APPLICATIONTax Parcel ID Number:
Zoning District:
Lot size:
General Information
2H. � I-O�
Detailed Description of Project [includes current & proposed use]:
Location of project:
Applicant Name:
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Address:
Home Phone
,w � � � ^ � � �
Cell:IM2-
Work Phone
Fax
E-Mail:
Agent's Name:
Address:
Home Phone
Cell:
Work Phone
Fax
E-mail
Owner's Name
Address
Ifip �OC&Ffflc)
Home Phone
Cell
Work Phone
Fax
E-mail
Site Plan Review application — Revised October 2016
Town of Queensbury Planning Office-742 Bay Road, Queensbury, NY 12804
oc�r�
Site Development Data
Area / Type
Existing sq. ft.
Proposed
Additions . ft.
Total sq. ft.
A. Building footprint
B. Detached Garage
C. Accessory Structure(s)
32
D. Paved, gravel or other hard surfaced area
�O i
' � �
E. Porches /Decks
IRDO
F. Other
—
G. Total Non -Permeable [Add A-F]
H. Parcel Area [43,560 sq. ft. / acre]
I. Percentage of Impermeable Area of Site [I=G/H]
Setback Requirements
Area
Required
Existing
Proposed
Front [1]
30
Front [2]
Shoreline
s
39/
23 1
Side Yard [1]
'1
I l. 3
1 /. 3
Side Yard [2]
Rear Yard [1]
1
`J v
vv .1 1
100
—7
� Vl/go . 1
Rear Yard [2]
Travel Corridor
Height [max]
Permeability
No. of parking spaces
Site Plan Review application — Revised October 2016
Town of Queensbury Planning Office-742 Bay Road, Queensbury, NY 12804
Additional Project Information
1. Will the proposal require a Septic Variance from the Town Board of Health?
2. If the parcel has previous approvals, list application number(s):
N/O
3. Does this project require coverage under the New York State Pollutant Discharge Elimination System
(SPDES) Permit Program ? iQ0
4. Estimated project duration: Start Date LP 1 2� End Date U
5. Estimated total cost of project:
6. Total area of land disturbance for project: —! V �7 • '�'
Floor Area Ratio Worksheet
FLOOR AREA RATIO (FAR) -- The relationship of building size to lot size, derived by dividing the total
building floor area by the lot size in square feet, yielding a percentage.
Zoning District
Symbol
Floor Area Ratio [FAR]
Waterfront Residential
WR
0.22
Commercial Moderate/ Intensive
CM/ CI
0.3
A. The combined area of all square footage, as measure from exterior walls of all structures on the property,
including all floors of the structures, garages, basements and attics with more than five (5) feet of ceiling
height and covered porches. Building square footage does not include: Open deck, docks and that portion of
covered docks extending over water and one storage shed of one hundred twenty (120) square feet or less.
Any additional sheds will be included. (See "FLOOR AREA RATIO").
B. Commercial or industrial: the total area in square feet as measured from the exterior of the outside walls of a
building or structure, and when applicable, the sum total of all floor areas of the principal and accessory
buildings or structures on the project site.
A.
Parcel Area
UL UORU sq. ft.
B.
Existing Floor Area
sq. ft. [see above definition]
C.
Proposed Additional Floor Area
sq. ft.
D.
Proposed Total Floor Area
sq. ft.
E.
Total Allowable Floor Area
(Area x . [see above table)
*If D is larger than E. a variance or revisions to your plan may be needed. Consult with Staff.
4
Site Plan Review application — Revised October 2016
Town of Queensbury Planning Office-742 Bay Road, Queensbury, NY 12804
§ 179-9-080 Requirements for Site Plan Approval.
The Planning Board shall not approve a Site Plan unless it first determines that such site plan meets the
following Standards. Please prepare responses to each of the following topics:
STANDARDS
A.
The proposed project furthers or is consistent with the policies of the Town's Comprehensive Plan.
B.
