Application & DeedSign Variance [ZBA approved November 15, 2019]
General Information
Tax Parcel ID Number: ____________________
Zoning District: ____________________
Detailed Description of Project [include current & proposed use]:
Location of Project: _______________________________________________________________
Applicant Name: Mailing Address
Home Phone City, State, Zip
Work Phone Cell Phone
E-Mail: FAX No.
Agent’s Name: Mailing Address
Home Phone City, State, Zip
Work Phone Cell Phone
E-mail FAX No.
Owner’s Name Mailing Address
Home Phone City, State, Zip
Work Phone Cell Phone
E-mail FAX No.
Page 1
Sign Variance [ZBA approved November 15, 2019]
Site Development Data
Area / Type Existing sq. ft. Proposed
Addition sq. ft.
Total sq. ft.
A. Building footprint
B. Detached Garage
C. Accessory Structure(s)
D. Paved, gravel or other hard surfaced area
E. Porches / Decks
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 Yard [1]
Front Yard [2]
Shoreline
Side Yard [1]
Side Yard [2]
Rear Yard [1]
Rear Yard [2]
Travel Corridor
Height [maximum]
Permeability
Number of parking spaces
Page 2
Sign Variance [ZBA approved November 15, 2019]
Compliance with Chapter 147 Sign Ordinance
1. A scaled drawing of the entire sign(s) and site plan drawing showing the location is to be included in the
submission packet ie on building and on site. Please note a survey is required unless a waiver is granted.
2.This application is for a change in the (check all that apply):
_______ Number of Signs: from (currently): ____________ to (proposed): _____________
_______ Setback for Sign
_______ Size of Sign
_______ Height of Sign
_______ Other (specify) __________________________________________
3.Sign Dimension(s)
Sign Type Existing
(Check)
Proposed
(Check)
Length
(ft)
Width
(ft)
Total
(Sq Ft)
Height
(ft)
Wall
Wall
Freestanding
Freestanding
Other ie panel
Projecting
Awning
Illuminated Type:
4.Property Line Setbacks Front/ Rear ______________Side _____________
5. Sign Wording: _______________________________________________________________________
6. Additional information if applicable_________________________________________________________
_________________________________________________________________________________________
Page 3
Sign Variance (ZBA approved November 15, 2019]The following questions reflect the criteria for granting this type of variance. Please complete them; use additional
sheets if needed.
1. 2. 3.
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 sign variance?
No. The sign is already exisitng
Whether the benefit sought by the applicant can be achieved by some method, feasible for the applicant to pursue,
other than a sign variance?
Any other method would be an additional finacial burden on the owner/tenenat.
Whether the requested sign variance is substantial?
It is not substantial, the existing sign is currently only 2sqft out of compliance. Changing the face of the exisitng sign is also
not a substantial change.
4.Whether the proposed variance will have an adverse effect or impact on the physical or environmental conditions in
the neighborhood or district?
The sign is already exisitng, and in its present state there is no adverse im pact to the neighborhood or district.
5.Whether the alleged difficulty was self-created?
Generally yes, all sign request are self created, however this was not a self created difficulty. The owner purchased the
property with the sign exisiting as is. Client needs to properly represent his business with his business name and logo.
Additional Project Information
1.lfthe parcel has previous approvals, list application number(s): 6Uf':) I-db j l}
2.Does this project require coverage under the New York State Pollutant Discharge Elimination System (SPDES) Permit
X Program? _ Yes /_No
3.Estimated project duration: Start Date 1/26/24
4.Estimated total cost of project: _;.$_80_0 ____ _
End Date 1/26/24
Page 4
Sign 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 -Das applicable to the proposed project.
A.General Shown on Sheet #
l Title, Name, Address of applicant & person responsible for preparation of drawing � ,(,JOllV fi 2 Deed '-n 3 North arrow, Tax Map ID, date prepared and scale [minimum: l inch = 40 feet ]c...._ "f"\)�\I ll 4 Boundaries of the property plotted to scale, zoning boundary , J-S c.(J��,5 Principal structures, accessory structures with exterior dimensions (' .( ,.o,, ii 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 C.
