Application �-o wiv Q� �uE�tvssz rr�Y
Z�12 BlL 1e`o"ad.R�resKay'+vf.N..+NY= 12FQtvT9A2'.,
P,abruary 13;:20t3
'��l-Marc Smres�.Iiva
k;Ftiitonvillc,_tut 72'7 i2
Lt�i 24 Qualc<r Ridge.8lvrl.
�✓HII S gn haripb5
Tax M p Pat;E[,l� 3f1�.15=}-25(.I
31gar'Siis9
I�writing Eo y n in raapexisa to yoaer maaiK}�+su6miKgd apPhcatio s for sgn's at yo�r;PrQpascd
Qu`pt�er road;t atfdn - -
� SasV r<yv<_wed ypur-s gn perm_ik 4pEel3cLio s aad:.Tied rise[ a v ce. {r m our Town" of
�iiecxsabury Sign Oa$rnance well be nccassary sh uld yov wleh to co Eruct the igns as proposed.
Sp< fi Ily,-our Code all ws a busan<ss M}!a nc{_<.atandmgs gn and oa wall sign Your
proposal cal]s for a number of waII signs that is in oXcess of both our xniaxtmum allowable
number o€signs as well as your-previous Sign Vanancc approval in 2Q09 with sa exteivsion_o'P
approval Arent<d in Zo.lO. (Our F`Ile- Sign Yarvance No_:'1-2009).
Plnas< not<-our established submiktal deadlines and prasubmiasion meetinS requirem<nts when
P[QP ring-ygpr aPPlecation m6t6na15_ - - '. `... . - ,._�
Slaossld you.;tave any;ucfher qucs�ioas or cadlfsienrs�:Htea.§t dc[aaot.�h<stvter contact this_o6lo0:,
tincore{y�. .
Town o Q sbury-
Craig Brown'
Zd$Yng gdrifi34ist3aUoy-
c13r3a.
cci�t.4'�li`cia IVlezti�ecz.—Y',r:.rr soar lEi�sioh��.�de"st3iaNaa
t 103 3 reValton Blvd-�-Busks�—'Beu€onulitay Aticansas 'z2yi2
1-_zei a��g+� �r24i.�x`_ai�mniai'�i;?7i+?eitXtYepa�ilyns t_t�'3=3�
••rNa fu e ,F:Y N a't q5,3'+�¢ ,8"YTe F'2t -, A< �o�a P F h'i-'i•' J_4 �.k�;�a -
�-�"�-�
41:.5.12� 1'� J
//� �z�.��iT
Date: 3/15/2019
Project: Wal-Mart 4403 Queensbury, NY
24 Quaker Ridge Blvd
Queensbury, NY 12804
Good ARernoon,
Tbis letter serves as a weaver request£or a site survey as required by [fie sign variance
application_ Includzd in the submittal is the latest site survey available o£the site as it existed
prior to construction o£the Walmart building_ The variance be rig requested is only{or signs that
are attached to the building. There{ore, an updated signed stamped site survey will not provide
any additional information relevant to the signage being proposed on dais application. Also
included in the submittal is a site plea showing the locations o£each proposed sign on the
building:
Ooug Braw®r rvcABs
Project Architect
[479.273.7780 axt 239
c 499.877.5528
i _ _ --- _-
I i'
HFA(Harrison Francs.s Assoda[as)
Creative Solutions. Maanin9ful P/ac®s
1705 S.Walton Blvtl Suite 3. Bentonville.AR 72712
i. � � �
i .. � Ind.. i � i .I i_� � vn in.. � �i._i _i
F3ardson Pmnch Sc Associams,L'I'D www_hfa-ae.com
1705 5.Walton Hlvd,Suicc 3,Benwaville,Arlmnsac 72712 p 479.273J780 t 588520.9685 Page 1 of 1
Applicant proposes to install a 1,296 sq R canopy structure with a fabric cover,project involves
interior and exterior renovations for Onlin¢ Grocery Pickup. Project includes new signage on
£ace o{building ie pharmacy, outdoor living etc. and new nolor scheme facade—grey. Pr jeer
ncludes specific signage For the Online Grocery Pickup includingpavement area signage.