The proposed project complies with all other requirements of this Chapter, including the site plan review standards as set forth in Paragraph
F of this section, the dimensional, bulk and density regulations of the zoning district in which it is proposed to be located (Article 3 and
Table 1), the applicable requirements of all other Articles that apply.
C.
The site plan encourages pedestrian activity internally and, if practicable, to and from the site with pedestrian paths or sidewalks connected
to adjacent areas.
D.
The site plan must conform to Chapter 136 Sewage and Sewage Disposal, Chapter 147 Stormwater Management Local Law, and other
applicable local laws.
E.
The proposed use shall be in harmony with the general purpose or intent of this Chapter, specifically taking into account the location,
character and size of the proposed use and the description and purpose of the district in which such use is proposed, the nature and intensity
of the activities to be involved in or conducted in connection with the proposed use and the nature and rate of any increase in the burden on
supporting public services and facilities which will follow the approval of the proposed use.
F.
The establishment, maintenance and operation of the proposed use will not create public hazards from traffic, traffic congestion or the
parking of vehicles and/or equipment or be otherwise detrimental to the health, safety or general welfare of persons residing or working in
the neighborhood or to the general welfare of the town. Traffic access and circulation, road intersections, road and driveway widths and
traffic controls will be adequate.
G.
Off-street parking and 19oading facilities will be appropriately located and arranged and sufficient to meet traffic anticipated to be generated
by the new use. The establishment of vehicle links between parking areas of adjacent properties are provided where feasible. This furthers
the Town's goal of reducing curb cuts and reducing congestion. A twenty -foot wide connection is required. If adjacent properties are either
undeveloped or previously developed without having made provision for future linkage, then a future connection must be identified and
provided for in the site plan under review for such future linkage when the time arises. The Planning Board may require proof that the
applicant has made contact with adjacent property owners for purposes of coordinating linkages with adjacent properties.
H.
The project shall not have an undue adverse impact upon the natural, scenic, aesthetic, ecological, wildlife, historic, recreational or open
space resources of the town or the Adirondack Park or upon the adequate provision of supporting facilities and services made necessary by
the project, taking into account the commercial, industrial, residential, recreational or other benefits that might be derived from the project.
In making the determination hereunder, the Planning Board shall consider those factors pertinent to the project contained in the
development considerations set forth herein under § 179-9-080 of this Chapter, and in so doing, the Planning Board shall make a net overall
evaluation of the project in relation to the development objectives and general guidelines set forth in § 179-9-080 of this Article.
1
The provision for and arrangement of pedestrian traffic access and circulation, walkway structures, control of intersections with vehicular
traffic and overall pedestrian convenience shall be safe and adequate for pedestrian movement. Pedestrian connections between adjacent
sites shall be provided to encourage pedestrian use.
J.
Stormwater drainage facilities will prevent an increase of post development drainage flows as compared to pre -development drainage flows.
Drainage of the site shall recharge ground water to the extent practical. Surface waters flowing off -site shall not degrade any streams or
adversely affect drainage on adjacent properties or public roads. Facilities shall be in conformance with the drainage standards of Chapter
147 of the Town Code and the Town of Queensbury Subdivision Regulations where applicable.
K.
The water supply and sewage disposal facilities will be adequate and will meet all applicable and current requirements set forth by
Department of Health regulations and Chapter 136 of the Town Code.
j,
The adequacy, type and arrangement of trees, shrubs and other suitable plantings, landscaping and screening shall effectively provide a
visual and/or noise buffer between the applicants and adjoining lands, including the maximum retention of existing vegetation and
maintenance, including replacement of dead or deceased plants.
M.
Fire lanes, emergency zones and fire hydrants will be adequate and meet the needs and requirements of emergency service providers.
N.
The design of structures, roadways and landscaping in areas susceptible to ponding, flooding and/or erosion will minimize or avoid such
impacts to the maximum extent practicable.
O.
The site plan conforms to the design standards, landscaping standards and performance standards of this chapter.
5
Site Plan Review application — Revised October 2016
Town of Queensbury Planning Office-742 Bay Road, Queensbury, NY 12804
§ 179-9-050 Checklist -Application for Site Plan Review.
