Town of Wales

Site Plan Review Application Form

 

 

 

Name of Property Owner:  _____________________________________________________

Address: ___________________________________________________________________

 

Property Location: ___________________________________________________________

Map: ____________ Lot: ____________ Zoning District: ____________________________

 

Name of Applicant: ___________________________________________________________

Address of Applicant: _________________________________________________________

Telephone: __________________ Fax: _______________ E-Mail: _____________________

 

Authorized Agent: ____________________________________________________________

Address: ____________________________________________________________________

 

Indicate the type of Right, Title or Interest in the Property:

 

 

 

 

 

Unless otherwise indicated below, all correspondence regarding this application will be sent to the Applicant:

Name:  ____________________________________________________________________

Address:  __________________________________________________________________

 

Provide a brief description of the project:

 

 

 

 

 

 

 

List all other local permits required for this project:

 

 

 

 

 

List all other State and Federal permits required for this project:

 

 

 

 

 

Anticipated date for construction to begin: ___________________________________________

 

Anticipated date for completion: ___________________________________________________

 

Identify method of water supply to the project: ________________________________________

 

Identify method of sewerage disposal for the property:  _________________________________

 

Identify method of fire protection to the project:  ______________________________________

 

Additional Comments:  __________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

 

Attach the application checklist form and all submissions to the application form.

 

 

To the best of my knowledge, all information submitted in this application is true and correct.

 

 

________________________________________

    (Signature of Applicant)                                                       

 

________________________________________

(Date)