HomeMy WebLinkAboutPermit Permanent Sign SN-18-26 - DORSET STREET DERMATOLOGYPermit Number SN-A-1-6_
City of South Burlington, Vermont
Application for Permanent Sign Permit
1) 9"ER OF RFy,CORD (4qmc as s4own on deedl mo}ng address, Oone and fax #)1
1t l t7 � � (o �7> ,-S-50.3 I $ i-' Z ..5� 91
2) APPLICANT (Name, mailing address, phone and fax #) �"� i EC�e 11 6c..�1cJ,ir'� z_
'32,S Ghee :5�-eef, 50- K-)c'knA4,-, Yt CLS�
3) SIGN LOCATION (inc}l �d business name, address, & phone #): Cu C r e l
7 O ✓G. d p p�iC,�il �C`y i�S 5, tom, --,z4-
16 Mv VL>_ t `f Cb 37,2. L-)c r5e. t- `5 r f-
4) TAX PARCEL ID # (can be obtained at Assessor's Office)
5) SIGNMi&)
CT R (Name, mailing address, phone and fax #): A .n 5 �I-ed`
�,_
e aka4 ,3�5- 1�>(-,e_4- 5l few c,xlJ 015 c��e 4.
1 7) DATE OF F,RECTION / a 1 0 Q r O'n j
J Q) crnrr ne•re
WALL SIGNS (list size in sq. ft., illumination, & type
FREE-STANDING SIGN
such as panel or cut-out letter
1. 91--es Ca�c�.� 4a"fa I j � �, ; I um
SIZE (in sq. ft.):
pane
2, 661p^5x q8 " �-2 CI
OVERALL HEIGHT:
SIGNABLE WALL AREA (in sq. ft.):
TYPE OF ILLUMINATION:
NU'I t;: A scaled rendering of each proposed sign must oe suonuum iuusuaang Luc w,vA vi Luc *is" &UU
noting the dimensions of each sicn.
9) DATE OF DESIGN REVIEW P OVAL (if a icable):
t� �
10) Applicant Signature: Date:
1
11) Signature of Land/Building O,vner: +/i,'1, iL �_ Date:
Do not write below this line
Fee: Application: Reject Approved ;7
Code Officer Signature: Date:
1.
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southburfington
PLANNING & ZONING
DEVELOPMENT REVIEW BOARD
WAIVER OF RIGHT TO APPEAL
The Administrative Officer may issue a Zoning Permit pursuant to an approval of a Zoning Per it Application
prior to expiration of the thirty -day appeal period set forth in 24 V,S,A. section 4471 only if all Interested
persons, other than the City, waive their rights to appeal any underlying Development Revie Board (DRB)
approvals. In order to ensure the finality and validity of any relevant DRB approvals, the applicant/landowner
and all other interested persons must waive their rights to appeal in order for the applicant/I ndowner to
receive a Zoning Permit prior to the expiration of the appeal period.
DR / Application #
Z (�eningpG�N] ermit Application #
DK
(office use only)
Subject property owner(s): The undersigned property owner(s) hereby waives any and all
approval(s) of the Development Review Boa , listed be w.
Property Owner (printed nary) (Signature) Date
Property Owner (printed name) (Signature)
Date
Appllcant(s): The undersigned applicant(s) hereby waives any and all rights to appeal the al
Development Review Board, listed below,
I` .4ckc((
Applicant (printed name) { ignature)
Date
Applicant (printed name)
(Signature)
Date
is to appeal the
s) of the
57S Dorset Street South Burlington, VT 05403 tel 802.846.4106 fax 802.846.4101 4vtw.sburl.com
Additional Interested Persond: The undersigned Interested Persons hereby waive any and
the approval(s) of the Development Review Board, listed below.
1.
(Printed name) (Signature) Date
(Address)
2.
(Printed name) (Signature) Date
(Address)
3.
(Printed name)
(Address)
4.
(Printed name)
(Address)
(Signature)
(Signature)
Date
Date
Do not write below this line - For office use only
Date of site plan approval/denial
Approval Date
Denial Date
Date of subdivision approval/denial
Approval Date
Denial Date
Date of conditional use approval/denial
Approval Date
Denial Date
Date of appeal variance approval/denial
Approval Date
Denial Date
Date of miscellaneous approval/denial
Approval Date
Denial Date
Date of desig approy�l/denial
Al4proval bate Denial Date
2 DRB Waiver of Right to Appeal 5-2015
to appeal