Application materials and site plan shall include sufficient information for the Board to review and provide a
decision. The applicant is to provide a site plan drawing and all attachments that address items A-V. The
applicant may request a waiver from A-V and is to provide reasons for waiver(s) requested. Please label
information to be submitted.
REQUIREMENTS
Sheet #
A.
A vicinity map drawn at the scale that shows the relationship of the proposal to existing community facilities which affect
or serve it, such as roads, shopping areas, schools, etc. The map shall also show all properties, identify owners,
subdivisions, streets and easements within 500 feet of the property. Such a sketch may be superimposed on a United States
Geological Survey map of the area.
B.
The site plan shall be drawn at a scale of forty feet to the inch (1" = 40 feet) or such other scale as the Planning Board may
deem appropriate, on standard 24" x 36" sheets, with continuation on 81/2 "x I I" sheets as necessary for written
information. The information listed below shall be shown on the site plan and continuation sheets.
C.
Name of the project, boundaries, date, north arrow, and scale of the plan.
D.
Name and address of the owner of record, developer, and seal of the engineer, architect or landscape architect. If the
applicant is not the record owner, a letter of authorization shall be required from the owner.
E.
The location and use of all existing and proposed structures within the property, including all dimensions of height and
floor area, all exterior entrances, and all anticipated future additions and alterations.
F.
The location of all present and proposed public and private ways, off-street parking areas, driveways, outdoor storage areas,
sidewalks, ramps, curbs, paths, landscaping, walls and fences. Location, type and screening details for all waste disposal
containers shall also be shown.
G.
The location, height, intensity and bulb type (sodium, incandescent, etc.) of all external lighting fixtures. The direction of
illumination and methods to eliminate glare onto adjoining properties must also be shown in compliance with § 179-6-020.
H.
The location, height, size, materials and design of all proposed signs.
1.
The location of all present and proposed utility systems including:
1. Sewage or septic system;
2. Water supply system;
3. Telephone, cable and electrical systems; and
4. Storm drainage system including existing and proposed drain lines, culverts, catch basins, headwalls, endwalls,
hydrants, manholes and drainage swales.
J.
Plans to prevent the pollution of surface or groundwater, erosion of soil both during and after construction, excessive runoff
and flooding of other properties, as applicable. A Stormwater Pollution Prevention Plan (SWPPP) for all land development
activities (excluding agricultural activities) on the site that results in land disturbance of one acre or more. A SWPPP shall
comply with the requirements of the DEC SPDES MS-4 General Permit and Chapter 147 of the Town of Queensbury
Code. It shall be at the discretion of the Planning Board as to whether a SWPPP or an erosion and control plan shall be
required for a site plan review project land disturbance of less than one acre.
K.
Existing and proposed topography at two -foot contour intervals, or such other contour interval as the Planning Board shall
allow. All elevations shall refer to the nearest United States Coastal and Geodetic Bench Mark. If any portion of the parcel
is within the 100-year floodplain, the area will be shown and base flood elevations given. Areas shall be indicated within
the proposed site and within 50 feet of the proposed site where soil removal or filling is required, showing the approximate
volume in cubic yards.
j,
A landscape plan showing all existing natural land features than may influence the design of the proposed use such as rock
outcrops, stands of trees, single trees eight or more inches in diameter, forest cover and water sources and all proposed
changes to these features, including sizes and types of plants. Water sources include ponds, lakes, wetlands and
watercourses, aquifers, floodplains and drainage retention areas.
M.
Land Use District boundaries within 500 feet of the site's perimeter shall be drawn and identified on the site plan, as well
as any Overlay Districts that apply to the property.
6
Site Plan Review application — Revised October 2016
Town of Queensbury Planning Office-742 Bay Road, Queensbury, NY 12804
REQUIREMENTS (CONTINUED)
Sheet #
N.
