Act 250 Land Use Permit

ACT 250 LAND USE PERMIT

APPLICATION TO EXTEND CONSTRUCTION COMPLETION DATE

NAMES:

1. Applicant(s) Name:_____________________________________________________________ Address________________________________________________________________________________________________________ Phone ____________________

Legal form: [ ] individual [ ] partnership (attach list of partners) [ ] municipal gov't [ ] state gov't

[ ] corporation: date formed ______ place formed________________ date registered in Vt. ____________

Legal interest in land: [ ] ownership in fee simple [ ] lease agreement [ ] other:_____________

2. Landowner(s) Name________________________________________________________________ Address___________________________________________________________________________________________________________ __Phone _________________

3. Contact Person_______________________________________________________ Address______________________________________________________________________________________________________________Phone_________________

PROJECT DESCRIPTION:

4. Type: [ ] Extension of Construction Completion Date; Existing Permit # ____________

5. General description: What is the status of the project and the reason the project could not be completed by required date. Has the project been delayed by litigation, proceedings to secure other permits, proceedings to secure title through foreclosure, or because of market conditions? If so, please explain.

_____________________________________________________________________

____________________________________________________________________

_____________________________________________________________________

6. Duration of extension request: ______________

Application to Extend Construction Completion Date

Page 2

LAND

7. Total acres owned or controlled by applicant and landowner at project site _______; Acres in additional easements or rights-of-way ________ ; Acres committed to this project ____________ Location: Town____________ Road________________nearby landmark__________________

Is the project located in more than one town or on a town boundary? [ ] Yes [ ] No. Names of Towns: ____________________ _____________________

8. Deed(s):Grantee's name as recorded_______________________________________

Book(s) _____ Page(s)_____Date(s)_________ Town _______

County _____________

SIGNATURES:

9. I hereby swear that the information provided above or attached to this application is true and accurate to the best of my knowledge.

Signature of applicant(s) ________________________________ Date ______________

________________________________ Date ______________

Please print names(s) clearly: __________________________________

10. I hereby authorize the processing of this application for the above project on land(s) that I own, control, or have significant property interest in. (attach letter if easier)

Signature of landowner(s) ______________________________ Date ______________

______________________________ Date ______________

Please print name(s) clearly: ___________________________________

DISTRIBUTION:

SUBMIT THE ORIGINAL AND THREE COPIES TO THE DISTRICT COORDINATOR.

SUBMIT ONE COPY EACH TO THE MUNICIPALITY, MUNICIPAL PLANNING COMMISSION, REGIONAL PLANNING COMMISSION, VERMONT AGENCY OF NATURAL RESOURCES (Division of Regulatory Management & Act 250 Review,

Agency of Natural Resources, 103 South Main Street, Ctr. Bldg., 3rd Floor, Waterbury, VT 05671-0301), AND TO ANY ADJOINING MUNICIPALITIES AND PLANNING COMMISSIONS IF THE PROPERTY IS LOCATED ON A TOWN LINE.

Last Updated: June 28, 2012

SCHEDULE A

Fee Information

(Effective July 1, 2012)

Submit with the application a check payable to the "State of Vermont". Municipal and state agency projects are exempt from fees but should still report construction costs on this form. Not-for-profit organizations are not exempt. Calculate the fee using the table below.

Note: All lines on the schedule must be filled out. If a line does not apply, or if there is no associated cost, enter 0. An incomplete schedule will result in a delay in application processing.

1) Number of lots to be created ______ x $100.00 = $ ____________

2) Earth Extraction (Gravel/Sand Pits and Quarries)

$.02/cubic yard X amount of total extraction proposed over the

life of the permit up to 1 million cubic yards = _____________

$.01/cubic yard X amount of total extraction proposed over the

life of the permit exceeding 1 million cubic yards = _____________

3) Construction costs:*

Site preparation . . . . . . . . . . $____________

Buildings:

a) sq. ft. ___________

b) $ per sq. ft. ______

Total (a x b) . . . . . . $____________

Roads and parking . . . . . . . . $____________

Utilities . . . . . . . . . . . . . . . . . $____________

Off-site improvements . . . . . . $____________

Landscaping . . . . . . . . . . . . . $____________

Other _____________. . . . . $____________

Total costs: $____________ x 0.00540 = $ _____________**

4) Total Fee (Sections 1 + 2 + 3) = $ _____________***

* For residential subdivisions, include the estimated construction cost of all improvements proposed to be constructed by the applicant or a related person or entity, including common facilities, infrastructure, dwellings, and other. (For more information, see definition of "person" at 10 V.S.A. § 6001(14).) (www.nrb.state.vt.us/lup/statute.htm)

** For projects exceeding $15,000,000 in total cost, multiply the first $15,000,000 in costs X .00540; multiply the balance of the costs X .00250. See 10 V.S.A. § 6083a (www.nrb.state.vt.us/lup/statute.htm) for the complete schedule of fees.