Reviewed application and drawing sets -Color Elevations; General NotesCPO-GP4; Exterior
Elevations A2, A2.1; General Remodel C1,A3.1, A2, 52,C 1,C2.
Site plan application and drawings updates to be c mpleted and to complete a separate sign
variance application with associated plan attachments.
I. Internal r vations areas—not clearly noted -label ar o{interior pick up area tlmat is to
be renovated For exterior pick up. Label other areas as needed
2. Canopy Plans CPO—CP4—need Fabric description -is the cover on year round
3. Signage C-1 —dir¢ctional signage is not to exceed 4 sq 8, plans indicated logo sign{or
parking stall would exceed 4 sq R and parking stall signag¢ would be considered one sign
(logo, phone number, stall#�
4. Signage A-2—Front elevation notes existing Senant sign"subway" sign to remavn but
Color Rendition plan doesn't include it.
5. Building square Footage is not labeled on plans—need to corr£irm Footprint o{store, lawn
and garden area
6. Survey—Sign variance application will need a signed stamped site survey
O. Sign Variance— 1 wall sign allowed and 1 Free standing sign. The wall sign proposed
now includes a blue paint scheme around the white lettering—the blue now counts
towards the signage and will need to be included in the square Footage.
8. General In{rmation sheet page 2—includ¢ canopy size in project description, zoning
district is CI Commercial Intensive we no longer use HC-1NT
9. Setback information page 3 Parking numbers need to be updated as there should not be
less thaw required
1 O. Additional Project in{ormation page 4—previous approvals—SP 61-200], SUB 11-2008,
SP 17-2004
11. Floor area ratio page 4—The canopy will need to be included in tkve floor area ratio also
conSm-nnation o{the building footprint and lawn and garden area.
12. Site.Plan Standards page 5—Response are inquired {or items A-O
13. Site Plan ChecMisx page 6 and Z—con5rm plan set attachments as there were£our
dii{event plan sets provided and there are two Cl sheets. Also—NA items should not be
left blank there should be an explanation—no changes
14. Hnvirornnental Fonxv—short BAF is not applicable £or tkvis application_ The canopy is less
than 4,000 sq£t the pr ject is considered a type 2 action meaning no Further
environmesntal review.
15_Number o£Copies £or Platming and Zoning
a. Site Plan application is 14 copies and 1 original.
b. Sign Variances application is 14 copies and 1 original <Separate pre-application
will also need to be completed prior to submission)
16. Building and Codes
a. Building and codes will review plans when Planning and Zoning Board review
process is complete.
- Town of Qu¢¢nsbury Site Plan Pre-Submission Con£¢rence Form/ Section 179-9-040
I. Applicant Nsm<� L<[iaia Martipcz(HFq grchitca[S)
2_ Tax Map ID 303.15-1-25.1 Location- 24'QuaXar Iiidga Blvd_
3_ Zontng Clasaitication �_---�'C�--
4. R¢asort For R¢H¢we Addition oFONina Grocery PicKup(OGP)Canopy and parking stalls
s. znnmg se¢tmn r*: [-JR- 3-[�YL7 �17R-�i-�ZC� e..�^�'tf.(i"�e.�e'�S
6. Pr¢-Submisalon M¢¢ting No[¢s: Prov4d¢d Outatanding� Please provide by
Deed YC
Ga ral lnfozrnationc mplete � r.. c\. rlo_�z-Pm`fc'c^SPY
