HomeMy WebLinkAboutSD-24-12 - Supplemental - 0500 Old Farm Road (15)
180 Market Street South Burlington, VT 05403 tel 802.846.4106 fax 802.846.4101
www.southburlingtonvt.gov
Application Number SD-______-__________
(office use only) APPLICATION FOR SUBDIVISION PLAT REVIEW
Preliminary Final
Applications involving land development must also provide a completed Application For Site Plan Review
PUD Being Requested? Yes No
If a PUD is being requested, you must also provide a completed Application For Site 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.
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):
2 Subdivision 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: Are Transfer of Development Rights (TDRs) being utilized? Yes No
If yes, please identify how many and from which parcel (street address)
e.Type of existing or proposed encumbrances on property (easements, covenants, leases, rights of way,
etc.)
f.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. Proposed coverages are those resulting from
subdivision of land. Changes resulting from development must be reported on Application for Site Plan
Review. Attach additional sheets if necessary for additional proposed parcels)
Lot Size (acres / sq. ft.)
Building Coverage Lot Coverage
Front Setback non-
building Coverage
(Commercial
Properties Only)
Sq. ft. % Sq. ft. % Sq. ft. %
Existing
Proposed #___
Proposed #___
3 Subdivision Application Form. Rev. 01-2020
9. NATURAL RESOURCE INFORMATION
a. Are there any Natural Resources (as defined in the Land Development Regulations Article 12) on the
subject property?
Yes No
b. If yes, please provide a site specific or GIS based natural resource mapping or delineation of the entire
property as required by Table 12-01.
10. PLANS AND FEE
Plat plans shall be submitted which show the information required by the City’s Land Development Regulations.
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 digitally. 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 subdivision application and have taken the following action:
DATE OF COMPLETE APPLICATION:
DATE REFERRED TO DRB:
_______________________________________________________
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.