Traffic flow patterns within the site, entrances and exits, loading and unloading areas, as well as curb cuts on the site and
within 100 feet of the site. The Planning Board may, at its discretion, require.a detailed traffic study for large developments or
for those in heavy traffic areas, which shall include:
1. The projected number of motor vehicle trips to enter or leave the site, estimated for weekly and
annual peak hour traffic levels;
2. The projected traffic flow pattern including vehicular movements at all major intersections likely
to be affected by the proposed use of the site;
3. The impact of this traffic on levels of service on abutting public streets and at affected
intersections. Existing and proposed weekly and annual peak hour traffic levels and road capacity
levels shall also be given.
0.
For new construction or alterations to any structure, a table containing the following information shall be included:
1. Estimated area of structure to be used for particular purposes such as retain operation, office,
Storage, etc.;
2. Estimated maximum number of employees;
3. Maximum seating capacity, where applicable; and
4. Number of parking spaces existing and required for the intended use.
p.
1. Floor Plans.
2. Elevations at a scale of one -quarter inch equals one foot (1/4" = 1 foot) for all exterior facades of the proposed structure(s)
and/or alterations to or expansions of existing facades, showing design features and indicating the type and color of materials
to be used.
Q.
Soil logs, water supply well and percolation test results, and storm water runoff calculations as needed to determine and
mitigate project impacts.
R.
Plans for disposal of construction and demolition waste, either on -site or at an approved disposal facility.
S.
Plans for snow removal, including location(s) of on -site snow storage.
T.
An Environmental Assessment Form ("EAF") as required by the SEQRA regulations, with Part 1 completed by the Applicant
shall be submitted as part of the application. If the proposed project requires a special use permit and an EAF has been
submitted in conjunction with a special use permit application, a duplicate EAF is not required for the site plan application.
U.
If an application is for a parcel or parcels on which more than one use is proposed, the applicant may submit a single
application for all such uses, provided the proposed uses are accurately delineated on a site plan drawn pursuant to the
requirements set forth above. The Planning Board may grant the application with respect to some proposed uses and not
others. For purposes of reviewing an application (and for SEQRA compliance) all proposed uses on a single parcel or on
contiguous parcels shall be considered together.
` .
A brief narrative statement on how the project proposed for review furthers or is consistent with the vision, goals and policies
in the Town's Comprehensive Plan.
Site Plan Review application — Revised October 2016
Town of Queensbury Planning Office-742 Bay Road, Queensbury, NY 12804
Area Variance Pre-Submission Conference Form / Section 179-9-040
1. Applicant Name: __________________________________________________
2. Tax Map ID ________________Location:_______________________
3. Zoning Classification __________
4. Reason for Review: __________________________________________________________
5. Zoning Section #: ________________________
6. Pre-Submission Meeting Notes: Provided Outstanding; Please provide by
Deed ____ _____________
General Information complete ____ _____________
Site Development Data Complete ____ _____________
Setback Requirements Complete ____ _____________
Additional Project Information Complete ____ _____________
FAR addressed ____ _____________
Compliance with Zoning Ordinance ____ _____________
Checklist items addressed ____ _____________
Environmental Form completed ____ _____________
Signature Page completed ____ _____________
Staff Representative: ________________________________
Applicant / Agent: ________________________________ Date: ___________
Page 6
Daniel Zotto
289.9-1-86 306 Glen Lake Road 12640 sq ft/0.28ac
WR
400 sq ft deck to be adding to existing home
179-3-040 WR, 179-4-080 deck, 179-13-010 expansion
X
NA
X
Missing WR
footprint to site data
survey information confirmation
confirm sq ft enclosed porch with house
x
x
x
Laura Moore via email 04/20/2022
Applicant proposes a 400 sq ft deck to be added to an existing home. The footprint of 798 sq ft (to be confirmed) and
floor area of 1,326 sq ft (to be confirmed). The deck is to be location is to face the shoreline area. There are no other
changes proposed. Site Plan for new hard surfacing within 50 ft of the shoreline, expansion of non conforming
structure. Area Variance for setbacks from the deck to the shoreline and side setbacks (will need survey to show all
setbacks to property line).
