Zoning Permit Application Form - 2015
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1
2
3Permit Fee:
_
Received_______ Date ___________
TOWN OF SHAFTSBURY
ZONING PERMIT APPLICATION
Rev. May 11, 2015
Permit #:
_______________ _____
Parcel ID# ______________________ Zoning District: _______________
Lot Size: ___________Cost of Project: _____________
Name of Landowner:
____
Landowner Email: ___________________________
Mailing Address:
_____ _____ Landowner Phone: ______________________
Name of Applicant:
____
_
Applicant Email: _____________________________
Mailing Address:
____Applicant Phone:
______________ ___
_
Physical Location of Property______________________________________
(E-911 address and distance to nearest intersection)
Builder:
___
Builder Telephone:
_______
__
PERMIT TYPE: New Construction: _ _ Addition:
Accessory Bldg: _ _
Other:
_______________________
PERMIT USE: If Residential, Building Type: __________
Commercial
Other
(Colonial, Ranch, Mobile Home, etc)
______
_______
Length: _____ _ft Width: _______ft Height: ______ft. # Of Bedrooms:_____ # Baths: _____Total Sq Ft:_________
Other Structure: ______________________________________________
(addition, trailer, roadside stand, garage, shed, barn, fence, etc.)
Length:_____ _ ft Width:_ ______ft Height_ __ __ft
# of Stories:_ _ __
Total Sq Ft: ______________
_ __
POOL:
__
In Ground
__
Above Ground Pool Size:
_____
Decking Size: ____________________
SIGN:
____1 Side ____2 Side ____Multiple Signs Width: _______ft Height: ______ft Total Sq Ft: _ _________
1.
You must include a plot plan showing your entire property and the proposed project. (Use attached grid paper). Show:
property lines; location of all existing and proposed buildings; location of all existing and proposed wells and septic systems; scale
(how many feet per inch); all front, rear and side yard setbacks from property lines. Include Site Plan, if any, prepared by
architect, engineer or surveyor.
Applicant is responsible for verifying lot line locations and complying with all setbacks, zoning bylaws and any other conditions
2.
as set forth in this permit. All costs to remedy non-compliance will be borne by the applicant and may include removal or
relocation of the structure as required to correct any violations.
State permits may be required for this project. Call 802-786-5907 to speak to the state Permit Specialist BEFORE beginning
3.
construction. These may include permits or certifications regarding wastewater treatment, compliance with Vermont Residential
Building Energy Codes, and others. (Your ability to sell your land in future may depend on being able to prove compliance with all
local and state regulations and laws.)
By affixing my/our signatures below,
1)
I/We authorize my/our representative, named below, to act on my/our behalf in all dealings regarding this application.
2)
I/We understand and agree that we must obtain a Certificate of Occupancy and/or Zoning Compliance from the Town of Shaftsbury
prior to using/occupying this structure or addition.
3)
I/We grant permission to the Zoning Administrator and/or Listers for access to the property for inspection purposes.
4) I/We certify that all statements contained herein and in all accompanying documents are true and correct, to the
best of my knowledge.
Landowner’s Signature: __________________________ ____________________________ Date: _______________
Applicant’s Signature (if not landowner): __________________________________________
Date: _______________
Name of Landowner’s Representative: _________________________________________________________________
(Circle one) Approved
Denied
Referred to DRB Date _______ By Zoning Administrator_______________________
To be completed by the Town of Shaftsbury:
Received for record this __ ____day of _____
____AD 20_____, at _________o’clock________minutes___________M.
Recorded in Book:____
____ Page:_____________ Attest:____
____________________
___ Town Clerk
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