Zoning Permit Application Form - Town Of Barnet Page 2
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2SUBDIVISION: NUMBER OF LOTS______; SIZE OF EACH LOT_________________________ACRES +/-
STATE PERMIT IS REQUIRED FOR SUBDIVISION & SEWAGE APPROVAL; PLEASE CALL ANDREW
E. FRASER AT (802) 751-0128. MUST ALSO COMPLY WITH VT ENERGY CODE; PLEASE CALL
ENERGY CODE ASSISTANCE CENTER TOLL-FREE AT (855) 887-0673.
APPLICANT CERTIFICATION:
The undersigned applicant(s) affirms that the information presented on this application is true, accurate and complete.
Any permit issued shall be null and void if any information provided in inaccurate or misrepresented.
APPLICANT(S) SIGNATURE_________________________________________________________DATE ___/____/_______.
_________________________________________________________DATE___/____/________
LANDOWNER(S) CERTIFICATION:
The undersigned property owner(s) hereby consent to submission of this application and understand that if the application is
approved the Zoning Permit and any attached conditions will be binding on the property. State of Vermont permits may also
be needed.
LANDOWNER(S) SIGNATURE(S) AS ON DEED______________________________________DATE___/___/____.
______________________________________DATE___/___/____
The Administrative Officer has 30 days to act on a permit application. An Interested Person as outlined in VSA Title 24,
Chapter 117, Section 4465 (a), can appeal any act or decision by the Administrative Officer by filing a notice of appeal with
the Secretary of the Board of Adjustment within 15 days of the date of such decision or act. An interested person may appeal
a decision of the Board of Adjustment to Environmental Court within 30 days of the decision in accordance with
VSA Title 24, Chapter 117, Section 4471.
ZONING PERMIT FEES: PERMITTED USES: $20.00 PLUS $10.00 RECORDING FEE (PLUS $10.00 FOR EACH
EXTRA PAGE RECORDED); CONDITIONAL USES, VARIANCES & APPEALS $30.00 PLUS $10.00 RECORDING
FEE. “LATE FILING FEE SHALL BE TWO TIMES’ THE ORIGINAL OR REGULAR FEE.” PLEASE MAKE CHECKS
PAYABLE TO “TOWN OF BARNET” AND INCLUDE WITH APPLICATION TO THE ADMINISTRATIVE OFFICER,
SHIRLEY WARDEN, 521 WARDEN ROAD, BARNET, VT. 05821. PHONE #(802) 633-4993 (BEFORE 8:30 A.M. IS
BEST).
DO NOT WRITE BELOW THIS LINE (form date 9/2014)
FOR TOWN USE ONLY
Original to Town Clerk; Copies to Applicant, Board of Listers, Adjoining Landowners & 1 posted at Town Clerk’s Office.
RECEIVED____/___/_____. FEE $_______________CASH______CHECK NO. _______ ACTED ON ___/____/________.
DENIED & REFERRED TO THE BOARD FOR:
(__) CONDITIONAL USE
APPROVED (__) OR DENIED (__)
DATE ___/___/_________
(__) BACK LOT OR SITE PLAN REVIEW
APPROVED (__) OR DENIED (__)
DATE ___/___/_________
(__) VARIANCE OR APPEAL
APPROVED (__) OR DENIED (__)
DATE ___/___/_________
SIGNED, CHAIRMAN, PLANNING/ZONING BOARD__________________________________DATE ___/___/_________
PERMIT APPROVED (__) OR DENIED (__) PERMIT EFFECTIVE ____/____/____. PERMIT EXPIRES___/___/________
SIGNED, ZONING ADMINISTRATIVE OFFICER_____________________________________DATE ___/___/_________
COMMENTS:
Page 2 of 2
Form revised: 18 September 2014
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