HomeMy WebLinkAboutAO-22-03 - Supplemental - 0029 0031 0039 0041 Elm Street (2)
575 Dorset Street South Burlington, VT 05403 tel 802.846.4106 fax 802.846.4101 www.sburl.com
Application #AO - ______ - ______
(office use only)
NOTICE OF APPEAL
All information requested below must be completed in full. Failure to provide the requested information
on this notice will result in rejection of your application and delay in the review of the appeal before the
Development Review Board.
I understand:
the presentation procedures required by State Law (Section 4468 of the Planning & Development
Act);
that the Development Review Board holds regular meetings twice a month;
that a legal advertisement must appear a minimum of fifteen (15) days prior to the hearing on my
appeal.
I agree to pay the required fee to offset the cost of the hearing on my appeal.
1) NAME AND ADDRESS OF APPELLANT(S):
____________________________________________________________________________________
____________________________________________________________________________________
1a) EMAIL ADDRESS OF APPELLANT(S)_____________________________________________
2) LOCATION AND BRIEF DESCRIPTION OF PROPERTY AT ISSUE IN THIS
APPEAL:___________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
3) WHAT ACTION OF THE ADMINISTRATIVE OFFICER ARE YOU APPEALING?
______________________________________________________________________________
4) WHAT PROVISIONS OF THE LAND DEVELOPMENT REGULATIONS ARE
APPLICABLE TO THIS APPEAL, IF ANY?
______________________________________________________________________________
2 Appeal Form. Rev. 12-2011
5) WHAT RELIEF DO YOU WANT THE DEVELOPMENT REVIEW BOARD TO GRANT?
_________________________________________________________________
_________________________________________________________________
6) WHY DO YOU BELIEVE THAT THE RELIEF REQUESTED IN NUMBER 5, ABOVE, IS
PROPER UNDER THE CIRCUMSTANCES?
_________________________________________________________________
_________________________________________________________________
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 appellant. After deeming a request complete,
the Administrative Officer will provide the appellant 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 notice of appeal has been submitted and
is accurate to the best of my knowledge.
_________________________________________
SIGNATURE OF APPELLANT
________________________________
DATE
_________________________________________________________________
Do not write below this line
DATE OF SUBMISSION:__________________________________
I have reviewed this 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.