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Fill and Sign the Insurance Policy Record Template Form

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Received:________________________ Complete Application: Yes:___________________ No:____________________ Adequate Public Facilities (APF) Application Section I: Background Information Unless otherwise exempt by the terms of the Adequate Public Facilities Ordinance (APFO), this APF Application shall be completed and approved prior to the submission of an application for any of the following "development proposals," which are defined by Section 13.3 of the Town Zoning Ordinance to include the following applications for development: apartment building or attached house site plans involving twenty (20) or more ● dwelling units ● subdivisions involving more than twenty (20) lots ● nonresidential developments or uses of 10,000 square feet or more of floor area or creating fifty (50) or more peak hour vehicle trips or 500 or more daily vehicle trips, whichever is less; and ● developments meeting any one of the thresholds above, which requires any one of the following ♦ a special use permit ♦ any overlay district for which a site specific development plan is required under the provisions of this ordinance ♦ a conditional zoning district ♦ a subdivision sketch plan or a preliminary plan when required by the subdivision ordinance ♦ a final plat when no sketch plan or preliminary plan is required Note: Please refer to Article 14, Zoning Ordinance, to determine whether a separate Traffic Impact Assessment is required to be submitted with an application for the Development Proposal. Pursuant to Section 13.6.2, Zoning Ordinance, a Pre-Submittal Meeting with the Zoning Administrator is required prior to submitting this application form. However, it is recommended that the Applicant become familiar with the requirements of this Application and of Article 13, Zoning Ordinance, prior to the Pre-Submittal Meeting No application for a Development Proposal shall be accepted by the Town, until a Determination of Adequacy has been issued by the Zoning Administrator, pursuant to Article 13 of the Zoning Ordinance and other applicable Town Laws. The APFO tests the capacity of three (3) Public Facilities to determine whether each is sufficient to absorb the impacts of the Development Proposal when it submitted. They are: ♦ Law Enforcement ♦ Parks and Recreation; and ♦ Fire Protection Page 1 of 4 Section II: Development Project Information Please provide the following information. Name of Applicant: Address of Applicant: ______________________________________ ______________________________________ ______________________________________ Name of Property Owner: Address of Subject Property: ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ Zoning - Current Zoning - Proposed Phone Number(s) of Applicant: ______________________________________ ______________________________________ Parcel Number of Subject Property: ______________________________________ Size of Subject Property: ______________________________________ Number of Phases & Total Sq. Ft.: ______________________________________ (If this Development Proposal will be phased, please see Section III below.) Number of Phases & Sq. Ft. Included in this APF Request: ______________ ______________________________________________________________ Number of Phases & Sq. Ft. Included in TIA Request (if applicable) ______________________________________________________________ (Phases not included in initial calculations for APF and TIA will be subject to APF & TIA requirements prior to development of those phases) Has any property adjacent to or within 300 feet of the Subject Property been developed by the Applicant or Property Owner since November 20, 2007? If so, please describe the nature, extent, and timing of that development and its location. ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Page 2 of 4 Describe in detail the nature of the proposed land use. Please address such matters as whether goods or services are to be sold or provided, any special transportation characteristics, the use of all enclosed and unenclosed portions of the property, and the square footage to be allocated to each land use. Space has been provided for indicating the extent of each proposed new land use as well as for a narrative description. Please attach additional pages as needed. Non-Residential Land Uses Proposed Square Feet Gross Floor Area _______________________________ _______________________________ _______________________________ _______________________________ ______________________________ ______________________________ ______________________________ ______________________________ Residential Land Uses Proposed Number of New Dwelling Units (please indicate whether single- or multi-family) _______________________________ _______________________________ _______________________________ _______________________________ ______________________________ ______________________________ ______________________________ ______________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Page 3 of 4 Section III: Phasing If the Proposed Development is to be completed pursuant to a Phasing Schedule, please indicate when each phase is to be completed and the extent of development proposed for each use within each Phase. Describe when approvals are expected to be sought including preliminary subdivisions, site plans, rezonings, building permits, and certificates of occupancy. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Section IV: Past or Proposed Public Facility Contributions Please describe any past or proposed dedication, construction, or funding provided by the applicant or the property owner in order to address the impacts of the Proposed Development on Public Facility capacity. Please explain the nature and timing of such contributions and whether or to what extent they will mitigate the impacts of the Proposed Development on Public Facility Capacity. If the applicant is proposing a Mitigation Plan, as described in Article 13, Zoning Ordinance, where capacity of one or more Public Facility is not otherwise adequate to support the demand resulting from a Proposed Development, please include a draft Mitigation Plan with this Application. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ ____________________________________________________ Applicant's Signature Date ____________________________________________________ Property Owner's Signature Date © 2010, Town of Huntersville, All Rights Reserved/FO-PL-102510-2 Page 4 of 4

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