Subdivision Application

• New Subdivision
• Legalization of Pre-Existing Illegal Subdivision
• Date:
• Paid:

Applicant and property

• Applicant's Name:
• Applicant's Mailing Address:
• Applicant's Phone number:
• Owner of property: (If different from applicant)
• Owner's mailing address:
• Owner's phone number:
• Property Acquisition Date:
• Acquired From:
• Applicant's Professional Engineer, Attorney or Land Surveyor: (Name, Address & Phone Number)
• Location of property to be subdivided: Road; Tax Parcel #; Zoning District
• Total area of existing lot: ____ acres
• Does this differ from the information on your deed? No / Yes
• Was a variance required before legalization? (If yes, attach copy) No / Yes
• Number of lots being created and approximate lot areas:
• Existing development, if any, on lands being subdivided:
• Natural features (e.g. streams, wetlands or floodplains) on land being subdivided:
• Restrictions or easements affecting the lands being subdivided:
• Nature of access to the proposed lots: Public Roadway / Private Roadway / Unimproved Easement

Appliciants Must Provide the Following Information for the Nearest Intersecting Road

• 1.) Road Name:
• Distance (ft.):
• 3.) Direction: (North, South, East, West)
• 4.) Tax Map Parcel (Map, Block, Lot) :
• 5.) Dimesnsions/Area of Property:
• 6.) Existing Zoning Distirct:
• 7.) Brief written summary of propsed action:

Applicant must provide:

1) Three copies of survey maps, one mylar, and pdf of the proposed subdivision. All maps must show parent parcel on them.

2) Names and address of all contiguous (eg. adjacent) property owners, including those across streets/streams which would touch the subject property if the street/stream were not there. Addresses must be obtained from the current tax rolls which are available in the assessor's office:

The form has numbered lines 1 through 12 for these names and addresses. (Use more space if needed)

Requested exceptions, if any:

The Planning Board is hereby requested to authorize the following exceptions to, or waives from, the Town's Land Subdivision Regulations in its consideration of this Subdivision Plat review and approval application (a specific list of any exceptions sought and a statement of reasons why each such exception should be authorized by the Planning Board must be attached in order for the exception to be considered by the Planning Board):

The undersigned hereby requests: Sketch plat endorsement / Final plat approval

of the above-identified lot-line revision and/or combination of lands by the Planning Board in accordance with the Town's Land Subdivision regularions and Section 276 of the Town Law of the State of New York. The undersigned further acknowledges that the official date of this application is that of the next scheduled meeting of the Planning Board, as established by the Planning Board's annual calendar, I provided this application form, the required Environmental Assesment Form and the required drawing have been submitted to the Planning Board Office at least ten days prior to the said meeting, at which meeting the application may be presented to the Planning Board in person or by representative. Upon determination of the Planning Board, the applicable subdivision application fee shall be paid at the Town Clerk with receipt therefor provided by tge Town Clerk to the Planning Board.

Application submitted by:

• Owner of Property Being Subdivided
• Agent for Owner (Evidence of right to act on behalf of Owner must be submitted)
• Date of Application Submission

TO THE TOWN OF HERKIMER PLANNING BOARD

This will authorize ________ to represent me/us and make statements on my/our behalf at the Town of Herkimer Planning Board Meeting of ________ in the matter of ________.

• Planning Board Case No.:
• Site Plan Review Case No.:
• Special Use Permit No.:
• Print Property Owner's Name
• Owner's Signature
• Second Owner's Signature
• Date
• Respresentative's Signature and Date
• Representative's Adress
• Representative's Phone

THIS SECTION TO BE COMPLETED BY PLANNING BOARD OFFICE

• Date application received by Planning Board:
• Planning Board Case Number Assigned:
• Date application assigned to Planning Board Agenda:
• Application classified by Planning Board as a: Major Subdivision / Minor Subdivision; Date
• Application referred by the Planning Board to the following for review (each with Date and Date Comments Received): Town Planning Consultant; Town Engineering Consultant; Town Environmental Commission; Town Attorney

Referrals to be made to above, as required by particular circumstances of application. Referrals to other parties may occur, but less routinely.

• Application entitles ________ and scheduled for public hearing as follows: Date; Time
• Notices sent to adjourning property owners: Date
• Legal notice published as follows: Date; Offical Newspaper
• Application fee of $ ________ set by Planning Board in accordance with Town schedule and paid to Town Clerk on ________ (date).
• Health Dept. Approval / Curb Cut Approval / Road Maintenance Agreement
• Planning Board SEQR determination made by resolution as follows: Negative Determination / Positive Determination; Date (See EAF for further documentation)
• Planning Board action taken on application by the following resolution: Resolution Number; Calendar Year; Date. Approval / Disapproval / Approval with Conditions (See Planning Board Resolution for details)
• If application for final plat approval, documentation of signing of final plat by Planning Board Chairman or other authorized Board member: Date of Plat Signing; Date of Transmittal to Applicant