B.Water & Sewer Shown on Sheet #
1 Project sewage disposal facilities, design details, construction details, flow rates, and number of f\. ){'\. bedrooms proposed2 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 usa2:e
5 Percolation test location and results
C.Parking / Permeable Areas Shown on Sheet #
I Number of spaces required for project including calculations and justification: existing &tJ p.. proposed2 No. of existing parking spaces, number to be removed, number to maintain and type of surfacing
material [ e.g., gravel, pavedl
3 Provision for pedestrian and handicap access and parking: existing & proposed
4 Design details of ingress, egress, loading areas and cutting: existing & pro posed
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 "-)'4. 2 Utility/ energy distribution system [gas, electric, solar, telephone]: existing & proposed
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: existing & proposed
5 Sif!11age: Location, size, type, design and setback: existing & proposed
6 Waiver Request: provide letter with application requesting any waivers: please reference p£f, � vt(2..
specific items -
-
·
r.M1f.0
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 aoPlication for all necessary permits I
Page 5
Sign Variance [ZBA approved September 21 2016]
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
Saxton Sign/HannoushJewelers
296.9-1-10 1054 State Route 9
CM
Applicant proposes to install a 32 sf wall sign for the new business
140
X
NA
X
need sf
x
x
x
Xits new
X
X
Laura Moore via email 02/05/2024
Darren Katz via email 01/18/2024 02/05/2024
Applicant proposes to replace the existing 32 sf sign with a new panel of 32 sf for the new jewelery business.
The existing 3,240 sf building is to remain. The current wall sign is considered not complaint with the sign
code. Sign Variance for a 32 sf sign when 30 sf is the maximum size allowed.
Items reviewed: sign variance application, survey, sign detail
Items to be updated or provided
1)general project description should include the existing and proposed square footage of the sign and
information about the business
2) site data and setback information will need to be completed, all calculations
3) sign ordinance - the size of sign should be checked also
4) sign wording - spelling should be updated of the Jewelers
5) additional project information - FOIL information
6) page 5 checklist - need to request a waiver for using a dated survey from 2011
7) sign detail indicates a new box - provide clarification if there is a new box
8) Environmental Assessment Form will need to be completed
9) Provide an updated sign variance application and materials as a pdf for another review.
®Sign 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:
Elidan Holdings LLC Owner:
Designates: _s
_
a
_
x
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to
_
n
_
S
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i
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rp ______ as Agent regarding the followi ng:
Variance Site Plan Subdivision
For Tax Map No.:;;),(1(,fj -1 · I ()1 � Deed Reference: ' Book&�(4 Pagea<t:i Date l{)/;i�/,23
OWNER SJGNATURE: ____________ _ 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, stom1
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 pem1its 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: l, 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 perfom1ed in accordance with the approved plans and in conformance with local zoning regulations. J
acknowledge that prior to occupying the facilities proposed, I or my agents, will obtain a certificate ofoccupancy 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
Signature [Agent)
Print Name [Applicant]
Darren Katz
Print Name [Agent]
Date signed
1/15/24
Date signed Page 7
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WARREN COUNTY-STATE OF NEW YORK PAMELA J. VOGEL, COUNTY CLERK 1340 STATE ROUTE 9, LAKE GEORGE, NEW YORK 12845 COUNTY CLERK'S RECORDING PAGE .. "THIS PAGE IS PART OF THE DOCUMENT-DO NOT DETACH"* 111 11111111111 1111
BOOK/PAGE: 6854 / 250 INSTRUMENT #: 2023-5733
Receipt#: 2023584935 Clerk: SSN Rec Date: 10/26/2023 11:48:25 AM Doc Grp: RP Descrip: DEED Num Pgs: 6 Rec'd Frm: SMPR TITLE AGENCY INC
Partyl: Party2: Town:
1054 ROUTE 9 LLC ELIDAN HOLDINGS LLC QUEENSBURY
Record and Return To:
DRIVER GREENE LLP 228 CHURCH STREET SARATOGA SPRINGS NY 12866
Recording:
cover Page Recording Fee cultural Ed Records Management -coun Records Management -Stat TP584 RP5217 -county RP5217 All others -State
sub Total:
Transfer Tax Transfer Tax -state
sub Total:
5.00 45.00 14.25 1.00 4.75 5.00 9.00 241. 00
325.00
6000.00
6000.00
Total: 6325.00 **** NOTICE: THIS IS NOT A BILL ****
***** Transfer Tax***** Transfer Tax#: 700 commercial Transfer Tax consideration: 1500000.00
Transfer Tax -State
Total: WARNING"""• 6000.00
6000.00 •u Information may be amended during the vcrlffcationprocess, and may not be renected on this cover 1>age.I hereby certify Iha! lhe wilhin and foregoing was recorded in lhe Wun:cn County Clerk's Office, Slale of New York. This sheel conslilules lhe Clerks endorsem.enl required by Section 316 of !he Real Properly Law of lhe S!ale of New York. Pamela J. Vogel Warren County Clerk
t I Sot, 1 ::, .... 0
WARRANTY DEED
with Lien Covenant
THIS INDENTURE, made the _Jj_ 'I-Say of October, Two-Thousand and Twenty-Three,
Between, 1054 ROUTE 9, LLC, a New York limited liability company, and
1048-NORTH LLC, a New York limited liability company, both having an address at 20
Rolling Brook Drive, Ballston Spa, New York 12020,
parties of the first part, and
ELIDAN HOLDINGS, LLC, a New York limited liability company having an address
at 112 Wolf Road, Albany, New York 12205,
party of the second pa1t,
Witncsscth that the parties of the first part, in consideration of ONE Dollar ($1.00)
lawful money of the United States, and other good and valuable consideration, paid by the party
of the second part, do hereby grant and release unto the party of the second part, its successors
and assigns forever, the prope1ty located in the Town of Queensbury, County of Warren, and
State of New York, which is more particularly described as follows:
See Schedule "A" attached hereto.
Parcel 1: Being the same premises described in a deed from Sutton's Properties, L.L.C.
to 1054 State Route 9, LLC by deed dated October 28, 2011 and recorded in the Warren County
Clerk's Office on October 31, 2011 in Book 4356 at page 294 (Instrument Number
2011-00007994).
Parcel 2: Being the same premises described in a deed from GAM of the Adirondacks,
LLC to 1048-North LLC by deed dated August 19, 2021 and recorded in the Warren County
Clerk's Office on August 24, 2021 in Book 6435 at page 243 (Instrument Number 2021-7246).
Together with the appurtenances and all the estate and rights of the party of the first part
in and to said premises,
To Have and to Hold the premises herein granted unto the party of the second part, its
successors and assigns forever.
And said parties of the first part covenant as follows:
First, That the party of the second part shall quietly enjoy the said premises;
Second, That said parties of the first pa1t will forever Warrant the title to said premises.
Third, that, in compliance with Sec. 13 of the Lien Law, the grantors will receive the
consideration for this conveyance and will hold the right to receive such consideration as a trust
fund to be applied first for the purpose of paying the cost of the improvement and will apply the
same first to the payment of the cost of the improvement before using any part of the total of the
same for any other purpose.
The property conveyed herein does not constitute all, or substantially all, of the property
owned by the parties of the first part.
In Witness Whereof, the parties of the first part have hereunto set their hand and seal the
day and year first above written.
In Presence of
STATE OF NEW YORK )
)ss.:
COUNTY OF WARREN )
1054 ROUTE 9, LLC
-arciobolo, Jr., Sole Member
1048-NORTH LLC
� �� Louis J. Carcio6olo, Jr., Sole Member
t On the 19 of October in the year 2023, before me, the undersigned, a notary public in
and for said state, personally appeared Louis J. Carciobolo, Jr. personally known to me or
proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed
to the within instrument and acknowledged to me that he executed the same in his capacities, and
that by his signature on the instrument, the individual, or the person(s) upon behalf of which the
individual acted, executed the instrument.
