Site Plan Application TOWN OF QUEENSBURY
Site Plan Review Application
Review `''amus,'
1. Required Pre-stib ission meeting with staffto determine general completeness to be Feld no later than 1
ri r limen . Call '51 8) 761-8265 or(,518) 761-8.220,for an appointment,
. Submittal of complete application- 1 original and 14 copiers of the application package by monthly deadline.
. DeteMination of application completeness. All necessary information must be provided and appropriate
fees)paid for consideration for placement on an agenda for that month.
4. Incomplete plete awlications will not be considered for placement on any Meftda Until all missing
information, :has been §Mbmitlz
'. Sum,ittal to Warren County Planning, if applicable.
. Planning Board meeting, generally the third & fourth. Tuesday of each month. You will be advised in
writing as to which meeting to attend,
7. Following the meeting you, will be provided with a copy of the resolution stating the Board's decision on
your application. if your application was approved, the next likely step is a Building Pen nit. Final
drawings must be provided for the next phase of review. If your application was denied,your project cannot
proceed as submitted.
DOCUMENTATION 1E (harry copy & electronic
Please submit I original & 14 commies,of the comleted application package to include:
• +f ornipfeted Application pages -9, signed&dated
rem ubmma,isslon MeetingNotes:, signed by staff
Gga 1DS 1
* Checklist & Plot Plan
o Env rommen�tal Amtn F rmmm for any non-residentialproject
� - � �
tN
• Fee: 10 — 1�M, tM0 fi. � �1
� 10,00 — 30,000 s tM
fi. , � 0 ,0 �� �" �-, �p �" 0[1
(10,0,,0100+ sq. ft.
/V( 10 20,17
Staff& Contact Information:
Craig Brown, Zoning,Administratorr i mm. ,nmet PL NRN( (5t=rlCE
Laura Moore,Land Use Planner Irnrrmo mmmmerenstmmmm�.net
Sunny Sweet Office Specialist—Planning sane snmeenslmmm .net (5110 761-8220
Visit our wrbsite at . g sbu for fudh(,ar information and forms
Site:Llan 1 evi aw application—'Revi d October 2016
Torn of Queensbury Ploaning Office-742 Elay Road,Queensbury,NY 12904
General nformat n
Tax Peel ILS Number:
r:
Zoriing District:
Lot size: '" ,
failp,l Description of Proj i des ctment&prop d apse]:
65
C xlec7 �.
-
or
Location,of met..
C
nnlirnf ,: drss: _" ",
r!� ;!515e) �
Morns Phone ;ll:
Work Pane 7 Ip Fax
-Mail: w
Agent's Name; Address:
onw P�hone cell:
Work Phone Fax
-i nail
Owner's Name Address
Home Phone Cell
'Work-Phone Fax
E-i.nail
Site Plan Review applici ion—Revised October 201
Town of Queensburi Planning Office-742 742 Bay Road,Queembury, 12804
Site Development Data
Area/Type Existing sq. , Pro Total sq. ft.
Addition sq.
A. Building footprint
B. Detached Garage 3
C. Accessory triaeture(s)
D. I' I velor em herd surfaced 4-
�'
14 r
C � , �" - � "
. P*rches Mee�
F. Other
G. Total No -I'erreeable [Add A rl
d�
72 �,
H. :Parcel area [43,5166 sq.fl.I acre] � — 7 'Z .,
..� .
I. Percentage ofImpermeable Area of Sil
Setback R
Muirements
Area Required Existing P'roposed
i
Front [11
Front [21
w
Sade Yard I I 1 7, 41
Side Yard Ill �
Rear YarPl
Rear Yard [ )
Traw4 Corridor
Height[ l
Pe eabi:l.i r
No. of parking specles
Site Ptarn Review,applimfion—Revised October 20,16
To of QueensburyPlanniOffice-7'42 Bay Road,'Queensbury,NY 128
Additional Pmject Information
1. Will the proposal require a Septic Variance from the Town Board of Health? 'X/C,5
2. If the parcel has previous wovals, list application nwnber(s):
3. Does this proj ect require coverage under,the'N'ew York State Pollutant Discharge Elimination System
(SPDES)Permit Program? A/C> Ir./I-
4. Estimated project duration, Start Dam End Date
5Estimated total costoflyroject:
6. Total area of land disturbance for project: C><-�
Floor Area Ratio Worksheet
FLOOR.. . ,P 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 0.2°
..................
