ApplicationSign Variance [ZBA approved September 21 2016]
General Information
Tax Parcel ID Number: ____________________
Zoning District: ____________________
Detailed Description of Project [include current & proposed use]:
Current Use: _________________________________________________________________
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.
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Sign Variance [ZBA approved September 21 2016]
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
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Sign Variance [ZBA approved September 21 2016]
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_________________________________________________________
_________________________________________________________________________________________
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Sign Variance [ZBA approved September 21 2016]
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 sign variance?
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2. Whether the benefit sought by the applicant can be achieved by some method, feasible for the applicant to pursue,
other than a sign variance?
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3. Whether the requested sign variance is substantial?
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4. Whether the proposed variance will have an adverse effect or impact on the physical or environmental conditions in
the neighborhood or district?
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5. Whether the alleged difficulty was self-created?
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Additional Project Information
1. If the parcel has previous approvals, list application number(s): _________________________
2. Does this project require coverage under the New York State Pollutant Discharge Elimination System (SPDES) Permit
Program? __ Yes / __ No
3. Estimated project duration: Start Date __________ End Date __________
4. Estimated total cost of project: _______________
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Sign Variance [ZBA approved September 21 2016]
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. Parking / 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: existing & 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 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 Signage: Location, size, type, design and setback: existing & 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
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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 ____ _____________
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Staff Representative: ________________________________
Applicant / Agent: ________________________________ Date: ___________
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