Page 2 of 3
5. Is the proposed action,
a. A permitted use under the zoning regulations?
b. Consistent
with the adopted comprehensive plan?
6. Is the proposed action consistent with the predominant character of the existing built or natural landscape?
NO YES
7. Is the site of the proposed action located in, or does it adjoin, a state listed Critical Environmental Area?
If Yes, identify: ________________________________________________________________________________
NO YES
8. a. Will the proposed action result in a substantial increase in traffic above present levels?
b. Are public transportation services available at or near the site of the proposed action?
c. Are any pedestrian accommodations or bicycle routes available on or near the site of the proposed
action?
NO YES
9. Does the proposed action meet or exceed the state energy code requirements?
If the proposed action will exceed requirements, describe design features and technologies:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
NO YES
10. Will the proposed action connect to an existing public/private water supply?
If No, describe method for providing potable water: _________________________________________
_____________________________________________________________________________________________
11. Will the proposed action connect to existing wastewater utilities?
If No, descri
be method for providing wastewater treatment: ______________________________________
____________________________
_________________________________________________________________
NO YES
archaeological sites on the NY State Historic Preservation Office (SHPO) archaeological site inventory?
13. a. Does any portion of the site of the proposed action, or lands adjoining the proposed action, contain
wetlands or other waterbodies regulated by a federal, state or local agency?
b. Would the proposed action physically alter, or encroach into, any existing wetland or waterbody?
If Yes, iden
tify the wetland or waterbody and extent of alterations in square feet or acres: _____________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
12. a. Does the project site contain, or is it substantially contiguous to, a building, archaeological site, or district
which is listed on the National or State Register of Historic Places, or that has been determined by the
Commissioner of the NYS Office of Parks, Recreation and Historic Preservation to be eligible for listing on the
State Register of Historic Places?
b. Is the project site, or any portion of it, located in or adjacent to an area designated as sensitive for