Siro Dcv<lopmcn[Data Complete _
Se[back Requirements Comple[< _ ]d -�e rrv.c�a.,/[
Addi[ionN Pr jec[In£oamation Complete _ X �e wJ
FAR addr<ss<d t (CrrtOC
R<quirom<nts £or Sit<Plan-Standards � - £t¢�.,I�S YPS�tct�eF Plum-�[a.n
eheelrliac icams aaaressea l a Hn.s..A-�f..it r¢a-g
Fnviroxtt+rea[al Form completed ��
Signature Page completed _ oG
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Stat£Aepresentative: �� ^ / 777
Applicant/Agen - Date:�U��
�_ s
Sitc Plan R<viaw ap -Revised Oc[ober 2016
"Gown of Queensbury Planning OFfca-74�Bay Aoad�Qu«nsbury�NY 12604
Sign Variance lzan aevrwca sapmmeev�:z¢rc]
Pro-Submission Conference Form/ Section 309-9-040
I. Appll¢art[Nam¢: Leticia Martina
2. Tax Map ID 303_15-1-25.i Location- 24 Qraalc¢r Ridge Bldq Qu¢¢vsbury�NY
3. Zoning Clasai£¢arion CI
4. Reason[or R¢vl¢w:/.�� �Aaa:a:onal signs
5. Zoning Secrion N: t-1f(�1.�y�
6. Pr¢-Subm£saion M¢¢[ing No[¢sa Provided OutstandinSi PI¢as¢provide by
Deed X
General Infonnatiov complete x
Sit¢Dcvdopmcnt Data Complete �
Sc[bacic Rcquircrtvmts Compl¢t¢ ��
Additional P jec[Information Complete �
FAR addressed �
Compliance with Zoning Ordinance �.i o b»r.<i�ya�z p�
Chccldist items addressed ��
Enviroamental Form completed �
Signature Page completed
�.-cAcA�-r�[l[-a .20�. 1 .c��_\\�cl.�i� � � �. L u- SPtJ-P ii
CZ� 1`2c�-r^cl-� '-�(,,:��1 sc� - -}- J-e (�\r<c-P �kr5d-...�� </��(.�
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tze \cc�-+z �c S � w -�-tc Gir-e�c-e Pl-t c<.c � -ec&.�<a aze.
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'7 A/2.t-r_"� V.Siren c-e���'=.f- m�-- �- YLsy
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sws�Cv.�cz>'wn s
a£f AePresentative: � c.Jiz �i/rmsC�2_ .J Ica QMC.r
APPlicant/Agent: Dahl tGl •�
Page 6
✓- 3- � c � si>�[Marianne I=aa.a�.�_�d s�.ea..K.�,=0.61
o¢n¢[al lnr[-mat,on Z bt��, ��.�PLcc�e. La�n.<
Tax Parcel ID Number: 303.15-1-25.1 ���-!` SM1-su�l 34 '�_r�-p
Zoning District Com.intensive[iiE�3'IV"q" �Cj.t � a__
Y 5[G!1 �Ls Qt[t[.-2 fir"«
Detaitea Dea¢ription of Pr rent[inclaae ea[rent�p[opoaea aael: 1,v. �r�5��t 11�3 S^. 7`/�o
M¢rcantile-exist vg to imam 3\.Z
Curr¢n[Usr ( §L ern t-P(J2¢f@
M¢rcancllm e q
Pzopoaea use: xist:ag to:¢main /-1 rQ( v � r�-e a-�� �a )�- d-� �.r,-.2«c�y
tscw.«tcc` .cic ..p.. 5-/.��Fz� Ym 2a
24 QnaA¢r Ridges Hldv.Que¢nsbury,NY
Location ofP jeer I ca L4 /t ��V�_l Lc
C��(�-�4
AppLcant Nam¢a Leticia Martina Marring Address t705 8.Waltov Hlvd Suite 3
Home Phossc N/w City, $m[e,ZiP. Bentonville,AR 02912
Wbrk Phoi1 499-2p3-9Z80a263 CeIL Ph-one N/A
H-Mail: � Ietic:amartinaC3hfa-a¢.com FAX No.
Ag¢nt's Nam¢: Sam¢as abav¢ Mailing Address 1005 5.Waiton Blvd Suit¢3
Home Phone City, State,Zip Bemonvillc,AR"12012
Work Phone a79-293-0080x236 Call Phones
5-meat le[icia.ma[tlnaz�hfa-a¢.rom FAX No.
Owsse["a Nam¢ Walmart Real Es[a<e Business[cast Mailing llddress 2001 5£ 30[h 5[
Home Phoae City.Statq Zip Hen[onvillq AR�2')12 _
Work Phove 409-2"13�LO00 C¢B lshone -
E-mail PAX No_
RECEIVE®
MAR 1 5 2079
TOWN OF QUEENSBU RY page I
ZONING OFFICE
Sign Variance Izan appwvaa smtcmee�zi zolsi
Site Develoument Data
Aroa-/`Type Eacts[ing sq.R. Proposed TotsDsq.Tt.
