Yes No

Yes No

First Name

First Name

Phone #

Last Name

Contractor Same as Owner?

Enter all additional contractors, including the architect or designer of record.

Last Name

First Name

City, State, ZIP

Property Owner Information

Phone #

Business Name (If Applicable)

City, State, ZIP

Business Name (If Applicable)

Email

Mailing Address

Fax #

Fax #

Contractor Information

Email

Address

Fax #

Applicant Same as Owner?

Applicant Information

Address

Business Name (If Applicable)

Last Name

Mailing City, State, ZIP

Phone #

Email

Additional Contractor Information

Development in flood hazard area.

Construction, reconstruction, conversion, structural alteration, relocation, enlargement of any building or other structure.

Accessory Structure

Landfill, mining, or excavation operations.

Razing Structure(s) Square Footage

In-Ground Swimming Pool

Mining, Excavation Operations, Earthen Material Removal Amount (in cubic yards)

Accessory Structure(s) Square Footage

If other, please specify the type of work

Change of Use

Interior renovations to residential structure in contemplation of increase in number of bedrooms or dwelling units.

Intended Start Date

Other

Intended Completion Date

Increase in number of Dwelling Units on a Parcel of Land.

Addition or Alteration

Interior renovations to a non-residential primary structure done in contemplation of a change in use or intensity of use.

Give a detailed description of the current use of the property, How many buildings and their respective uses, dimensions, setbacks, etc.

Division of parcel into two or more parcels.

Sign(s).

Reconstruction

Describe the construction (Include building dimension, size and location), and the proposed use

Estimated Cost of the Project

Home Occupation.

Fence

Razing any structure, temporary or otherwise, over 500 sf or any structure in the central business district.

Application Type (Check All That Apply)

Fence Height (in inches)

New Construction

Type of Work Being Performed (Check All That Apply)

Substantial change in nature or intensity of the current use of any building, structure or parcel of land.

Project Details

Extension of current use of land.

Town Sewer Private Septic Not Required

Yes No

Yes No

Town Water Private Well or Water Source Not Required

Yes No

Town Highway State Highway Class 4 or Private Road Right of Way

Yes No

Yes No

Yes No

N/A Using Existing Access

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Will your project have flickering, pulsing, rotating, or flashing lights?

Does it impede the flow of pedestrian traffic in the CBD?

If yes, please explain

If yes, will the requirements of this section be met?

Will there be an increase in noise levels as a result of the project?

How wastewater is/will be disposed?

Will the emission of detectable objectionable odor result from your project?

If yes, please explain

Will traffic flow generated be beyond the capacity of local roads?

What steps will be taken to minimize environmental damage?

Does your project involve use of pesticides herbicides, and fertilizers within 400’ of any well or fire district?

Are you increasing the # of bedrooms?

If yes, what tests have been done to ensure the soundness of the tanks?

Will there be any hammering, drilling, cutting or blasting within 100 feet of any underground tank used to store petroleum projects?

What is the maximum # of vehicles expected on site at any given time?

Will the use require loading and unloading of commercial products?

Will it be installed and anchored as required?

If yes, please explain

Will the project result in fly ash, dust, fumes, vapors, gasses or other forms of air pollution?

Performance Objectives and Standards Information

Has the secretary of Vermont agency of agriculture, food and markets indicated that the farm operation complies with the accepted agricultural practices?

Will this project create an increase in the intensity of traffic?

Will noise level exceed 60 decibels during other times of the day at the property?

Does your project involve farm animals?

Will the project result in any fire, explosive, or other safety hazard?

Will there be development within 100’ from the mean high water mark of named river and streams?

Is the proposed use agricultural?

Will a sufficient # of off-street parking spaces be provided?

Will there by any excavation or blasting of the clay layer that protects the public water supply?

Will you be storing greater than 500 gallons of flammable liquids in tanks above ground?

How many bedrooms?

Is the proposed use in the aquifer district?

Are you increasing the # of dwelling units?

Is this display within the required setback from a street or road?

How many dwelling units?

How many customers are expected per day?

Does the proposed use involve forest harvesting?

Does your project involve any areas of steep slope?

How access for emergency vehicles is/will be provided?

Is this a structure over 400 cubic feet in volume (Incl. mobile homes)?

Will there be an outdoor display of retail products?

Is there space within the boundaries of the lot for loading and unloading?

What is the grade of the slope?

Will the project result in any noticeable, clearly apparent vibration on the property of another landowner?

If yes, please explain

How many employees are expected?

If yes, will the requirements of this section be met?

If yes, please explain

Will noise level exceed 70 decibels during daylight hours at the property?

How many parcels will access drive serve?

If yes, is the lot at least one acre in area?

If yes, explain procedures for handling and containment

Will there be any storage of junk or uninspected/unregistered junk vehicles visible from the traveled way of a highway or abutting landowners, or within 50’ of any property line?

Is this a business/home occupation?

Will the project cause an excessive increase in quality, rate or rechanneling of water runoff on neighboring properties?

Will the project involve the emission of any smoke?

If yes, please explain

Will all new driveways have an area to turn around on site?

Is it a farm stand?

Will the project destroy or significantly alter wetlands or natural areas?

If yes, please explain

What is the minimum distance of animal housing and piles of manure, feed or bedding from any lot line?

What is the distance of the closest residence in HDMU?

All References are to the Brandon Land Use Ordinance - Article VI, Section 600.

If yes, what provisions have been made to avoid this possibility?

If yes, please explain

What is the minimum distance of manure piles to wells and surface waters?

Will the number of vehicles using the existing access increase?

Will any hazardous materials be used in this project?

If yes, please explain

Does the property have existing driveway access?

Will your project have lights that illuminate in excess of 0.5 foot candles when measured at adjacent residential boundaries?

