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HomeMy WebLinkAboutSD-22-10 - Supplemental - 0500 Old Farm Road (10) South Burlington Sample Certificate of Service Form. Rev. 3-2022 CITY OF SOUTH BURLINGTON CERTIFICATE OF SERVICE I hereby certify that on this ______ day of ________, 20___, a copy of the foregoing public notice for _________________[type of application] #___________ [application number], was sent by U.S. mail, postage prepaid to the owners of all properties adjoining the subject property to development, without regard to any public right-of-way, and including the description of the property and accompanying information provided by the City of South Burlington. I further certify that this notification was provided to the following parties in accordance with 24 V.S.A. §4464(a) and Section 17.06(B) of the South Burlington Land Development Regulations: List of recipients: (full names and addresses) Dated at __________[town/city], Vermont, this _________ day of ___________, 20_____. Printed Name:_______________________________________________ Phone number and email: _______________________________________________ Signature:_______________________________________________ Date:_______________________________________________ Remit to: City of South Burlington Department of Planning & Zoning 180 Market Street South Burlington, VT 05403