*** Minimum fee of $150 for new applications; minimum fee of $50 for amendment applications

Maximum total application fee is $150,000.00

Treat expansions of approved projects as new applications.

I attest by my signature that the above is true to the best of my knowledge:

__________________________________________

(signature of applicant)

SCHEDULE E

Adjoiner Information

Submit with the application a list of all adjoining landowners with mailing addresses. An "adjoiner" is a person or organization which owns or controls land or easements on lands which physically abut the tract or tracts of land on which your project is located. Be certain to include landowners on the opposite sides of highways, railways, and rivers. Also include homeowner associations, utility companies, and others with significant legal interest in the project land. It is very helpful if you indicate the location of each adjoiner on your site plan.

If you do not provide a list which is thorough and up-to-date, your application could be delayed because of improper notice distribution!

NAME MAILING ADDRESS WITH ZIP CODE

_________________________________________________________________

Attach additional sheets if necessary.

SCHEDULE F

Certification of Service and Notice of Application

You are required by Section 6084 of 10 V.S.A. to send notice and a copy of your application to the municipality, the municipal and regional planning commission in which the land is located, the Vermont Agency of Natural Resources (Division of Regulatory Management & Act 250 Review, Agency of Natural Resources, 103 South Main Street, Ctr. Bldg., 3rd Floor,

Waterbury, VT 05671-0301), and any adjacent Vermont municipality, municipal or regional planning commission if the land is located on a boundary on or before the date of filing your application with the district commission. You are also required to send notice and a copy of your application to the solid waste management district in which the land is located, if the development or subdivision constitutes a facility pursuant to subdivision 6602(10) of Title 10 V.S.A. Chapter 151. You must also post a copy of the notice in the town clerk’s office of the town or towns where the land is located. A notice form is attached for your convenience.

In order to verify that the statutory parties to the application have received copies of the application and thus avoid delay caused by improper distribution of the application, have a representative of the parties sign this form when they receive the application. You may, in the alternative, send copies of the notice and application by Certified U.S. Mail and list the names below.

Applicant(s) Name _________________________________________________________

I, the undersigned, have received a copy of an Act 250 application for the above applicant(s).

____________________________________________ ______________________

for the selectmen, aldermen, or trustees date

____________________________________________ ______________________

for the municipal planning commission date

____________________________________________ _____________________

for the regional planning commission date

___________________________________________________________________

for the Agency of Natural Resources date

____________________________________________ _____________________

for an adjacent municipality, if any* date

____________________________________________ _____________________

for an adjacent planning commission, if any* date

____________________________________________ _____________________

for an adjacent regional planning commission, if any* date

____________________________________________ ______________________

for regional solid waste mgt. district, if applicable date

I hereby certify that I have forwarded a complete copy of this application to each of the parties entitled to notice pursuant to 10 V.S.A. Section 6084 and that I have posted a copy of the notice of application in the town clerk’s office(s).

____________________________________________ __________________

Applicant(s)/Agent Signature Date

* Attach additional sheets if more than one town is adjacent to the project lands.

Schedule F - Continued

Note To Applicants: This notice must be included with all copies of the application. You must also post, or cause to be posted, a copy of this notice in the town clerk’s office of the town or towns wherein the land proposed for subdivision or development lies.

Notice of Act 250 Application

By application dated _____________, (name and address of applicant) ____________________________________________________________________________________________________________________________________________________________________ filed an application pursuant to 10 V.S.A. § 6001 et seq. (“Act 250") to: (description of project including road location and Town) ______________________________________________________________

______________________________________________________________

A copy of this application may be reviewed at the Town Offices, Town of _______________, Vermont.

Signature ______________________

Date ____________

In the event you wish to receive further notice concerning this application, please contact the district office for your area:

Environmental Comm. Environmental Comm. Environmental Comm.

Districts #1 and 8 Districts #4, 6 and 9 District #7

440 Asa Bloomer State 111 West St. 1229 Portland St.

Office Building Essex Jct., VT 05452 Suite 201

4th Floor 88 Merchants Row (Tel. 879-5614) St. Johnsbury, VT 05819

Rutland, VT 05701 (Tel. 751-0120)

(Tel. 786-5920)

Environmental Comm. Environmental Comm.

