. Adjustments to the proposed subdivision to minimize or mitigate the impact of “yes” answers may be required.

CERTIFICATION:

I hereby certify that I have researched the listed reference sources and that the information supplied on and included with this site assessment checklist is correct to the best of my knowledge.

______

Signature or subdivider, engineer, or surveyor Printed Name and registration/license numberDate

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REVISED 6/2017