Planning Board Application Form - Town Of Greece

1 Vince Tofany Boulevard

TOWN OF GREECE

Greece, New York 14612-5016

PLANNING BOARD

APPLICATION FORM

Phone: (585) 723-2344

Fax: (585) 723-2442

William D. Reilich

Supervisor

APPLICANT:

PROPERTY OWNER (If same as Applicant, mark “SAME”):

(Name)

(Applicant’s Street Address)

(Name)

(City)

(State)

(ZIP Code)

(Street Address)

(Phone)

(Fax)

(City)

(State)

(ZIP Code)

(E-mail)

Note: An application made by the agent of an owner must be accompanied by a nonreturnable copy of an instrument that conveys the right to represent the owner(s) of the property for which an application is made.

Such instrument may be in the form of power of attorney, a lease agreement, authorization by contract, or a purchase contract.

CONTACT PERSON:

(Name)

(Phone)

(Fax)

(E-mail)

PROJECT LOCATION:

CURRENT ZONING:

(Street Address, or Distance and Direction to Nearest Intersection)

TAX MAP NUMBER(S):

APPLICATION FOR:

[ ] Concept Plan Review

[ ] Site Plan

[ ] Minor Improvement Plan

[ ] Change of Lot Line [ ] Other (Describe below)

[ ] Minor Subdivision

[ ] Preliminary Plat

[ ] Final Plat

[ ] Check if application is submitted under New York State Town Law, Section 278

(Brief Description of Proposal, including Subdivision Name & Number of Lots, if Applicable)

DISCLOSURE: As defined by New York State General Municipal Law, Section 809, an officer or employee of the Town of Greece shall be deemed to have an

interest in an application when he or she, his or her spouse, or their brothers, sisters, parents, children, grandchildren, or the spouse of any of them: (1) is the

applicant; (2) is an officer, director, partner or employee of the applicant; (3) legally or beneficially owns or controls stock of a corporate applicant or is a member

of a partnership or association which is applying; or (4) is a partner to an agreement with such an applicant, expressed or implied, whereby he or she may received

any payment or other benefit upon the favorable approval of such application.

Pursuant to the provisions of New York State General Municipal Law, Section 809

:

(Please check one of the following)

[ ] There is (are) no person(s) who have an interest in this application.

[ ] There is (are) person(s) who have an interest in this application. (On a separate sheet of paper, to be attached to this application form, indicate the name(s)

and address(es) of such person(s), the nature and extent of the relationship to the applicant, and the nature and extent of the interest in the application.)

SWORN STATEMENT: As applicant or legal agent for the above-described

Subscribed and sworn to before me

property, I do hereby swear that all statements, descriptions, and signatures

appearing on this form and accompanying materials are true and accurate to

This

day of

, 20

the best of my knowledge.

(Notary Public)

(Owner or Applicant — PLEASE PRINT)

(SIGNATURE of Owner or Applicant)

DO NOT WRITE IN THIS SPACE (For Office Use Only)

Date Received:

By:

Fee: $

Receipt No.:

Decision:

Date:

J:\Planning Board\Application Packages\APPLICATION FORM\Planning Board Application Form 20170210-Color Top.docx