HomeMy WebLinkAboutSD-24-03 - Supplemental - 0500 Old Farm Road (11)
180 Market Street South Burlington, VT 05403 tel 802.846.4106 fax 802.846.4101 www.sburl.com
Application Number SD-______-__________
(office use only) APPLICATION FOR SUBDIVISION SKETCH PLAN REVIEW
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 before the Development Review Board. For amendments, please provide pertinent
information only.
1. PROJECT STREET ADDRESS:
2. OWNER(S) OF RECORD (Name(s) as shown on deed, mailing address, phone)
3. APPLICANT (Name, mailing address, phone)
4. CONTACT PERSON ((person who will receive all correspondence from Staff. Include name,
address, phone):
4a. Contact email address:
6. TAX PARCEL ID # (can be obtained at Assessor’s Office):
7. PROJECT DESCRIPTION
a. General project description (explain what you want approval for):
b. Existing Uses on Property (including description and size of each separate use):
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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. Other (list any other information pertinent to this application not specifically requested above, please
note if Overlay Districts are applicable):
8. LOT COVERAGE (ALL information MUST be provided. For Planned Unit Developments involving multiple
parcels, attach additional sheets)
Total Parcel Size: acres / 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.
9. NATURAL RESOURCE INFORMATION
a. Are there any Natural Resources (as defined in the Land Development Regulations Article 12) on the
subject property?
3 Sketch Plan Application Form. Rev. 01-2020
Yes No
b. If yes, is the proposed development encroaching into any of these natural resources (list area of resource
encroachment by type)
c. If yes, please submit the following with this application:
i. A site specific or GIS based natural resource mapping or delineation of the entire property as required by
Table 12-01.
10. TYPE OF ADDITIONAL EXISTING OR PROPOSED ENCUMBRANCES ON PROPERTY (easements, covenants,
leases, rights of way, etc.)
11. ESTIMATED PROJECT CONSTRUCTION SCHEDULE AND DATE OF COMPLETION
12. PLANS AND FEE
Plans shall be submitted which show the information required by the City’s Land Development Regulations. One
(1) regular size copy (24” x 36”) and one (1) reduced copy (11" x 17") of the plans must be submitted. 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 also 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
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I have reviewed this site plan application and have taken the following action:
Date of Complete Application:
Date 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.