Application For A Hearing Before The Development Review Board Form

TOWN OF ELMORE, VERMONT

APPLICATION FOR A HEARING BEFORE THE DEVELOPMENT REVIEW BOARD

Copies of (The Zoning and Subdivision Bylaws are available for purchase from the Town Clerk's Office or the

Zoning and Planning Office

Tax Map Number:_________________________

Permit Number: _______________________________

XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX)

All questions Must be completed in full or application will be Denied (Please print or type information)

Road Name: _______________________________________________________________________________________

E-911 Property Address: _____________________________________________________________________________

Property Owner: ____________________________________________________________________________________

Mailing Address: ____________________________________________________________________________________

Applicant: ____________________________________________________________________________________

Mailing Address: ____________________________________________________________________________________

Telephone Number: Work: __________________________

Home: ______________________________________

Engineer of Plan: __________________________________________________________________________________

Mailing Address: ___________________________________________________________________________________

: ___________________________

Telephone Number

Fee: $ _______ ________Paid: Y/ N

Nature of Request: Conditional Use:____Site Plan Review:____Variance:____Appeal:_____Waiver:_____

Description of Project: Four copies of a site plan must be submitted with this application

Existing use of property: ____________________________________________________________________________

Proposed use of property: __________________________________________________________________________

Describe the proposed project and the nature of the request you are applying for: ____________________________

__________________________________________________________________________________________________

Project Dimensions: ___________________________ Lot Size: _______________________________________

Lot Frontage:_________________Parking Spaces: Required:________________Planned:_________________

Access Permit:

Y/N

Light Plan:

Y/N

Easements and Rights of Ways Shown: Y/N

Interdepartmental Sign-Offs:

Y/N

Act 250 permit required:

Y/N

Traffic Flow Plan:

Y/N

Landscaping Plan:

Y/N

Contour Map:

Y/N

Application For A Hearing Before The Development Review Board Form - Town Of Elmore Page 3