Commerd ModerateY Intensive CM/Cl 0.3
A. The combined area ofall 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 (l fib) square feet or less.
Any additional sheds will be included. (See "FLOOR AREA RATIO"),
13, Commercial or industrial: the total area in square fed,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 z- -2- sq. ft.
z:LALS
B. Existing Floor A ,�Z sq. ft. [see above definition
............
C,w Priopoud Addidonal.Floor Area 71 7 T-- L 7 sq.
D. Proposed Total Floor Area 0/
L Total Aftowable Floor Area
[we above table]
*If D is larger than E. a variance or revisions to your plan may ben d. Consult,with Staff.
4
Site Plan Review application—Revised October 20,16
Townof Queensbury Wnineo.ffice442 Bay Road,Qsue ensbury,NY 12.804
17'9-9- .eguir 1" encs it'br Site Plan Approval.
'The Planting Board shall. not approve Site Plan unlessit first date es that such site pia me is the
following Standar .s. Please Prepresponses tin each of the following topics:
STANDARDS
A. "Mo proposed project funrthners or is consistent with the policies of the Towa,�nws Comprehensive l'"laut.
1lte r seal ro u t coin lues with all unit r uircaneats of Cha ter including sti e plan r
... ..
F�. p�� p j p e � p � to plan,review standards as� t`ordn nn Parapn�h
F on tluis sos rioru,Ole dimensional,bulk and density regulalions ol"ft zoning district in which it is proposed to be tocatod(Article 3 annual
Table I),the applicable requirmneots of all other Articles that apply.
C. The site plain encourages pedestrian activity internally and,if ppracdicablic;to and,from[lie site with pa dcsdriarn p albs or sidewulks;connected
to adjacent areas,
D. dlic site plan must con.fonn to Chapter 13 Sewage and Sewage Disposal,Chapter 147 Stormwater Management Local Law,and other
applicable local laws.
E. The proposed use shall be in harnnony wvidu the general purpose or intent of this Chapter,specifically taking,into account the location,
character and sire of tie proposed use arid the description and purpose of the district in which such use is proposed,die nature and intensity
of the activities to be involved'in or conducted in connection with.dao proposed use and,the nature and rate of any increase in the lnuurdoi cru
supporfing public services and facilities which will follow the approval of tivc proposed use.
F I The-establislirmcunt,neaduotenaa°aou autd;jtcratl.........M n of thw pnnp',ansud al uuse gill p nol creaatu abliv Wards from,trallt`tw; Ir ... ..aQ�c con�estiunn or the
parking of vehicles and/or equipment or be otherwise cletrinteotal To the health,safety or,genteral welfare of Persons resiling Or Working in.
the neighborhood or to the guieral welfare of the town. Traffic acT ss and circunlantia'a'u„moan intersectiorcs,road and driveway wvi40hs and
traffic controls%vilI be adequate.
kt.,� .
G. C)fi`-sera et pass matt sinal l9oadin> liaci licit s will be appropriately located and annPcd and sunliaecnd to meet trauffic anticipated to be generated
by the new use. '11'ne eslablishrnent of vehicle links lay twvcL-n parking areas,of adjacent properties are provided where fbasibic. This funrthers
tlm`I'awri's goal of reducing curia cats and reducing von$csdion. A tww -rity-:fool wide connection is roqu iteJ. Ifadjaccril profXxtics arc either
unndcvclopcd or previously developed without having made provision liar future linkage,then a future connection must be ideanti ;ed and
provided rdrr in Ilic site plan under review for such future linkage when die time:arises. Ilio Planning.Board may require proof tbant the
appheant has manic contact with adjacent property owners for purposes of coordinating linkages withadjacent properties.