Additioa'a ..tt.
A. Baailding foOtpatin[ t53,943 O 153,943
8. Detached Garage O O O
C. Accessory Strucmrc<sj O 1,296 1,296
D. Paved,gravel or other hard surfaced area 415,950 O a1a,654
E. Porches/Decks O o O
F. Other a O O
G_ Total Non-Pexnreable [Add A-F] 5�2,a50 O 572,460
H. Parcel Area [43,560 aq_ ft./acre] 1449,241 O 1,449,2a1
I_ Percentage o£impea'-mcable Area of Site [I=G/H] 0395 O 0.395
Setback Aeouirexnems
Area Acquired Existittg � Proposed '.
FrontYaad C1] 7S 22T _ 220 •
Front Yard[2] p5' 090' "190•
Shoreline p5' N/A N/A
side Yard C 1] 20• I Sa• 184"
Side Yard [2] 20• N/A N/A
Rear Yard [1] 25' I00' 100•
Rear Yard[2] 25 N/A N/A
Travel Corridor 50' 1,04�' 1,04T
Height[maximum] 40• q0` 1,040'
Peax¢eability 30% 60.5% 60.5
Number oP parking spaces 693 781 p77
Page 2
Siga Variance lz¢n.pv���sryem.bmv zmd
Comolianc¢with Chanter 149 SLQu Ordinance
1. A scaled drawing o{the entire sign<s)and site plan drawing showing the location is to be included in the
submission packet ie oa building and on site. Please note a survey is required uxdess a waiver is granted.
2. This application is for a cttan m the(check all that apply):
x s �
Number of Signs: Rom(currently): to (proposed):
Setback For Sign
X
Size of Siga
Height of Sign
Other(spccify)
3. Sign Dimension<s)
Sign Typc Existing Proposed Letagtk� Width Total Haight
(Check) fCheck) <R) (R) (Sq Ft) CR)
Wall x s•5•• aao.00
k�all X 5.6^ 37.3^ 320.OD
Preestanding
Freestanding
Other is panel
Pro]ectirtg w-.
Awttattg
Illum:aat¢d Type:
4. Property Line Setbacks Front Reartt�Oar2a OO' Sid¢ ���'
walmart�
5. Siga Wording:
6. Additional ittfbrmation if applicable
Pagc 3
Sig[i Variance[ZBA nppmv�d acy¢mbcr2l 2016]
Comolianc¢with Chaot¢r 149 Siau Ordinance
1_ A scaled drawing o£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 not¢a survey is required utIIeas a waiver is granted.
2. This application is for a chance m the(check all thax apply):
x s �
Number o£Sigtvs: Rom C¢arrendy): to(proposed):
Setback For Sign
x
Size o£Sign
Height o£Sign
Other CsPecify)
3. Sign Dimension(s).
Sign Type Exist:^9 Proposed Leagdi Width Total Height
(Check) (Check) <R) (R) (Sq Ft) (R)
Wall x. lam^ a.aa
Wall x t•_p•• a•-s s/a•• a.aa
Freestanding
Freestanding
Other ie panel
P jeering
Awttirtg
Illuminatcl Type:
�: Z2-1'
4. Property Lin¢Setbacks Front/Rear �.= �00' Side� o�
R�ayal�
5. Sign Wording:
6. Additional information i£applicable
Page 3
Sign Variance Izsn.nm'o�ea sea�..ee•v zo�sl
Comnlianc¢avlth Chant¢r 149 Slt=n Ordinanc¢
1. A scaled drawing of rtve entire sign(sj and site plan drawing showing the location is to be included in tive
submission packet ie on building and on site. Please note a survey is required urHess a waiver is granted.