Will the project have lights that will distract drivers on roads in the vicinity?

How water supply is/will be provided?

What % of slope will be developed, regraded or stripped of vegetation?

If yes, will it violate this section on public service uses or uses listed in section 429?

Yes No

Yes No

Yes No

Yes No

Yes No

# of lots, including the resized original parcel(s) that will be created

Do you plan to create additional lots from this parcel in the future?

Pre-subdivision/line adjustment property size (in acres)

Do you plan to utilize cluster development?

Do you plan to dedicate any portion of this parcel as open space or common land?

# of lots created from the original parcel in the last 5 years/being created at this time

Subdivision

Subdivision / Boundary Line Adjustment Information

If yes, name of subdivision

If yes, please explain

Type of Work

Boundary Line Adjustment

If yes, please explain

If this subdivision is approved, do you plan to develop it?

Is the parcel located within a subdivision previously approved by the development review board?

Total # of Signs

Sign(s) Permit Information

Yes No

Size of structure (length, width and height)

State Definition

Notice of Intent to Build an Agricultural Building

Are setbacks met?

Type of structure

Describe how proposed structure meets state definition of farm structure

Use of structure

A Farm Structure a structure or structures that are used by a person for agricultural production that meets one or more of the following:

(A) Is used in connection with the sale of $1000 or more of agricultural products in a normal year; or
(B) Is used in connection with the raising, feeding, and management of at least the following number of adult animals: four equines; five cattle or American bison; fifteen swine; fifteen goats; fifteen sheep; fifteen fallow deer; fifteen red deer; fifty turkeys; fifty geese; one-hundred laying hens; two-hundred and fifty broilers, pheasant, Chukar partridge, or Coturnix quail; three camelids; four ratites (ostriches, rheas, and emus); thirty rabbits; one hundred ducks; or one-thousand pounds of cultured trout; or
(C) Is used by a farmer filing with the Internal Revenue Service a 1040 (F) income tax statement in at least one of the past two years; or
(D) Is on a farm with a business and farm management plan approved by the Commissioner.

Yes No

Cost of replacements

Storage/Junkyards

Critical Facility

Building Utilities

Shortest horizontal distance from project to the top of bank of any stream/river

Proposed Fill

Extent of damage

Recreational Vehicles

Method and practices of construction to minimize flood damage

Grading/Excavation/Pond

Development in Hazard Areas

Improvements to existing structure(s)

Building removal in whole or part

Open Space, Recreation

Existing or proposed drainage

Materials used in construction (materials must be flood resistant)

New Structure(s)

At Grade Parking

Storage Tanks

Date of event

Stream Crossing/Access

Agriculture

Cost of repairs

Dimensions of existing/proposed structures

Channel Management

Cost of improvements

Road Improvements

Project Cost Details

Project Activities

Dimensions of additional structures

Small Accessory Structure

Provide information on any previous repairs, replacements or improvements you have made to structures located on your property

Provide information to demonstrate that the cumulative effect of your project, when combined with all other existing and anticipated encroachments on the hazard areas, will not increase the base flood elevation more than 1.00 foot at any point within the community (the demonstration must be supported by rechnical data that conforms to standard hydraulic engineering principles and certified by a licensed professional engineer)

Fill

Road Maintenance

Is the proposed project a result of a flood event?

Project costs means all structural costs including material, labor, built-in appliance, overhead, profit, repairs made to damaged portions of the building worked on at the same time. Please include the following in your project costs:

All structural elements, including:
~ spread or continuous foundation footings and pilings
~ monolithic or other types of concrete slabs
~ bearing walls, tie beams and trusses
~ floors and ceilings
~ attached decks and porches
~ interior partition walls
~ exterior wall finishes (brick, stucco, siding) including painting and moldings
~ windows and doors
~ rehinging or retiling a roof
~ hardware
All interior finishing elements, including:
~ tiling, linoleum, stone, or carpet over subflooring
~ bathroom tiling and fixtures
~ wall finishes (drywall, painting, stucco, plaster, paneling, marble, etc.)
~ kitchen, utility and bathroom cabinets
~ built-in bookcases, cabinets, and furniture
~ hardware
All utility and service equipment, including:
~ HVAC equipment
~ plumbing and electrical services
~ light fixtures and ceiling fans
~ security systems
~ built-in kitchen appliances
~ central vacuum systems
~ water filtration, conditioning, or recirculation systems
Cost to demolish storm-damaged building components, including:
~ labor and other costs associated with moving or altering undamaged building components to accommodate improvements or additions
~ Overhead and profits

Do Not Include plans and specifications, survey costs, permit fees, post-storm debris removal and clean up, outside improvements such as landscaping, sidewalks, fences, yard lights, swimming pools, screened pool enclosures, detached structures (including garages, sheds and gazebos), or landscape irrigation systems in your project costs.

Bridges/Culverts

Forestry

(Special Flood Hazard Areas and Fluvial Erosion Hazard Areas)

Section 803 of the Brandon Land Use Ordinance applies to any land development/construction proposed or undertaken in the designated Fluvial Erosion Hazard Areas and Special Flood Hazard Areas (“Hazard Areas”). Please provide the following information if your property is located in a designated hazard area.

Elevation/relocation or demolition of existing structure (whole or partial)

Storm Water Drainage

Project Description

Replacement or New Water Supply/Septic Systems

Estimated Fee

I certify that the statements made by me in this Application For Land Use Permit are accurate and complete. I hereby grant permission to the Town of Brandon to allow its agent to inspect this property relative to this application for both approval and to ensure compliance once project is complete. I understand that this is an application for a local permit only.

Signature

Note: Your application fee will be reviewed and we'll reach out to you when it's finalized.

Fee Schedule

Attachments

Certification