Items reviewed -site plan and area variance application, real property information
Items to be updated or provided
1) page 1 general information - zoning is WR waterfront residential zoning
2) page 2site data - the building footprint is not the same as floor area -the surveyor should be able to indicate the
footprint from the survey, remaining calculations need to be completed
3) page 2 setback information - both side setbacks need to be completed, remaining calculations need to be completed
4) page 3 -floor area needs to be confirmed with covered porch areas and both floors of the home - if there is a
basement 5ft or greater it would also need to be included
5) page 4 - responses needed questions
6) page 5- information needed for landscaping 179-8-040 shoreline buffer requirement, stormwater management
179-6-080 25 year storm/ explain how stormwater will be managed from new deck ie eave trench/gravel under deck,
elevations, floor plans (similar to construction plans for a deck probably fairly basic but dimensions need to be noted, if
there are steps, railing)
7) signature page needs to be completed
Provide an updated pdf of the application with survey and deck drawings. Might need to work with the surveyor or
other professional to complete the application materials. We can go over this via zoom as well.
Signature Page
This page includes the 1.) Authorization to Act as Agent Form: 2.) Engineering Fee Disclosure; 3.) Authorization for Site Visits; 4.)
Other Permit Responsibilities; 5.) Official Meeting Disclosure and 6.) Agreement to provide documentation required.
OWNER'S AGENT FORM:
Complete the following if the OWNER of the property is not the same as the applicant
Owner:
Designates:
As agent regarding:
Variance Site Plan Subdivision
For Tax Map No.:
Section Block Lot
Deed Reference:
Book Page Date
OWNER SIGNATURE:
DATE:
APPLICANT'S AGENT FORM:
Complete the following if the APPLICANT is unable to attend the meeting or wishes to be represented by another party:
Owner:
Designates:
As agent regarding:
Variance Site Plan Subdivision
For Tax Map No.:
Section Block Lot
Deed Reference:
Book Page Date
OWNER SIGNATURE:
DATE:
2.) ENGINEERING FEE DISCLOSURE: Applications may be referred to the Town consulting engineer for review of septic design, storm
drainage, etc. as determined by the Zoning or Planning Department. Fees for engineering review services will be charged directly to the applicant.
Fees for engineering review will not exceed $ 1,000 without notification to the applicant.
3.) AUTHORIZATION FOR SITE VISITS: By signing this page and submitting the application materials attached herein, the Owner, Applicant,
and his/her/their agent(s) hereby authorize the Zoning Board or Planning Board and Town Staff to enter the subject properties for the purpose of
reviewing the application submitted.
4.) OTHER PERMIT RESPONSIBILITIES: Other permits may be required for construction or alteration activity subsequent to approval by the
Zoning Board or Planning Board. It is the applicant's responsibility to obtain any additional permits.
5.) OFFICIAL MEETING MINUTES DISCLOSURE: It is the practice of the Community Development Department to have a designated
stenographer tape record the proceedings of meetings resulting from application, and minutes transcribed from those tapes constitutes the official
record of all proceedings.
6.) AGREEMENT TO PROVIDE DOCUMENTATION REQUIRED: I, the undersigned, have thoroughly read and understand the instructions
for submission and agree to the submission requirements, I acknowledge no construction activities shall be commenced prior to issuance of a valid
permit. I certify that the application, plans and supporting materials are a true and complete statement/description of the existing conditions and the
work proposed, and that all work will be performed in accordance with the approved plans and in conformance with local zoning regulations. I
acknowledge that prior to occupying the facilities proposed, I or my agents, will obtain a certificate of occupancy as necessary. I also understand that
I/we may be required to provide an as -built survey by a licensed land surveyor of all newly constructed facilities prior to issuance of a certificate of
occupancy
I have read and agree to the above.