the prow ct shall not have an undue advnrs.a impact upon dwe natural,scenic„aesthetic,ecological,wildlife,historic,re atioo ul a'rr open
spade resource$of the town avr the Adirondaek Park or upon thuc adequate provision of supporting Fad Mics and services ma<dc necessary by
the project,tacking into account the commurciatll,industrial,residcntial,recreational or other benefits that might,las:derived horn the project.,
In.making the determination hereunder,the Planning Board shall consider those racdors p crtincnd to the prurojcact c;ortained inr the
development considerations set forth herein under§ ITIL9-1080 of This C ieapder,arid)in saw doing,the Planning Board shall anakc a net,overall
cvalu ation ofthe project in relation to the development nt of ectives and general guidelines set forth in§ 179-9.080 of this Article,
j m the provision for and arrangementofpedestriailtraffic mess antd,ciroulatiorn,wvallawvay sdruetuute$�control of ittlersea:ti outs With vehicular
trunl'l'ic and overall pedestrian convenience shall be safe and adequate for pedestrian anovement. Pedestrian connections between adjacent
Sites 111411,be provided tea encourage pedcstriaii use.,
J, Slonlywate drainage Edlitiics will Prevent all iruucmase orpost development drainage flowsas compare-M to pre dcvclopnncnd drainaF:Clow+u^s.
Drainage of tine site shallrecharge ground water to the extent practical. Surface waters flowing off-she shall not degrade any streams or
a4vers,Wy aflccl draainaW on adilpaccnt properties or public roads. 'Facilities shall be in conforinannce with the drainage-standar&of C bapter
147 of the'Townna,(,'ode amd tic'l°o)n of QUCansbury Subdivision lxuuladions wvhere.appal"aoabl,e.
K. Tbo water supply and sewage disposal foci lilies;will he adequate and wvill ntw:et al I auppfivnbku and currerud retptuiru:urncnts set fw1h by
DDzppartmcnt of Health regulations and Chapter 136 of the"l bWA Codle.
...............__.—.,,... ... _.....
j Tbc,adequacy,type and ar+ran einest't or trees,shrubs sail other suitable:plantings,lauradscapin, and screening shall crrw�ctiwAy prawidc a
visual anohfornoise buffer between[lie applicants acrid adjoining lands, incluudinpp the nnauttinmturn retention c'bl"enaistin vepletanticruand
maintenance,including replacement of dead or deceased plants-
M.
Dire lines,emerp enoy zones aund fire hydrants Will be adequate and meet the needs and requircmaonts of emergency service providers-
N.
The desigtu of structures,roadwways and landscaping in areas suasa cpt:ible to,pondinS flooding and/or erosion wwil:I minimize or avoid such
impacts to Clic:maximum extent pmllieahle.
0. TW site plana conforms to the design standards,landseap nap standards and performance standards of this chapter.
5
Site flan Review application—Revised October"Fill
`l'o n utf t uueensbuury Platnrtinz fiice-742 Bay Road,Queensbury,NY 12804
1'79-9-D80 REQUIREMENTS FOR SITE PIAN APPROVAI.
A. Prqject is consistent with towns comprehetisive plan.
B. Requesting to build(�ya fbot print of an existing gala a built in 1926
C I was raisedt n Glen Lake,my parents,built in. 1926(next door to this property).I remember around
1955 and on When you,could walk around the whole Glen Lake. Now people have paid up fimces and
landscaping to delete this,. There am no longer any pathways.
D. This will lie done
E. I bought this canip a year ago,it has a pump up sanitary system that pumps sewerage:approximately
1900' away from the shore of Glen Lake, Hopebully someday a sewer fine will be built,to surround Glen
Lake
F, Yes,the road and driveway widths,are adequate and n-affic,will riot.sat nificantly change at all
G. This driveway has not been changed in sixty years. Off"strut parking is appropriarte. There is one
driveway that.is dirt from Jay Road to said residence
H, I am proposing to add an addition to,tht front(not lake side)of the camp that is now classi fled rour
bedromus. I arn going to reduce the bedr(mirns to two. 'This addhion will fit into tieighborhood thenen e and
will not stand out
1. The camp has two accesses to any brothers property to the north(always has existed)property to the
south has aqjoining access by the back(take side),other than the two neighbors,there would be no,
pedestrian traffic
J. I am familiar wide the site and there has never been ariy kind of drainage issues,however I am going to
install any kind of stonn water drainage to reeharge an the existing site(:stony gravel )
K I have this week had a now 6"well (400")installed and have hired an engineer to certi fy die existing
Sewerage SYSILM
L. I am trying to leave theexisting trees and scrubs that exist to remain
A Access to,the residerice is an existing driveway frorn.Jay.Road
N. Ilic site is not susceptible to ponding or flooding
o. Yes
§ 17'9- -050 Checklist-Appileation 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 AN T'he
applicant may request a waiver from-A-V and is to provide reasons f6r waiver s') requested. Please label
infoartation to be;submitted,
REQUIREMENTS Sheet#
sic aaat moa da y
that�Wws the t)f tbo proposal to existing oommunity faci Ries whkh affeki
or serve it,such,as roads,shapping areas,schoo4s,etc. "Me map shall also show all prop enies,identify owners,, -7
subdivisions,street s:and easernents within 5,00 fLtA of the property. Such,a kkeh may be superhinposed on a United States
(kological Survey map of the emu.