Districts #2 and 3 District #5

100 Mineral Street 324 North Main Street

Suite #305 Barre, VT 05641

Springfield, VT 05156 (Tel. 476-0185)

(Tel. 885-8855)

Act 250 Electronic Submission Guidelines

The Natural Resources Board is working to improve on-line access to Act 250 files for applicants, state agency staff, and the general public. As part of this effort we will be expanding the on-line Act 250 database (www.anr.state.vt.us/site/cfm/act250/search.cfm) into a comprehensive, searchable database of all Act 250 applications, as well as an internet-based map which will allow users to geographically locate lands subject to Act 250 permits.

To help implement this effort, applicants and parties are required to provide an electronic copy of all Act 250 submittals, including the original Act 250 permit application and any follow up submittals, pursuant to Act 250 Rule 10(E), unless this requirement creates an undue burden for the applicant or a party. Please note that the required electronic copy is in addition to the required paper copies, which must still be submitted to the district office and parties.

The following guidelines provide further information about the format of electronic submissions.

Guidelines for Electronic Media, File Formats, and Folders:

1) Acceptable electronic media, in order of preference, include compact disc (CD) and digital video disc (DVD). Depending on the size of your electronic files, we may also be able to accept your electronic submission by email. Please check with our district office staff before sending any files by email. Alternatively, you may transmit your files electronically via FTP. Please see the instructions below for FTP filings.

2) All document files and site plans should be submitted in Adobe PDF format (.pdf). Microsoft Word (.doc) is acceptable if Adobe PDF is not available. Wherever possible please convert your documents to PDF directly from the word processing or engineering design program where they were created rather than scanning the paper version of the document. If you need to scan a paper document to PDF, please make sure you enable Optical Character Recognition (OCR) in the scanning program. This is very important as it will make the PDF document searchable in the future. Photographs may be submitted in JPEG format (.jpg). For large documents, those with extensive use of color, and those with multiple photos or graphic images, please use settings such as “reduce file size” or “PDF optimizer” in Adobe Acrobat or other scanning programs to keep file sizes to a minimum while still maintaining adequate quality. Contact the district office staff (see below) if you need more information about how to reduce file sizes.

3) Files should be organized into three directory folders named Schedules, Supporting Materials, and Plans, with the following documents in each folder (See example below):

a) The Schedules Folder should contain the Application Cover Sheets and all Schedules. The Application Cover Sheets should be saved in a file named Cover Sheets. The Schedule B and Municipal and School Impact Questionnaires should be saved in a file named Schedule B. All other Schedules should be saved in one file named Schedules A E F G.

b) The Supporting Materials Folder should contain all supporting documents (letters, reports, photographs, etc.) except site plans. Each document should be saved as a separate file.

c) The Plans Folder should contain all site plans, location maps, and engineering drawings. All plan sheets should be saved as separate files.

4) All file names should be descriptive of the document contents. For example, a Visual Analysis Report could be named: Visual Analysis.pdf. File names may contain spaces, but the following characters may not be used in any file names: " # % & * : < > ? \ { | }

5) Use the same folder structure for follow up submittals.

Example of File Organization on CD or by FTP:

Schedules Folder

Cover Sheets.pdf

Schedule B.pdf

Schedules A E F G.pdf

Supporting Materials Folder

09 Herb Permit.pdf
ACOE Authorization.pdf
Distribution Standards.pdf

Erosion Policy.pdf

Forestry Goals & Practices.pdf

Suppinfo.pdf

Wetlands Office Letter.pdf

Plans Folder

Location Map.pdf
Overall Site Plan.pdf

Erosion Control Plan.pdf

Instructions for Electronic Submission via FTP

1) Create a directory folder on your own computer using the name of the project (e.g. Bob’s subdivision, Acme commercial building) as the name of the folder.

2) Create subfolders under the directory and place your files in these subfolders using the same file structure and naming convention described above for creating a CD.

3) Open Windows Explorer (NOT Internet Explorer). Windows Explorer is easily accessed by RIGHT CLICKING on the START button. Go to the location of the project directory folder that contains the subfolders and files. Highlight the directory folder and choose either Edit, Copy or CTRL C.

4) Open a second session of Windows Explorer; in the Address bar, type: ftp://ftp.anr.state.vt.us, then click on “Go”. You will be prompted for a username and password. They are:

Username: A250

Password: Simple1 Note: The username and password are case sensitive.

5) Place the cursor in the directory on the right side of the window and paste using either Edit, Paste or CTRL V.

6) Send the appropriate Act 250 office an email saying the files for your application have been uploaded under a folder named “[your folder name].”

7) If you are uploading files for a pending Act 250 application, follow the same procedures above, but use the application number assigned by the Act 250 office (e.g. 4C1234) to name the directory folder you create.

If you have questions about these new electronic filing requirements, please contact our district office staff (see contact information on the cover page of the Act 250 application forms or at http://www.nrb.state.vt.us/lup/commission_members.htm