Signature [Applicant]
Signature [Agent]
Print Name [Applicant] Date signed
Print Name [Agent] Date signed
Site Plan Review application — Revised October 2016
Town of Queensbury Planning Office-742 Bay Road, Queensbury, NY 12804,
W
Area Variance [ZBA approved: November 15, 2019]
Additional Project Information
1. Will the proposal require a Septic Variance from the Town Board of Health?
2. If the parcel has previous approvals, list application number(s):
'Np
3. Does this project reqZo
verage under the New York State Pollutant Discharge Elimination System (SPDES) Permit
Program? _ Yes / _ _
4. Estimated project duration: Start..tD,ate: 1 1Z End Date:
5. Estimated total cost of project: `�'
6. Total area of land disturbance for project: W
Floor Area Ratio Worksheet
FLOOR AREA RATIO (FAR) -- The relationship of building size to lot size, derived by dividing the total building floor
area by the lot size in square feet, yielding a percentage.
Zoning District
Symbol
Floor Area Ratio [FAR]
Waterfront Residential
WR
0.22
Commercial Moderate / Commercial
Intensive
CM / Cl
0.3
A. The combined area of all square footage, as measure from exterior walls of all structures on the property, including all
floors of the structures, garages, basements and attics with more than five (5) feet of ceiling height and covered
porches. Building square footage does not include: Open deck, docks and that portion of covered docks extending
over water and one storage shed of one hundred twenty (120) square feet or less. Any additional sheds will be
included. (See "FLOOR AREA RATIO").
B. Commercial or industrial: the total area in square feet as measured from the exterior of the outside walls of a building
or structure, and when applicable, the sum total of all floor areas of the principal and accessory buildings or structures
on the project site.
•, It 1)
Parcel Area
s . ft.
Existing Floor Area
'sq. ft. see above definition
Proposed Additional Floor Area
s . ft.
Proposed Total Floor Area
s . ft.
Total Allowable Floor Area
(Area x [see above table
Page 3
Area Variance [ZBA approved: November 15, 2019]
Compliance with Zoning Ordinance
Requesting relief from SECTION:
Need relief from the requirement(s) listed below which can not be met by the project as proposed.
'P� [Check all that apply] Setback ❑ Buffer Zone ❑ Lot Width ❑ Other
The following questions reflect the criteria for granting this type of variance. Please complete them; use additional sheets if
needed.
1. Whether an undesirable change will be produced in the character of the neighborhood or a detriment to
nearby property will be created by the granting of this area variance?
�4(2 .
2. Whether the benefit sought by the applicant can be achieved by some method, feasible for the applicant
to pursue, other than an area variance?
No.
3. Whether the requested area variance is substantial?
4. Whether the proposed variance will have an adverse effect or impact on the physical or environmental
conditions in the neighborhood or district?
5. Whether the alleged difficulty was self-created?
Page 4
Area Variance [ZBA approved: November 15, 2019]
Section 179-14-030
Application materials and site plan drawing is to include sufficient information for the Board to review and provide a decision. The
applicant is to provide a site plan drawing(s) — a survey showing existing conditions, a proposed conditions map (see page 00 for
specific criteria) and include any other attachments that address A - D as applicable to the proposed project.
A.
General
Shown on Sheet #
1
Title, Name, Address of applicant & person responsible for preparation of drawing�.
2
Deed
3
North arrow, Tax Map ID, date prepared and scale [minimum: 1 inch = 40 feet ]
4
Boundaries of the property plotted to scale, zoning boundary
5
Principal structures, accessory structures with exterior dimensions
6
Site improvements incl. outdoor storage areas, driveways, parking areas, etc.: existing !&
proposed
7
Setbacks for all structures and improvements: existing & proposed
8
Elevations and floor plans of all proposed and affected structures
B.
Water & Sewer
Shown on Sheet #
1
Project sewage disposal facilities, design details, construction details, flow rates, and number of
bedrooms proposed
2
Water supply [i.e. well] & septic on adjoining lots with separation distances to existing or
proposed on -site water supply and septic
3
Separation distances for proposed sewage disposal system to well and water bodies
4
Existing public or private water supply [well, lake, etc.]. Method of securing public or private
water, location, design and construction of water supply including daily water usage
5
Percolation test location and results
C.