Nott;��
TIMOTHY S. SHULER
Notary Public, Slnte of New York
Washington County, No. 4949151
My Commission Expires Aprll 3, 20 'J.':/-
SCHEDULE "A"
Parcel 1
1054 NYS Route 9
(Conveyed by 1054 Route 9, LLC)
"All that certain piece or parcel of land situate, lying and being in the Town of
Queensbury, County of Warren and the State of New York, more particularly bounded and
described as follows: BEGINNING at a point in the easterly bounds of NYS Route 9 at the
n01thwest comer of the lands of GAM of the Adirondacks LLC as described in book 3883 of
deeds at page 10 l; running thence along the easterly bounds of said Route 9 the following three
courses and distances:
(I)North 20 degrees, 52 minutes and 50 seconds West a distance of 86. 00 feet;
(2)North 68 degrees, 11 minutes and 28 seconds East, a distance of 3 .28 feet;
(3)No1th 21 degrees, 48 minutes and 32 seconds West, a distance of 64.l l feet;
thence running through the lands of the grantor herein, the following five courses and
distances:
(I)North 65 degrees, 08 minutes and 00 seconds East, a distance of 126.90 feet;
(2)South 53 degrees, 05 minutes and 32 seconds East, a distance of 84.92 feet;
(3)North 65 degrees, 08 minutes and 00 seconds East, a distance of 167.70 feet;
( 4)South 20 degrees, 54 minutes and 00 seconds East, a distance of 236.44 feet;
(5)South 65 degrees, 08 minutes and 00 seconds West, a distance of 42.20 feet to a point in
the easterly bounds of said lands of GAM of the Adirondacks LLC; thence running along
said lands the following two courses and distances:
(I)North 20 degrees, 54 minutes and 00 seconds West, a distance of 161 .44 feet;
(2)South 65 degrees, 08 minutes and 00 seconds West, a distance of 300.05 feet to the point
and place of beginning, containing 1.00 acres of land to be the same more or less.
Bearings given in the above description refer to magnetic No1th.
SUBJECT to easements of record.
SUBJECT TO that ce1tain sewer easement to the Town of Queensbury dated March 11,
2003 and recorded in the Wanen County Clerk's Office on August 21, 2003 in Liber 1335 at
page 26.
TOGETHER WITH AND SUBJECT TO a non-exclusive reciprocal easement for the
benefit of the Grantor and the Grantee their respective customers, vendors, guests, employees,
agents and invitees for the use of the drive aisles and four parking spaces located on the Grantee's
premises for ingress and egress to the four parking spaces located immediately adjacent to the
real property of the Grantor, hereby conveyed and for ingress and egress to Route 9, all as shown
as "proposed reciprocal easement" on a map entitled "Map of a Survey made for 1054 Route 9,
LLC", Town of Queensbury, Warren County, New York by Van Dusen & Steves dated October·
14, 2011, last revised October 21, 2011" a copy of which is attached hereto.
SUBJECT TO a non-exclusive vehicle and pedestrian easement for ingress and egress use
by Sutton's Properties, L.L.C., its customers, vendors, guests, employees, agents and invitees,
over the drive aisle located on the Grantee's property at the rear of the existing building for
access to the building of the Grantor shown as the "proposed access easement" as shown on a
map entitled "Map of a Survey made for 1054 Route 9, LLC", Town of Queensbury, Warren
County, New York by Van Dusen & Steves dated October 14, 2011, last revised October 21,
2011" a copy of which is attached hereto.
Parcel 2
1048 NYS Route 9
(Conveyed by 1048-North LLC)
ALL THAT CERTAIN PIECE OR PARCEL OF LAND, located in the Town of
Queensbury, County of Wan-en and State of New York, and identified as Parcel B, as shown on a
map of the property entitled "Map of a Boundary Line Adjustment made for 1048 State Route 9,
LLC" dated October 8, 2009, prepared by Bolster and Associated Professional Land Surveyors
and filed in the Wai,-en County Clerk's Office October 9, 2009 as Instrument #2009-3000128,
Plat C 147.
SMPR Title Agency, Inc. 1-800-724-7856Tltfe No: s - g- &> � '-\ °\
Instructions for Completing
Short Environmental Assessment Form
Part 1 -Project Information
Part I -Project Information. The applicant or project sponsor is responsible for the completion of Part I. Responses become part of the application for approval or funding, are subject to public review, and may be subject to further verification. Complete Part I based on information currently available. If additional research or investigation would be needed to fully respond to any item, please answer as thoroughly as possible based on current information.
Complete all items in Part I. You may also provide any additional information which you believe will be needed by or useful to the lead agency; attach additional pages as necessary to supplement any item.