2. This application is for a chance itv Ha¢(check all Heat applyj:
x s �
Number o£Signs: R-om(ot.rrentlyj: to (proposedj:
Setback£or Sign
x
Size o£Sign
Haight of Sign
Oliver(specify]
3. Sign Dimension(sj
Sig.Type Existing Proposed Length WidHv Total Heigkvi
<Checkj <Checkj <Rj (R) (Sq Ftj <Rj
Wall
Wall X 4'-5 1/2" 14'-8 5/16" 38.69
Freestanding
Freestanding
Other ie panel
Protecting
Awrving
Illumitvated yEs Type.
zsn
F 2 z�•
4_ Property Line Setbacks Front/Rear R.= 1 a� Side I �� �
Pickup
5_ Sign Wording:
6. Additional itafbrmation if applicable
Pages 3
Sign Variance taw erv'o�=a svpm...�.v zo�s�
Comrtliart¢e wiRa Chartt¢r 149 Sitm Ordirtartc¢
1. A s sled drawing of the entire signs) and site plan drawing showing the location is to b¢included in the
submission packet ie on building and on site_ Please note a survey is required unless a waiver is granted_
2. 'I1tis application is for a than¢¢m the(ch¢ck all that apply):
x s �
Number of Signs: Rvm(teen-early): to(proposed):
S¢tback for Sign
x
Size of Sigrt
Height o£Sign
Other(specify)
3. Sign Dimension<s)
Sign Type Existing Proposed Length Width Total Height
(Check) (Check) <R) <R) (Sq Ft) (R)
Wall X 24" 39.35
Wall X 2"-O" 29.t4
Freestanding
Freestanding
Other ie penal
Proj erring
Awtaing
IIlutrtirtated Type: (.y
4. Property Line Setbacks Front/Rear R� ���" Sida �S 6/
putdooi Living [o Law��Sc Gardm
5_ Siga Wording:
6. Additional information if applicable
Page 3
Siga Vaa'ianCe[ZBA approved Srymmba 21 2016]
Compliance with Chaot¢r 14"]Sian Ordinance
L A scaled drawing o{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 uttless a waiver is granted.
2. This application is £or a chance m ttve(check all that apply):
x s �
Ntunber o£Signs: Rom(currentlyj: to (proposed):
Setback for Sign
x
Size o£Sign
Height o£Sign
Other CsPeciry)
3. Sign Dimensaon(sj
Siga Type Existing Proposed Length Width Total Height
(Check) (Check) <Rj <Rj (Sq Ft) <R)
Wall X 24" 35.74
�/�1 X 2^-O" 1T-6 5/8" 31.23
Freestandirag
Freestanding
Other ie panel
P jetting
Awrving
Illutxvinated Type:
Existing Front:22'l' 184'
4. Propea-[y Line Setbacks Front/12¢ar ExSxcx:na�Rear 300' Side
Ho:n��Living
5. Sign Wording:
6. Additional information i{applicable
Page 3
Sign Variance[zen vpv"c�'�sea«.vxev zmc�
COmoliance wlRt Chant¢r 14'1 Sian Ordinance
1. A scaled drawing oFthe entire aign(s) and site plan drawing showing the location is to be included in the
submasston packet ie on building and on site. Please note a survey is r¢quired unless a waiver is granted.
2. This application is for a ebanae in the<checic all that apply):
X 5
Number of Sighs: Rom Ccurreatly): to CProposed):
Setback For Sign
x
siz¢of sign
Height of Sign
Other(specify)
3. Sign Dimenston<s)
Sign Type Existing Proposed Lengdt Widilt Total Heighf
(Check) CChecic) CR) (R) (S4 Ft) CR)
Rrall x 2a" 51.70
K/mil X 2'O" 25'-O 15/16•' 40.80
Freestanding
Freestanding
Other ie panel
ProJecring _
Awtaittg
Illurt�ix�ated Typo:
NO
'-ZZl
4. Properly Line S¢tbaOlcs Front/Aear R.' lOo' Side �g�/
Grocery ffi Pharaivcy
5. Sign Wording_
6. Additional inforanation if applicable
Page 3
Sign Variance�zan evnro��s�oa�...eRv zo�s�
Comoliart¢¢with Chanter 14'1 Slim Ordirtartce
1. A scaled drawing of the satire signs)and site plan drawing showing the location is to be included in the
submission packet ie on building'and on sitc. Pleasc note a survey is required u�ess a waiver as graatcd.
