HomeMy WebLinkAboutSP-23-009 - Supplemental - 0054 0056 West Twin Oaks Terrace
575 Dorset Street South Burlington, VT 05403 tel 802.846.4106 fax 802.846.4101 www.sburl.com
APPLICATION FOR SITE PLAN REVIEW
□ Administrative □ Development Review Board
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 site plan will result in your application being rejected and a
delay in the review before the Development Review Board.
1. OWNER(S) OF RECORD (Name(s) as shown on deed, mailing address, and phone):
2. APPLICANT (Name, mailing address, phone):
3. CONTACT PERSON (person who will receive all correspondence from Staff. Include name,
address, phone):
4. CONTACT EMAIL ADDRESS:
5. PROJECT STREET ADDRESS:
6. PROPERTY INFORATION
a. Tax Parcel ID # (can be obtained at Assessor’s Office):
b. Location of Last Recorded Deed (Book and page #):
7. PROJECT DESCRIPTION
a. General project description (explain what you want approval for):
Permit Number SP-______-__________ (office use only)
2 Site 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. Height of building & number of floors (proposed buildings and existing buildings to remain, specify if
basement and mezzanine):
f. Number of residential units (if applicable, new units and existing units to remain):
g. Number of employees (existing and proposed, note office versus non-office employees):
h. Other (list any other information pertinent to this application not specifically requested above, please note if
Overlay Districts are applicable):
3 Site Plan Application Form. Rev. 01-2020
8. LOT COVERAGE Total Parcel Size: Sq. Ft.
a. Building: Existing % / sq. ft.
Proposed % / sq. ft.
b. Overall impervious coverage (building, parking, outside storage, etc)
Existing % / sq. ft.
Proposed % / sq. ft.
c. Front setback non-building coverage (along each street, commercial properties only)
Existing % / sq. ft.
Proposed % / sq. ft.
d. Total area to be disturbed during construction (sq. ft.) *
* Projects must follow the City’s specifications for erosion control in Article 16 of the Land Development
Regulations. Projects disturbing more than one acre require a permit from the Vermont Department of
Environmental Conservation.
9. COST ESTIMATES
a. New Building or Addition, including initial fit-up (if initial fit-up cost not available, contact Department staff):
$
b. Landscaping: $
c. Other site improvements (please list with cost):
10. ESTIMATED TRAFFIC
a. P.M. Peak hour for entire property (In and out):
11. PEAK HOURS OF OPERATION:
12. PEAK DAYS OF OPERATION:
13. ESTIMATED PROJECT COMPLETION DATE:
4 Site Plan Application Form. Rev. 01-2020
14. SITE PLAN 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 DATE OF SUBMISSION
_________________________________________ ______________________________
SIGNATURE OF PROPERTY OWNER PRINTED NAME OF PROPERTY OWNER
___________________________________________________________________________
Do not write below this line
I have reviewed this site plan application have taken the following action:
○ Issued Decision
○ Referred to Development Review Board
________________________________________________________
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.