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