Middlebury Planning and Zoning Commission
Application for Approval of Sub Division.

Name of owners of all adjoining properties and properties separated from the subdivision by existing streets:

_________________________________________

_________________________________________

_________________________________________

Describe provision for open space or parks or recreation areas (P. 4.14)
Type of protection: conveyance of title ___ Conservation easement __ combination of both __

Proposed recipient: Land trust __ Name __________

Town of Middlebury ____

Other Conservation Organization Name _____________

Number of Acres: ___ Percentage of total area ___%

Other open space, park or recreation areas nearby

___________________________________________

___________________________________________

Prior gifts of open space that qualify for this subdivison:
Acres: ___ Held by: ______________
Under deed ______ Easement: ______

How does the open space area fit with the open space plan of the Town of Middlebury?
___ _________________________________________

_____________________________________________

Does the area contribute to the Green Belt System? ______

Description of area and uses __________________________________

________________________________________________________

________________________________________________________

Has solar acces been provided for wherever feasible? yes __ No __
If no, explain reasons: _____________________________________

________________________________________________________

Description of method of sanitary sewage disposal: _____________

____________________________________________________

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