2. This application is For a thanes in the(check all that apply):
X s 'l
Numbcr of Signs: from(cuvzcssdy): to(proposed):
Setback{r Sign
x
Sizc o£Sign
Height of Sign
Outer Cspeci£y)
3. Sign Dimensions)
Sign Type Existing Proposed Length Width Total Height
(Chock) CCheck) CR) CRJ CS4 Ft) CRJ
Wall
Wall x 2•_p•• s•-a ssa^ �.a2
Freestanding
Freestanding
Other ie panel
P jetting
Awning
Illuminated Type:
F'-.2Z-!� 1��'�
4. Property Lin¢Setbacks Front/Rear 12'- ���- Side
vision center
5. Sign Wording:
6. Additional information if applicable
Page 3
Revised 3/'19/'19 Sign variance lzsn=vvro-=a seve.nnar z[zolal
The following qu¢sHons r¢11ect th¢ crit¢rta £or granting [his typ¢ o£yari arrc¢_ Please compi¢t¢ th¢mq uae additional
sh¢¢ts if n¢¢d¢d.
1. Wfietfier an undesirable change will be produced in the character of the rteighborfiood or a d¢himant to nearby
property will be created by the granting of this sign variance?
b - 1 d" [h 1 w't}[diff<rcnt words t dos<lv al;en with the s oFFcred a[Wulmart For
m la "MarKe[ will be re laced with"Grocer - The prop so ed PicKup and Vision Cemer signs will b<n<w.
2. Wh¢thar the bane{[t sougfit by the applicant can ba achieved by some method,feasible for.the applicant eo pursue,
other than a sign vazianc¢?
d' [h "1 bl th" 'F Walmar[ Si tlae my feasible adtod[ achie a[his and a
' d fo th<adtlif nal s
3. Whether Che requested sign variance is substantial?
d F 1 h I d b 1 th tad
4. Whether the proposed v will have an adverse effect or impact on tfic physical or cnvu-onmental coadiiiotts is
th¢neighborhood Or disn-ict?Ce
5. Whetfier dt¢alleged difficulty was sal£-cmated?
tl rho..
the"Walmar["s n(wbiclt w usly [ed a valance).the.s re Foo[a¢a of tb¢md.v.dual s molt'wtth[he
c W d d Hnl h -dd" - ale a A bvildin of[his nobly
accommodate a higher quantity of s[gn tban the[own ordinance allows.
A IP
I. If Chc part<l has previoas approvals, list a5ppliGaCion nu[nber(sj:BP 2011-39Z BP 2008-652.BP 2008-653.HP 2008-654
2. Does this Y rHequiOreOcovcr HP 2deOr8the New YorK 3 sste Pollutant D;schar Elimination S [em(SPDHS Parini[
prod<c a8e un Se Ys
Ptogram? Yas/X No
3. Estimated project duration: Start Date 4ivnot9 End Date 6/I
4. Estimated total cost o£p jact: e1388400
Page 4
Sign Variance[za.a avpro..�a seam.nserm zptsl
Th¢ Pollowing qu¢aHona reH¢ct [h¢ crlt¢rla £or YranHng thla typ¢ o£yartanc¢. Pl¢as¢ compl¢t¢ th¢mg use addGHpnsl
sheets If needed_
1. Whether an undesirable change will be produced in the character o£the neighborhood or a detriment to n¢arby
property wilt be creased by the granring of this siga variance?
re beinc replaced in[hc s e looation widt dim ent words to ¢tosdv atian with the s ot£rcd at Walmart. For
pl¢,••Max'YCP'will be replawd with"Grocery The proposed Pichuo and Vision Center signs will be new.
2. Wh¢th¢r the bene5t sought by the applicant can be achieved by some method,Feasible for the applicant to pursue,
other chart a sigt[y ¢?
ivdirat¢those s ailable a[this s cific Walmart_ Sienaee is[be only Feasible method to achieve this vnd a
red For the add["onal s
3. Whether The requested sign variance is substantial?
We don t F el that the r ted v s[abstatnial than p s granted.