Parkin / Permeable Areas
Shown on Sheet #
1
Number of spaces required for project including calculations and justification: existing &
proposed
2
No. of existing parking spaces, number to be removed, number to maintain and type of surfacing
material [e.g., gravel,paved]
3
Provision for pedestrian and handicap access and parking: existing & proposed
4
Design details of ingress, egress, loading areas and cutting: existin & proposed
5
Location and character of green areas [existing and proposed], modification to green area, buffer
zone to remain undisturbed
6
Lighting, location and design of all existing and proposed outdoor lighting
D.
Additional Site Development and Miscellaneous °
Shown on Sheet #
1
On -site & adjacent watercourses, streams, rivers, lake and wetlands
2
Utility / energy distributions stem [gas, electric, solar, telephone]: existing & ro osed
3
Location, design and construction details of all existing and proposed site improvements
including: drains, culverts, retaining walls, fences, fire & emergency zones and hydrants, etc.
4
Square footage of bldg. area proposed for office, manufacturing, retail sales or other commercial
activities: existin & proposed
5
Si a e: Location, size, type, design and setback: existin & proposed
6
Waiver Request: provide letter with application requesting any waivers: please reference
specific items
7
Commercial / Industrial Development requires submission of Landscaping, Stormwater
Management, Grading & Lighting Plans
8
Identification of Federal, State or County permits required for the project together with a record
of application for all necessary permits
Page 5
Area Variance [ZBA approved: November 15, 2019]
This page includes the 1.) Authorization to Act as Agent Form: 2.) Engineering Fee Disclosure; 3.) Authorization for Site Visits; 4.)
Other Permit Responsibilities; 5.) Official Meeting Disclosure and 6.) Agreement to provide documentation required.
OWNER'S AGENT FORM: Complete the following if the OWNER of the property is not the same as the applicant:
Owner:
Designates: as Agent regarding the following:
Variance Site Plan Subdivision
For Tax Map No.: Deed Reference: Book Page Date
OWNER SIGNATURE: DATE:
APPLICANT'S AGENT FORM: Complete the following if the APPLICANT is unable to attend the
meeting or wishes to be represented by another party:
Owner:
Designates: as Agent regarding the following:
Variance Site Plan Subdivision
For Tax Map No.: Deed Reference: Book Page Date
OWNER SIGNATURE: DATE:
2.) ENGINEERING FEE DISCLOSURE: Applications may be referred to the Town consulting engineer for review of septic
design, storm drainage, etc. as determined by the Zoning or Planning Department. Fees for engineering review services will be
charged directly to the applicant. Fees for engineering review will not exceed $ 1,000 without notification to the applicant.
3.) AUTHORIZATION FOR SITE VISITS: By signing this page and submitting the application materials attached herein, the
Owner, Applicant, and his/her/their agent(s) hereby authorize the Zoning Board or Planning Board and Town Staff to enter the subject
properties for the purpose of reviewing the application submitted.
4.) OTHER PERMIT RESPONSIBILITIES: Other permits may be required for construction or alteration activity subsequent to
approval by the Zoning Board or Planning Board. It is the applicant's responsibility to obtain any additional permits.
5.) OFFICIAL MEETING MINUTES DISCLOSURE: It is the practice of the Community Development Department to have a
designated stenographer tape record the proceedings of meetings resulting from application, and minutes transcribed from those tapes
constitutes the official record of all proceedings.
6.) AGREEMENT TO PROVIDE DOCUMENTATION REQUIRED: I, the undersigned, have thoroughly read and understand
the instructions for submission and agree to the submission requirements, I acknowledge no construction activities shall be
commenced prior to issuance of a valid permit. I certify that the application, plans and supporting materials are a true and complete
statement/description of the existing conditions and the work proposed, and that all work will be performed in accordance with the
approved plans and in conformance with local zoning regulations. I acknowledge that prior to occupying the facilities proposed, I or
my agents, will obtain a certificate of occupancy as necessary. I also understand that Uwe may be required to provide an as -built
survey by a licensed land surveyor of all newly constructed facilities prior to issuance of a certificate of occupancy
I have read and agree to the above.
Signature [Applicant]
Signature [Agent]
Print Name [Applicant]
Print Name [Agent]
Date signed
Date signed
Page 7