TOWN OF CHAMPION

PLANNING BOARD

 

Application for Site Plan Approval

 

Preliminary [     ] Date:____________         Final [    ] Date:____________

 

Name of proposed development:_____________________________________________

 

Applicant:                                                     Plans prepared by (if applicable):

 

Name:____________________________       Name:_____________________________

 

Address:__________________________       Address:____________________________

 

              __________________________                      ____________________________

 

Telephone:________________________        Telephone:__________________________

 

Owner (if different):

 

Name:___________________________

 

Address:_________________________

 

              _________________________

 

Telephone:_______________________

 

Ownership intentions (purchase options):_________________________________________

 

________________________________________________________________________

 

Tax Map Number:_______________________________

 

Current Zoning Classification:_____________________

 

County, State, or Federal permits that will be required (List type of permit and regulating agency):__________________________________________________________________

 

________________________________________________________________________

 

Proposed Use of Site:______________________________________________________

 

________________________________________________________________________

 

 

Page 2

 

Total Site Area (Square feet or acres):____________________________________________

 

Anticipated Construction Time:______________________________________________

 

Will Development Be Staged?  Yes_____   No ______

 

Current Land Use of Site (Agriculture, commercial, undeveloped, residential, etc):_______________

 

______________________________________________________________________________________

 

Current Condition of Site (buildings, woods, brush, etc):______________________________

 

________________________________________________________________________

 

Character of Surrounding Lands (Suburban, agriculture, wetlands, etc):____________________

 

________________________________________________________________________

 

Estimated Cost of Proposed Improvements: $________________

 

Anticipated increase in number of residents, employees, customers, etc (if applicable):________________________________________________________________

 

Describe proposed use, including primary and secondary use; number of stories; gross area; floor(s) area; and height of each building:

 

-for residential buildings include the number of dwelling units by size (efficiency, one-bedroom, two-bedroom, three or more bedrooms) and number of available parking spaces.

-for non-residential buildings include the gross floor area and gross leasable area; number of available parking spaces.

-other proposed structures; roadways; pedestrian routes; paving; site buffers, etc.

 

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

(Use a separate sheet if necessary)

 

>Attach a plat map drawn to scale showing:

 

  • Project name, scale, north arrow, and date of preparation
  • Property boundaries
  • Contiguous properties with the names and addresses of owners
  • Existing roads, streets, utilities, and structures
  • Land contours at 10 feet intervals, or other indicators of slope
  • Water courses, marshes, wooded areas, and other significant physical features on or near the site.
  • Proposed layout of project.  The layout shall be drawn in sufficient detail to and shall contain sufficient data so that the location, bearing and length of every structure, lot line, boundary line, road and street line can be readily determined and may be reproduced on the ground.

 

>Prepare and attach the NYS SEQR Full Environmental Assessment Form - Part 1 
  The form may be downloaded on the NYS Department of Environmental Conservation
  website at:  http://www.dec.ny.gov/public/6191.html

 

 

The undersigned hereby requests approval by the Planning Board of the above identified plat.

 

 

_________________________________________
Signature


__________________________
Date