HomeMy WebLinkAboutSD-22-02 - Supplemental - 0916 Shelburne Road (8)
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 SKETCH PLAN REVIEW
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. For amendments, please provide pertinent
information only.
1) OWNER(S) OF RECORD (Name(s) as shown on deed, mailing address, phone and fax#)
2) LOCATION OF LAST RECORDED DEED(S) (Book and page #)
3) APPLICANT (Name, mailing address, and phone #)
4) APPLICANT’S LEGAL INTEREST IN THE PROPERTY (fee simple, option, etc.)
5) CONTACT PERSON (Name, mailing address, and phone #)
5a) CONTACT EMAIL ADDRESS
6) PROJECT STREET ADDRESS
7) TAX PARCEL ID # (can be obtained at Assessor’s Office)
8) PROJECT DESCRIPTION
a) General project description (explain what you want approval for):
2 Sketch Plan Application Form. Rev. 01-2020
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) Proposed height of building (if applicable)
f) Number of residential units (if applicable, new units and existing units to remain)
g) Other (list any other information pertinent to this application not specifically requested above, please note
if Overlay Districts are applicable)
9) LOT COVERAGE
a) Building: Existing % Proposed %
b) Overall (building, parking, outside storage, etc)
Existing % Proposed %
c) Front yard (along each street) Existing % Proposed %
10) TYPE OF EXISTING OR PROPOSED ENCUMBRANCES ON PROPERTY (easements, covenants, leases, rights of
way, etc.)
11) PROPOSED EXTENSION, RELOCATION, OR MODIFICATION OF MUNICIPAL FACILITIES (sanitary sewer, water
supply, streets, storm drainage, etc.)
12) ESTIMATED PROJECT COMPLETION DATE
3 Sketch Plan Application Form. Rev. 01-2020
13) 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
____________________________________________________________________________________
Do not write below this line
DATE OF SUBMISSION:
I have reviewed this sketch plan 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.