Be The sigma plan shall W.drawn at,a scale of forty feet No the inch(I"—40 fect)or stvzh other Neale as the Planning Board may
detm iippfopnatc,on standard 24"as 36shat ls,with conlinuation(in 8 1/2"X.I F'sheels auks iteemny forwtitten,
information.. '1111;information listed Mow shall be shown omm t1w ske plan=4 continuation sheets.
C. Name of the project,bmtndarics,date,north arrow,and scale of the plan.
D. Name and address of the oviner of record,developer,and seal of the engineer,architect or landscapcarchitcct. If the LF 4�r/Le-'
_ECELicant is not the rccwd oi�,�later authorimtio�n shall be,rF uircd ftom the owner.
_q
The location and usc,of all existing and pio�' A"s ""wwilhin the property,including all dirnensions,of height and
,.112oE arcanwall Exterior entrances,and all ankipated future additions:and alterations.
T-' 11W loo4tion 4WO prestm' t and proposed publicand private ways,olf-strcct plarking arcas,driveways,ouldbor storage area%,,
sidenva&s,rarnrn,curbs.paths,landsicaping,walls and femms. Location,type and screening(lcaiLq,For all Waste disposal
containers shall also he sliovai.
G. The location,height,intcnsity:and bulb type(sodiuni�incandescent,etc)of all external lighting fixtures. The direction of
illurninatiogi and mthods to eliminate Ware onto,ad panun RMernes must also be shown in coMpl iancc with' 179-6-020.
The location,,height,si7c,materials and design of a]I proposed Signs.,
i. The location of all present and proposed utility s ystemi imluding;:
1. kwage or septa system;
2. Water supply systcm:,
3' Tele'olone'Cable and OWCdtal'LXy-'1CM&;L and
4, Storm drainage system including oxisfing and proposed drain lines,culvcrls,catch basins,bcadmills,cndwalls„
hydrants,maillioles and drainage swales.
Plans to,prevent the pollution of'surface or groundwatcr,erosion of soil boffi during and after construction,cxccssivc,runoff
AStorraNvatcr pollution Pnevcntion Plan(SWPPP)for all land dmelopruent
2clivides(excludiog agricultural aefivifics)onthe,silt that results in lanmed disturbance of one:am or more. A SWPPP shal 1,
comply with the requirements ofthe MS-4(jencral lkennit and Chapti", 147 ofthe Town of Queensbury
Co&, It shall be at the discretion of the Planning Board as to whether a SWPPP or an crosion and control plan,shall be
required for a site pkui review pmjitet land disturbance of less then, u", Wre, C,
EiZnij Omd pnqwwd 107ography at two-Foot contour intcTvals,or such other contour interval as the Planning Board shall
allow. Alt elevations shall]TO14 lo the ricarcst Unilcd States Czastal and,Geodetic Bench Mark. If any portion of the plarcel
is within,the]GO-year Otiodplain,the area will bc shown and bascflood elmlions given. Areas shall be indicated within
the proposed site and within 50 feet of 010 proposed site:wh msoil remmal or filling Lq rcquim. 4 sIKAving theapproximate
volume in cubic yards.
