Application 7- k
UILDING
Q U E E N S B U R Y TDrM07i �E11s41�Ai
BAY AND HAVILAND ROADS. R. D. 1
GLENS FALLS. NEW YORK. 12801
APB 3-1 TELEPHONE: 13181 792.5832_
PLANNINd ZONI (I{ OFFICE USE ONLY (�Jt7
DEPARTMENT Application Number <f
Fee
Hearing Date
County Referral
Application for Site Plan Review APA Referral
Type II (X) Type I ( )
1. Applicant's Name ram- wm N akMIM1 � Phone
Street Address nblon
City, State, Zip
2. Owner's Name (if different from 1.)
Street Address
City, State, Zip
DESCRIPTION OF PROPOSAL
3. Property Location 1
Street or Road T 1. �GVII►OYl f� C n���'+�I� L
✓✓
Deed Ref. Book Page
Tax Map Number Section -/,Q Block__/_Lot
Is lot in question within 500 feet of a County or a State R.O.W. or park,
municipal boundary, or watershed draining any County or State facilities,
requiring review of the Warren County Planning Board:
YES X NO
4. Zone Classification L.Fz " I A
5. Present Use of Property Jl�1Tll'Y1L�S" K1G `
Applicant shall enclose in duplicate any substantiating evidence.
Dated this_&p _day of tAQMk. -. 19-A7- /
Si nature of Applic
__�.. ... .....� ..� uwruRei RcsuTV A GOOD PLACE TO LIVE
'S. Proposed Use Summer Home
7. Location of Property (Description of how to find property)
8. A. Total Acreage
B. Total Site Area (Sq. Ft. or Acres)
9.' Anticipated construction time Start Finish
10. List other required permits or approvals and status
11. Current condition of Site (Bldgs, brush, open field, forest)
12. Character of surrounding lands (Suburban, Agricultural, Wetlands, etc.)
13. Please provide the following information (use additional pages if necessary)
A) An estimated project construction schedule
Applicant please initial o —
-2-
14. The Site Plan: Draw to scale a detailed description of the proposed site.
Items A - I must be included on Site Plan drawing.
Items J-U shall be included as may be appropriate and necessary.
rATitle of drawing, including name and address of Applicant and person
responsible for preparation of such drawing.
B) North arrow, scale and date
C) Boundaries of the property plotted to scale
D) Existing watercourses
E) Location of existing structures and their use with exterior dimensions
F) Location of proposed use(s) and their location with exterior dimensions
G) Location of any outdoor storage
H) Location and design of sewage disposal facilities indicating construction
materials
�I) Description of the method of securing public or private water and location,
design and construction materials of such facilities
J) Location, design and type of construction of all parking and loading areas,
showing ingress and egress
K) Provision for pedestrian access
v,'6 Location, design and construction materials of all existing or proposed
site improvements including drains, culverts, retaining walls and fences
M) Location of fire and other emergency zones, including the location of
fire hydrants
N) Location, design, and construction materials of all energy distribution
facilities, including electrical, gas and solar energy
O) Location, size, design and type of construction of all proposed signs
P) Location and proposed development of all buffer areas, including
existing vegetative cover
Q) Location and design of outdoor lighting facilities
R) Identification of the location and amount of building area proposed
for retail sales or similar commercial activity
IS) General landscaping plan and planting schedule
/T) Grading and drainage plan, showing existing and proposed contours
U) Other elements integral to the proposed development as considered
necessary by the Planning Board.
Applicant please initalOr
-3-
15. List Names & Addresses of ALL adjoining property owners.
Northerly
Easterly
Southerly 'yIF-I - ;an V 6{466
Westerly
Applicant please initial
-4-
TOWN OF QUFPNSBURY
"The parties hereto consent that the proceedings
which result from the within application may be tape
recorded and transcribed by the Town Clerk or his agent
and that such minutes as may be transcribed shall constitute
the official record of all proceedings regarding this
application, unless the same may vary from the handwritten
minutes taken by the Town Clerk or the Secretary bf the
Planning Board or Zoning Board of Appeals, in which event
the handwritten minutes as to such inconsistencies shall
be deemed the official record. "
Date 19
licant s signature
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