4. Whether the proposed varianc¢will have an advcTse¢££t or impact on[he physical or envuonmenral conditions in
the neighborhood or dianictT
5. Whether the alleged difficulty was ael£cmatea?
1. If[h¢parcel has previous approvalsps list 5pplipca�tippn number(s):BP 2011-39'�,BP 2008-652,BP 2008-653,BP 2008-654
2. Does[his [reP P'008-655 B unde�rStl6c Ncw YOOrK Stair Pollutant Discha Elimination S
pr jec qune coycraga rgc ystcm(SPDES)Permit
Program" _Yes/X No
3. Estimated pi ject duration: Siart Dale 6/")/2n19 Ead Dale 6/t;/2019
4. Estimated total coat of pr jeer S�.;S81
Page 4
Sign variance lzan.pn.o-=a s�te.mery zold
Section 109-14-030
Application m prials and sits plan drawing is[o include suFFcien[information For the Board[ore and provide a decision. iha
applicant is to provide a site plan drawings)—a survey showing existing conditions,a proposed conditions map(see pager 00£qr
speci£ac criteria)and include any other attaehmrnts that address A-D a applieabla to the proposed p jmt.
q: General �` - Shownon Shee[c#
1 Title Name Address oFa lican[8c sibl¢F taTion of drawin C-1
2 Deed Anaohed document
3 North arrow,Tax Ma ID date erred and scale m 1 inch=40£ee[ C-1
4 Boundaries of the ert lotted to scale,z - bounder m c-1
5 Priaci a] structures ra structures with ex[at'ior dim C-1
6 Si[c improvements ind.outdoor storage areas,driveways,parking areas,etc.: existing 8c
C-1
ed
'1 Setbacks for all structures aad i nts: tstia 8c ed C-1
8 Ele ations and Fto lan o£all ed and a££eted structures Arch pla
B. Water Fe Sawa - Show.non Sheet#
1 Project sewage disposal facilities,design details,construction details,Flow miss, and number of N/A
bedrooms sed
2 Water supply tie.well] 8c septic o atljoining lots with separation distances[o existing or N/q
sed o site water au 1 nd se tic
3 Sro station distances£or sed sewer a dis osal s stem[o well and water bodies N/A
4 Existing public or private water supply[well,lake,eic.]. Method of securing public or private N/q
stet location desi ad c astruction of water a 1 cludin dail stet u
5 Percolation test locarion and re ults N/A
s i. Shower ion Shed#
C. Parkin /Permeable Areas - "-�
1 Numbe of spaces requ red for pr jec[including calculations andjusti£1ca[ion. extsting 8�r C-1
sed
2 No. of existing parking spacers,number to be removed,number[o maintain and type of surfacing C-1
material val, ved
3 Provision£or edestrian and handica and arkin istin Fc osed C-i -
4 De details of in loadinc nd cuttin Latin 8c r ed C-I
5 Location and character of green areas [existing and proposed],modiFcation to Bean area,buF£
e to re - adisturbed C 1
6 Lirthtin location aad desi of all exiatia ad sed outdoor li tin El,s t.1
D '"Ad'di&octal Siie Devel" t and�Ii3iscell8neous ro o __ Slbwn oa'".Sheail'!R
I On-site 8c ad'acen[watercourses streams a s,lake and wetlands N/A
2 UriliC /eaer distributions tem electric solar tal hone : iatin � sad N/A
3 Location,design and construction details of all a fisting aad proposed site impro rvcitaents C-I
ncludin draws,culvert9 retainin walls £nces £are 8c etn and h dran[s etc.
4 Square Footage o£bldg. a a proposed for office,manufacturing,retail sales or other commeretal C-I
acCvities: isCn sed
5 Sit Location,a e,desi aad setback: a i3tin 8c sed C-I
6 Waiver Request provide letter with application mquesting any wa""[vets: please refcrmce Aaaohed documrnt
cific item
9 Commercial/Industrial Development requires submission of Laadscapiag, Stormwater N/A
Mara anamt Gradin 8c Li tin Plans
8 Idaati£cation of Federml, State or County permits required for the project together with a record N/q
of a t"cation for all n ermita
Page 5
` Sigtl VeriartCe[Z9A appmvetl 5<pt<mb<`2[20[6]
This pag< includ<s the 1J Authorization[o Act as Ag<nt Form: 2J Engine<ring F<m Diselnsurq 3_)Authorization f r Site Visits 4J
Other P<cmi[Rcsporeibili[ics 5.)Of£cisl Mcc[ing Dix105utn 8nd 6J Agrttm<nT t0 provid<.documenta[ion r<quired.