A lanttwaTv plan showing all existing natural land features flim may influenoe the design of the proposed use such as rock
ou'lerops,slar"I&of trces,,single trees eight or more inches in diameter,forest cover and,water.sources and all proposed
elvatiges to these feaures,including sizes and types of plants. Water sources include ponds,lakes,wctlandsand
watercourses,,aquifers,floo4plains and draintkgc retention aura s.
M. Land Use District boundaries within 500 feet of the site's,perimetaT shall be drawn and idenfified on the site p1m, as well
as,any Olverlay Districts thaws apply to Ow property'.
Site Plan,Review appi icalion,—Revised October 7.1,1 tin
Town of Queensbury Plauniing Office-742,Bay Road,Queensbury,NY 12904
REQUIREMENTS (CONTINUED) Sheet#
N. Traffic flaw patterns willfin die she,entrwices and exits,loading and unloading,areas,as well.as curb cuts on the site and.
NOthin 100 fect, of the site. The Plaimling Board,may,at its discre-fion,require a.detafled.traffic study for large devc1opments or
roT thou in heavy traffic.Aare s,which shall include,
1. 'Me projected nuniber of motor Vehicle trips to Onler or leave ft site,cstirnated for Wcc;kly'and
annual peakhour traffic levol,,V,
']'be projedcd traffic flow pattern including vehicular inovaments at al:l majer hitersections likely A
to be affected by the proposed,use of[lie site,,
3. 111e impact of this traffic on levels of service on abutting public strects and:at affected
hilersecAi0m. 1xisting and pwposml weekly and zrrtnual peak hour ftaffir,levels,and road capacity
levels sell also"be given, IJIA-
6. fox jlc;rr—0(; allZralionsto any structure,a,table containing the following infbnnadon shall beincluded..
1.. Estimated area of structure to be used far particular punXises such,"retain opemt�ioni,office,
Storage,etc..;
2, Dfimalcd inaximurn number of employees;
3. Maximum soot ing capacity,whercapplicable;mid
4. Number of parking spaces exis%itkg Wid required for 1he inkn&-d usc.
P. -1—FGTr Ff ,
1. 1-31evations at a scale ofonc-qpartcT inc:h equals one foot(114"=I foot)for all exterior facades of tlie pniposed,structurc(s)
and/or alterations to or expansim ofcxisfing facades,showwing design fcantres and indicating the type mid color,of materials
to be used.
....................- ----........................._m.............
Q. soil logs,Water supply well and,percolation rest results,and stom wutcl ruloff calculatiowl as ncckd to determine and
rut iliga w project iMIM015.
............I
R. Plum%lk)r disposal of construction mid dem alit ion waste-,eillier arra-site Or at an approved disposal facility.
S —F 4
'17", Hnow removal,including locatioil(s)ofan7shu snowslorage.
T. A"Environmental M.Wswricni,Form C'EAF'j as required by the SI-QRA regatafions,with Part I completed by the Applicant
sliall be submitted.&s part of the application. If tbc proposed project requires a special we peimit and an EAF hm en
submitted in conjunction with a special use permit application,a duplicate HAT-*is not required fi)r the site plart application.
1. 'Tf—zapplicalion is for a parcel or parcels an vAtich more than one M90 is P04054 the applicant maysubmit a single
application for all such uses,,provided the proposed uses are accurately&-fincated on a site plan drawn punuant to the
requirements set forth above. l'be Planning.Board may gnmt the application vAth respect to some proposed usesand not
olhcrs". For purposes of reviewing an application(and fiyr SEQPjk compliance)all proposed uses on,a.single parcel or on
configuous parcels,shall be considered tn8olhm
V. A onhowthaw project proposed kirreview harthersm is consistcatarith the vision,pals andpolicles
in the"I"omm's Compmhon s i vc P I a n
4 4
(7—
/4
7
Site Plan Review applieal ion—Revised October 2016
Town of'QueensburyP,Wiii,ng,,OS ce-742 Bay Road,Queensbury,NY 12,804
�.A
Town of Queensbury Site: Plan Pre-Submission. Conference Form Section 179-9-040,
2. Tax Map ED 2 6 Location: -,1,4 !� A7L,4
3. Zoning Classification , Alm
Reason for Review-, Ly
4,
5. Zoning&Ction#: Ole>
6. Pre-Subm6siori Meeting Notes: Provided, Outstanding; Please provide by
Deed
Gemmel Infonnation complete
Site Developrnmt Data Cbmolete
Setback Requirements Complete
Additional Prpject Information Complete
FAR addressed
Requiremmts or Site,Plan-Standards
Checklist items,addressed
Envirommental Form completed
Signature Page completed
C, (h Cv7 V� C
41) (YLQ-t il
Pe
or
G 7, C, /1 C L)C_A�_ le(We.
