HomeMy WebLinkAboutSP-22-030 - Supplemental - 1475 Shelburne Road1 Rev 2019-11
CITY OF SOUTH BURLINGTON
Z O N I N G P E R M I T A P P L I C A T I O N
PROPERTY Street Address: _________________________________________ Application No: _________________
[office use only]
Property Owner: __________________________________________________ Parcel Size: ___________________
Property Owner Mailing Address:___________________________________________________________________
APPLICANT: __________________________________________________________________________________
Applicant Mailing Address: _______________________________________________________________________
Applicant Email: ______________________________________________ Daytime phone: _________________
1. PROPOSED project including building dimensions (describe): ________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
2. RELATED Site Plan, Conditional Use, PUD, Subdivision, or Misc Approval ______________________________________ 3. Present USE(S) of the property:
Single family home on its own parcel
Other (please state the USE per Land Development Regulations- retail, general office, multifamily residential, etc.):
_________________________________________________________________________________________________
4. List all present structure(s) on property (describe including dimensions or square footage of each): ___________________
___________________________________________________________________________________________________
5. Does the project include a proposed change of USE?
No (the property will still be used for the same purpose)
Yes (please state proposed changed or added USES per Land Development Regulations- retail, general office,
multifamily residential, etc.): ___________________________________________________________
6. ESTIMATED total cost of improvements (materials and labor): $_______________________________
7. BUILDING footprint i.e. size in sq. ft. of main floor of house and all attached and detached structures including enclosed
breezeways, garages, and sheds (describe): Existing:______________________ Proposed:_______________________
__________________________________________________________________________________________________
8. TOTAL impervious surfaces on site (i.e. Building footprint PLUS size in s.f. of driveways, patios, decks)
Existing:______________________ Proposed:_______________________
9. ATTACH SKETCH PLAN OR SITE PLAN
Complete the following only if the project involves changes to the dimensions of your building or other site changes (ie, not interior
renovations or roof / window / deck replacement)
2 Rev 2019-11
10. APPLICANT/OWNER CERTIFICATION
The undersigned property owner hereby consents to submission of this application and understands that if the application is
approved, the Zoning Permit and any attached conditions will be binding on the property.
_____________________________________________________________________ _________________________
Property Owner Signature PRINT NAME Date
The undersigned applicant hereby affirms that the information presented in this application is true, accurate and complete.
_____________________________________________________________________ _________________________
Applicant Signature PRINT NAME Date
OFFICE USE ONLY ADMINISTRATIVE OFFICER ACTION OFFICE USE ONLY
DATE Received: ___________________ FEE Received: $ _____________ Identification of zoning district: _______________
Project description: ______________________________________________________________________________________
SITE PLAN _____________________________________ ____________________________
Application # Approval Date
SUBDIVISION _____________________________________ ____________________________
Application # Approval Date
CONDITIONAL USE _____________________________________ ____________________________
Application # Approval Date
VARIANCE _____________________________________ ____________________________
Application # Approval Date
MISCELLANEOUS _____________________________________ ____________________________
Application # Approval Date
FINAL ADMINISTRATIVE OFFICER ACTION
Z O N I N G P E R M I T
APPROVED _________________________ ____________________________________________________________
Approval Date
Permit EFFECTIVE date _________________________ Permit EXPIRATION date ___________________________
CONDITIONS of Approval __________________________________________________________________________
Provided applicant copy of URBEC or VCBE Standards Handbook or Not Applicable
DENIED _________________________ _____________________________________________________________
Denial Date Administrative Officer
REASON for DENIAL ______________________________________________________________________________________
Notice of Appeal Rights: Any interested person may appeal this decision by filing a written Notice of Appeal with the clerk of the Development Review
Board within fifteen [15] days of the date of this decision. The notice of appeal must be accompanied by a filing fee of $223.00.
This permit does NOT authorize commencement of any development activity approved by the permit until the permit takes effect as set forth
above. Site modifications and improvements made prior to this permit becoming effective may be subject to removal and site restoration if a timely
appeal is commenced.
NOTE: The applicant or permittee retains the obligation to identify, apply for, and obtain relevant state permits for this project. Call (802) 477-2241 to
speak with the regional Permit Specialist.