HomeMy WebLinkAboutAD-19-01 - Supplemental - 0037 Helen Avenue575 Dorset Street South Burlington, VT 05403 tel 802.846.4106 fax 802.846.4101 www.sburl.com
Permit Number AD-______-__________ (office use only)
APPLICATION FOR MINOR LOT LINE ADJUSTMENT
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 by the Administrative Officer.
1)OWNER(S) OF RECORD (Name as shown on deed, mailing address, phone and fax #)__________
____________________________________________________________________________________
____________________________________________________________________________________
2)LOCATION OF LAST RECORDED DEED(S) (Book and page #)__________________________
3)APPLICANT (Name, mailing address, phone and fax #)____________________________________
____________________________________________________________________________________
4)APPLICANT’S LEGAL INTEREST IN THE PROPERTY (fee simple, option, etc.)___________
____________________________________________________________________________________
5)CONTACT PERSON (Name, mailing address, phone and fax #)_____________________________
____________________________________________________________________________________
5a) CONTACT EMAIL ADDRESS _____________________________________________________
6) PROJECT STREET ADDRESS:_____________________________________________________
____________________________________________________________________________________
7) TAX PARCEL ID # (can be obtained at Assessor’s Office)_________________________________
8) PROJECT DESCRIPTION
a) Existing Uses on Property (including description and size of each separate use)_________________
____________________________________________________________________________________
b) Other (list any other information pertinent to this application not specifically requested above, please
note if Overlay Districts are applicable)____________________________________________________
____________________________________________________________________________________
(802) 878-0375, F: (802) 878-9618
2 Minor Lot Line Adjustment Application Form. Rev. 12-2011
9) LOT COVERAGES FOR EACH LOT
LOT #1 (Street Address): ______________________________________________________________
a) Building: Existing________ % Proposed_________%
b) Overall (building, parking, outside storage, etc)
Existing________% Proposed_________%
c) Front yard along each street Existing________% Proposed__________%
(applies only to commercial property)
LOT #2 (Street Address): ______________________________________________________________
d) Building: Existing________ % Proposed_________%
e) Overall (building, parking, outside storage, etc)
Existing________% Proposed_________%
f) Front yard along each street Existing________% Proposed__________%
(applies only to commercial property)
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.)________________________
____________________________________________________________________________________
____________________________________________________________________________________
13) PLANS AND FEE
Plat plans shall be submitted which shows the information required by the Land Development
Regulations. Three (3) regular size copies, one reduced copy (11" x 17"), and one digital (PDF-format)
copy of the plans must be submitted. Applicant fees must be included.