JIG CC>
..............
S,W, 9 P , C. e Lc rt c C,
L�z 4ccn /I S"L."LI
-F®r m. C_
f
Staff, 'RqresentafiveL�_A_) PL
Applicant/Agent. I t,e: ,
LIZ
8
Site Plan Review application—Revised Octobcr 2016
"rown.of Quecnsbury PlanningOffice-742 Bay Road,Queensbury,NY 12804
Signature P,age
This page includes the I.) Authorization to Act as Agent Form: 2.),Engineering Fee Disclosure; 3.) Authorization for Site Visits; 4.)
OtherPenrlit RespDrtsibilifies;5.)Official Meeting Disclosure and 6.)Agreement to provide dwmmentation required.
OwNER's AGPNT FoRm:
Complete the following if the OWNER of the property is not thesame as the applicant
Owner.
Designates-
As ag=t regarding,: Variance Site Plan Subdivision
For Tax Map No.- Section Block Lot
Deed Referente';', Ito Page Dal
OWNER SIGNATIJRIE- A)ATE, Z
... ...... ............
APPLICANT'S AGENT FO.RM:
Complete the U lowing If the APPLICANT is unable to attend the meeting or wishes to he represented by another party:
Ownen.
Desi nates-
agent regarding: Varianco Site Plan -Subdivision
For Tax Map No.. Section Block Lot
Deed ReferenQe: Book page Date
OWNER SIGNATURE- DATE:
Zd-YAQE1ffERJNG FEE DI$MMUB , Applications may be referred to the Town ecosulting en neer fur review of septic design, slorm
drainage,etc, as determined by the Zoning or Plarm ing Department. Fees for engineering review services will he charged directly to the appljcauj�
Fees for engineering review will not exceed$ 1,MO without w. tification to dic applicant.
3,) AUTHQRIZATJ[ '4 SI By signing this page and sulitting the application materials anached herein,the Owner,Applicantl
mid hi0berlagents} hereby authorize,the Zoning Board or Planning Ward and Town Staff'.to cooter the subject properties for the pw?oc of
reviewing the application submitted.
4.) 0THERPERMrJ:B%$rQ
_NSIBILITIES, Other pewits may be reqpircd for construction or alteration activity subse4pent to approval by the
Zoning.Board or Planning Board. It is the applicant's,responsibility to obtain any additional permits.
S 5
) OFFICULL IM EFFING AM=,5, DISC-10SURE: It is the pr=lice of the C*minunity Eb.-mlopnient Department to have a designated
stenographer tape record the:proceedingi of mectings resulting from applicatkm,,and Minutes transcTibcd from those tapes cowtirtoes the official
record of all,proceedings.
6.) AGREEMENT TO EBOYIDE DOCUMENTATION IFIDMEJ) 1,the undiersiguccl,have thoroughly read and understand the instructions
kyr submission and agree to the submission requirements,I acknowle4p no construction activities shall be commenced prior to issim.cc,of valid
permit. I certify that the applical;iom plans and supporting materials are a true and compldc statcutent/description offhe existing conditions and the
work proposed, and that all work will be performed in accordance WM,the approved plans and in conformance with localzwihig regulations. I
acknowledge that prior to accupying the facilities pro"4,I or my agents,,vAll obtain a cartificate of occupancy os ncccssary. I also understand that
Ywc maybe required to provi&an as-built survey by a licensed land surveyor of all newly constructed facilities rxior to isguanoc of a,certificate of
occupancy
I ha e read and uta to- e.
O-e C
�el
i hur, [A canti Print Name [Applicant] Date signed
Sipature [Agent] P'rint Narne [Agent) Date signcd
9
Site Plan Review application-Revised October 2016,
To ofQLmensbury Planning O 74 Bay Road,Queensbury,NY 12804