Owb1En's AGENT FOrtm: Complete the Followin8 iF[h<OWNER oFthe property is not th<sam< as the applicant
Walmart Real Estate Business Trust
Own<r
D<signa[<s: Harrison French and Aseociat<s as gg<ttt r<garaing tlt<£oolowing:
Vatiau¢< X Si[<Plan Subdivision
For Taz Map No.: Deed A<Ferenc<: HooK Page Dat<
OWNER SIGNATURE: DATE: .�—�S l�
APPLte.[N'r'S AGENT FOaM: Complete he Following lP th<APPLICANT is unable to art<nd th<
nt«t[vg or wish<s to be mprmscnmd by anoth<r party:
Owne
n<aigaatea: 5 Agmnt rmgara:ng tn<r uow:ng:
Varian« site Plan sabaiyisirtn
For Tax Map No.: Deed Aef'erenc<: BooK Pa&< Datc
OWNER SIGNATURE: DATE:
_ gppliea[ions may b¢ refec[vd m [h¢ Town c salting rngin¢¢c foe c of s¢pNc tl<eign. s
drainage.¢ as d¢tvrntin¢d by tb<Zoning or Planning Oepartm<nt Fe<s£or c ravtmw sarvtc¢s will by charged ditatly [o'the applian
Fays Toe vngm¢¢ ng revaaw will not eae¢¢d$ 1.000 without noti5v`a[ion[o th<appli<an[.
3_l A RORIZAT[ON _ _ _ By a g Ltis page and submitting Lta application m vale a ached h¢reiq[hv Own<q gppbcant.
and his/heNtheic ag¢n[(sJ h¢by au[bonm th<Zoning Board or Planning Board antl Towa Stag m ante thv stu b'vc[pcopvrti¢a Toc the pu[pose of
mvtaw ng thv application submin¢d.
_ O _ _ _ O[hec pamti[s m y b¢required foe c alt¢m[ion acn i[y aubaequen[[o appeoval by th<
Zon ng Board oc Plann ng Board. V[s tT¢apphcan[5 r<sponslbdity to obtam any additional p<muty.
TES Dt5CLO5VRE: s the pm<tic< of the Community O<v<lopm¢nt O<pnrtin¢nt to hav< a dmaignal¢d
ograph¢ tape ortl [h<pmc«dings o£mm[mgs resulting Tiom appticanoq and mmu[es[canscrib¢d IIom d[os¢tape consnmt¢s th< offmal
record of allcptoccedings.
ENTAT[ON RE V[RE D: [.[h¢unde[aigned,have ebomughly read and vudets[and N<in <tions
foe ubm and afire¢ th< ubm- S aeRrtowlatlg shall ba evd pci of a alitl
l c n[ify[hat the applic ,plea and suppo[t ng m -ale nd c mp[< nVd< riptm o£tlt< s[ing[< ndit� and the
worKt➢roPosM. nd [ha all wo ac will be Pew�� i ocdan �[h a[a aPProv¢d Plvn andsi nfo cm i[h local i n8 i<Sula [
acKnowl<tlg<Nat prior to occupying[he Eacili[i¢s pmposed.¢l oc my agents.will obtain a rti£cate ofoccupancy as n nary. !also and<rstand drat
Vwv may b q�c¢d m provid<au as-burl[surv<y by a bernxd land survryor of all newly conatmc[M£acili[ias prior[o isauancm of a certilcate of
C -tied re
��e�C97�i//2iil�i/�ez ��/Sf��J(�J
fins arc[ can[] Print Nam<[Appliaani] Datd siglacd
Signature[Agent] Print Nam<[Agent] note signed Page')