Part I -Project and Sponsor Information
1054 Rt 9 Hannoush Jewelers Name of Action or Project:
Hannoush Jewelers Project Location (describe, and attach a location map):
1054 rt 9 Brief Description of Proposed Action:
Removing the existing 32sqft face from existing internally illuminate wall sign, and replacing it with a new 32sqft face to represent new owner
Name of Applicant or Sponsor:
Saxton Sign Corp
Address:
1320 rt9
Telephone: 518-754-2026
E-Mail: dkatz@saxtonsign.com
City/PO: State: I Zip Code:
Castleton NY 12033 1.Does the proposed action only involve the legislative adoption of a plan, local law, ordinance,administrative rule, or regulation?If Yes, attach a narrative description of the intent of the proposed action and the environmental resources that may be affected in the municipality and proceed to Part 2. If no, continue to question 2. 2. Does the proposed action require a permit, approval or funding from any other government Agency?If Yes, list agency(s) name and permit or approval: Town of Queensbury Zoning Board
3.a. Total acreage of the site of the proposed action?b.Total acreage to be physically disturbed?c.Total acreage (project site and any contiguous properties) ownedor controlled by the applicant or project sponsor?
4.Check all land uses that occur on, are adjoining or near the proposed action:
[Z) Urban □ Rural (non-agriculture) □Industrial IZl Commercial D
D Forest □ Agriculture □Aquatic □ Other(Specify):
0 Parkland Page I of 3 na acres o acres
acres
Residential (suburban)
NO
0
NO
SEAF 2019
YES □
YES x
5.Is the proposed action,NO YES NIA
a.A permitted use under the zoning regulations?□[l] □
b.Consistent with the adopted comprehensive plan?□ [l] □
NO YES 6.Is the proposed action consistent with the predominant character of the existing built or natural landscape?□ [l]
7.Is the site of the proposed action located in, or does it adjoin, a state listed Critical Environmental Area?NO YES
If Yes, identify: [Z] □
NO YES 8.a. Will the proposed action result in a substantial increase in traffic above present levels?[l] □ b.Are public transportation services available at or near the site of the proposed action?□ [l]
C. Are any pedestrian accommodations or bicycle routes available on or near the site of the proposed □ [l] action?
9.Does the proposed action meet or exceed the state energy code requirements?NO YES
If the proposed action will exceed requirements, describe design features and technologies: □ [l]
10.Will the proposed action connect to an existing public/private water supply?NO YES
If No, describe method for providing potable water: [l] □
11.Will the proposed action connect to existing wastewater utilities?NO YES
If No, describe method for providing wastewater treatment: [l] □
I 2. a. Does the project site contain, or is it substantially contiguous to, a building, archaeological site, or district NO YES which is listed on the National or State Register of Historic Places, or that has been determined by the [l] □ Commissioner of the NYS Office of Parks, Recreation and Historic Preservation to be eligible for listing on the
State Register of Historic Places?
b.Is the project site, or any portion of it, located in or adjacent to an area designated as sensitive for [l] □
archaeological sites on the NY State Historic Preservation Office (SHPO) archaeological site inventory?
13.a. Does any portion of the site of the proposed action, or lands adjoining the proposed action, contain NO YES wetlands or other waterbodies regulated by a federal, state or local agency?[l] □
b.Would the proposed action physically alter, or encroach into, any existing wetland or waterbody?[l] □
If Yes, identify the wetland or waterbody and extent of alterations in square feet or acres:
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14.Identify the typical habitat types that occur on, or are likely to be found on the project site. Check all that apply:□Shoreline D Forest 0 Agricultural/grasslands 0 Early mid-successional□Wetland 0 Urban IZ) Suburban
15.Does the site of the proposed action contain any species of animal, or associated habitats, listed by the State or NO YES Federal government as threatened or endangered?[Z] □
16.Is the project site located in the I 00-year flood plan?NO YES
[Z] □
17.Will the proposed action create storm water discharge, either from point or non-point sources?NO YES
If Yes,[Z] □
a.Will storm water discharges flow to adjacent properties?[Z] □
b.Will storm water discharges be directed to established conveyance systems (runoff and storm drains)?[Z] □If Yes, briefly describe:
18.Does the proposed action include construction or other activities that would result in the impoundment of water NO YES or other liquids (e.g., retention pond, waste lagoon, dam)?
If Yes, explain the purpose and size of the impoundment: 0 □
19.Has the site of the proposed action or an adjoining property been the location of an active or closed solid waste NO YES management facility?
If Yes, describe: 0 □
20.Has the site of the proposed action or an adjoining property been the subject of remediation ( ongoing or NO YES completed) for hazardous waste?If Yes, describe:0 □
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF
MY KNOWLEDGE
Applicant/sponsor/name: Darren Katz ,Saxton Sign Corp Date: 217/24
Signature: Darren Katz Title: Permit Guru
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