Fillable Town of Pine Plains Planning Board Site Plan (Town of Pine Plains)

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Town of Pine Plains Planning Board Site Plan (Town of Pine Plains)

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Town of Pine Plains
Planning Board
Site Plan and Special Permit Application
APPROVAL REQUESTED FOR:
Please type or print clearly
Site Plan Review_____ Special Permit_____
Site Plan Review and Special Permit ____ Extension of a Non-Conforming Use___
Amendment to an approved Site Plan or Special Permit ____
Please review Articles VII, XI, XII, and XIII of the Pine Plains Zoning Law before
applying
Name of Project: _________________________________________________________
_______________________________________________________________________
Location of Project/Street Address: ___________________________________________
_______________________________________________________________________
_______________________________________________________________________
Tax Map Number of all Parcels:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Attach a copy of the current deed and any easements affecting property
Detailed Description of Proposed Project and land use: (attach additional sheets as required)
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
1
Print Form
Name, Address and Telephone & Email of Applicant and/or Applicant’s agent:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Is the Applicant the Property Owner? If no, list Name, Address and Telephone & Email
of the property owner(s):__________________________________________________
_______________________________________________________________________
_______________________________________________________________________
If the applicant is not the owner of the subject property, the applicant shall provide the
Planning Board with a notarized statement from the owner authorizing the applicant to
act for the owner as agent for the owner and to make the application for the site plan
review and/or special permit. The statement shall be submitted on a form supplied by the
Planning Board.
Has the Zoning Board of Appeals taken action on this project? ________
Is the site in an approved Critical Environmental Area? ______
Is site in a State and County approved Agricultural District? ___If so, list which______
If within an Ag District, does the property contain, or is it within 500 feet of an
Agricultural Operation? _____ If yes, submit an Agricultural Data Statement as per 283-a
of Town law.
Zoning District(s) the property lies within:_____________________________________
_______________________________________________________________________
Current Land Use of Site: __________________________________________________
Surrounding Land Uses: ___________________________________________________
_______________________________________________________________________
Has the applicant complied with any applicable individual standards for Special Use
Permits set forth in Section 100-56 of the Pine Plains Zoning Law?_____ If yes, supply
the required information and documentation.
2
3
Total Acreage of Parcel Controlled By Owner/Applicant: _________________________
Total Acreage included in submission: ________________________________________
Is the parcel in application under Option or Contract to Sell? ______
If yes, To Whom:
______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
.
The signature of the Owner or Agent of the Owner below shall certify that the applicant
is familiar with and will comply with the requirements of the Pine Plains Zoning Law,
the Town’s Subdivision Regulations, and any other appropriate Town ordinance and
regulation with regards to this project.
Additionally, said signature will serve as written permission for the Planning Board,
ZEO, Building Inspector, Highway Superintendent, or any of the Town’s contracted
consultants or agents to conduct site visits as may be required during the review and
subsequent construction.
Signature: _______________________________________________________________
Print or Type Name: ______________________________________________________
Date: __________
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Town of Pine Plains Planning Board Site Plan (Town of Pine Plains)

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Completed 14 July 2020

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