HomeMy WebLinkAboutSD-22-07 - Supplemental - 0047 Cheesefactory Road (12)
575 Dorset Street South Burlington, VT 05403 tel 802.846.4106 fax 802.846.4101 www.sburl.com
Permit Number SD-______-__________
(office use only) APPLICATION FOR SUBDIVISION PLAT REVIEW
□ Preliminary □ Final
PUD Being Requested? □ Yes □ No
All information requested on this application must be completed in full. Failure to provide the requested
information either on this application form or on the plans will result in your application being rejected and a
delay in the review before the Development Review Board.
1. OWNER(S) OF RECORD (Name(s) as shown on deed, mailing address, phone)
2. LOCATION OF LAST RECORDED DEED (Book and page #)
3. APPLICANT (Name, mailing address, phone)
4. CONTACT PERSON (Name, mailing address, phone)
a. Contact email address:
5. PROJECT STREET ADDRESS:
6. TAX PARCEL ID # (can be obtained at Assessor’s Office)
2 Subdivision Application Form. Rev. 01-2020
7. PROJECT DESCRIPTION
a. General Project Description (describe what you are proposing):
b. Existing Uses on Property (including description and size of each separate use):
c. Proposed Uses on property (include description and size of each new use and existing uses to remain):
d. Total building square footage on property (proposed buildings and existing buildings to remain):
e. Height of building & number of floors (proposed buildings and existing buildings to remain, specify if
basement and mezzanine):
f. Number of residential units (if applicable, new units and existing units to remain):
g. Number of employees (existing and proposed, note office versus non-office employees):
h. Other (list any other information pertinent to this application not specifically requested above, please
note if Overlay Districts are applicable):
i. List any changes to the subdivision, such as property lines, number of units, lot mergers, etc.
3 Subdivision Application Form. Rev. 01-2020
8. LOT COVERAGE (ALL information MUST be provided here, even if no change is proposed)
a. Size of Parcel: (acres /sq. ft.)
b. Building Coverage:
Existing square feet %
Proposed square feet %
c. Overall Coverage (building, parking, outside storage, etc):
Existing square feet %
Proposed square feet %
d. Front Yard Coverage(s) (commercial projects only):
Existing square feet %
Proposed square feet %
9. WETLAND INFORMATION
a. Are there any wetlands (Class I, II, or III) on the subject property?
□ Yes □ No
b. If yes, is the proposed development encroaching into any of these wetlands
associated 50’ buffers (describe)
c. If yes, please submit the following with this application:
1. A site specific wetland delineation of the entire property or a written statement that the applicant is relying
on the City’s wetland map.
2. Response to the criteria outlined in Section 12.02(E) of the Land Development Regulations (applicant is
strongly encouraged to have a wetland expert respond to these criteria)
10. AREA DISTURBED DURING CONSTRUCTION: ___________________SQ. FT. *
*Projects must follow the City’s specifications for erosion control in Article 16 of the Land Development
Regulations. Projects disturbing more than one (1) acre require a permit from the Vermont Department of
Environmental Conservation.
4 Subdivision Application Form. Rev. 01-2020
11. COST ESTIMATES
a. New Building or Addition, including initial fit-up. (If fit-up not available, contact Planning & Zoning staff)
$
b. Landscaping: $
(Please submit itemized list of landscaping proposed)
c. Other site improvements (please list with cost)
12. ESTIMATED TRAFFIC
a. P.M. Peak hour for entire property (In and out):
13. PEAK HOURS OF OPERATION:
14. PEAK DAYS OF OPERATION:
15. ESTIMATED PROJECT COMPLETION DATE:
16. PLANS AND FEE
Plans shall be submitted which show the information required by the City’s Land Development Regulations. One
digital (PDF format) copy of all application materials listed in LDR Appendix E, with plans provided as individual
sheets and named to include sheet number and latest revision date, must be submitted. An application fee shall
be paid to the City at the time of submitting the application in accordance with the City’s fee schedule.
NOTE: NOTIFICATION of ADJOINING PROPERTY OWNERS: Notification of adjoining property owners, in
accordance with 24 V.S.A. §4464(a) and Section 17.06(B) of the South Burlington Land Development
Regulations, is the responsibility of the applicant. After deeming an application complete, the Administrative
Officer will provide the applicant with a draft meeting agendas or public hearing notice and sample certificate of
service. The sworn certificate of service shall be returned to the City prior to the start of any public hearing.
I hereby certify that all the information requested as part of this application has been submitted and is accurate
to the best of my knowledge.
________________________________________
SIGNATURE OF APPLICANT
_________________________________________________________________________
SIGNATURE OF PROPERTY OWNER PRINT NAME
5 Subdivision Application Form. Rev. 01-2020
___________________________________________________________________________
Do not write below this line
DATE OF SUBMISSION:
I have reviewed this preliminary plat application and find it to be:
Complete Incomplete
_______________________________________________________
Administrative Officer Date
The applicant or permittee retains the obligation to identify, apply for, and obtain relevant state permits for this
project. Call (802) 879-5676 to speak with the regional Permit Specialist.