STATE OF WISCONSIN                     WAUKESHA COUNTY                    TOWN OF OCONOMOWOC                          

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SUBMIT TO:

Jeffrey C. Herrmann, Town Planner/Administrator or

                       Town Clerk/Treasurer (262)-567-0251

DEADLINE:  10 copies of all handouts for the meeting and this completed form must be received in the Clerk’s Office no later than noon, 10 days prior to the next Town Board meeting.

APPLICATION FOR TOWN OF OCONOMOWOC BOARD AGENDA

Owner___________________________________________ Daytime Phone Number (       )-_______-__________

Contact Person ____________________________________ Daytime Phone Number (       )-_______-__________

Property Address______________________________________________________________________________

Billing Address (if different)_____________________________________________________________________

Fax number (if available) to send agenda to_________________________________________________________

SPECIFIC REQUEST FOR TOWN BOARD CONSIDERATION                                                    

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

I, the undersigned, have been advised that pursuant to the Town of Oconomowoc Ordinance to utilize Section §66.60 (16), Wisconsin Statutes, if the Town of Oconomowoc Attorney, Town Engineer, or any other Town Professional provides services to the Town as a result of my activities, whether at my request or at the request of the Town, I shall be responsible for the fees incurred by the Town.  Also, I have been advised that prior to obtaining final approval, all costs incurred by the Town must be paid in full.  If a dispute arises as to the amount of the fees incurred, said dispute shall be forwarded to the Town of Oconomowoc Town Board of Supervisors for resolution.

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               (Signature of  Property Owner)                                                                        (Witness)

_________________________________________                          ____________________________________

                                (Date)                                                                       (Town Representative Accepting Form)