Application for Planning Board
Applicant to complete information in this box only.
Typewritten or printed P.B. No.
Applicant:
Mailing Address
Phone No.
Responsible Person
DATE:
TO: APPLICANT
FROM: PLANNING BOARD
A review of your survey for a building permit application indicated non-compliance. If necessary, please contact
the appropriate department as indicated below:
Access: Section 28A of N.Y.S. Town law
( ) Application does not demonstrate access to a suitably improved highway
( ) Access not suitabley improved.
( ) Request_____________widening. Per:
GRADING ORDINANCE: Chapter 35 Town of Brookhaven Ordinance
( ) Submit site grading plan to the Planning Divison for review. Per:
MUNICIPAL ACQUISITION:
( ) To be acquired. Per:
( ) Area being studied for acquisition Per:
SUBDIVISION REGULATIONS:
( ) Submit Land Division application. Per:
OTHER: (specify)
Per:
WETLANDS: Chapter 81 Town of Brookhaven Ordinance
( ) Requires further review and/or application.
OTHER: (specify)
Per:
( ) Maintained
( ) Inproved - jurisdiction other than Town
( )Paper Street - should be inproved to Town Specifications.
( ) Non-existing or dirt road.
( ) Pending Development
( ) Work Permit not required
( ) Work permit required for apron, curb cut, continuation of curb, sidewalk (circle requirement)
( ) No apparent grade problem
( ) Property lower than road.
( ) Property higher than road.
( ) Request topo map.
( )No apparent street drainage problem.
( ) Highway Department will install catch basin at this location.
( ) Overall drainage problem - Planning Board review.
( ) Existing basin.
Date of Inspection: Highway Inspector:
Remarks:
Town of Brookhaven Planning Board
HAMLET:
PLANNING DEPARTMENT USE ONLY
DEPARTMENT OF ENVIRONMENTAL PROTECTION
HIGHWAY DEPARTMENT USE ONLY
HOUSE No.
