HomeMy WebLinkAbout20260747 11 Eastman Ln Land Disturbance Activity ApplicationHANDWRITTEN APPLICATIONS WILL NOT BE ACCEPTED!! IroaoPrtceuset
Property Address/Location:
CITY OF SARATOGA SPRINGS
PLANNING BOARD
CITY HALL -474 BROADWAY
SARATOGA SPRINGS, NEW YORK 12866-2296
TEL:518-587-3550 X2533
www.saratoga-springs.org
APPLICATION FOR:
LAND DISTURBANCE ACTIVITY PERMIT
11 Eastman Lane
Tax Parcel #: 165.-2-36.1, 165.-2-34, 165.-2-75
(for example: 165.52-4-37)
Zoning District: RR
(Application #)
(Date received)
(Project Title)
Staff Review
Proposed Use: Grading - Possible Residential Subdivision
Date of any existing Land Use Board approvals (if any):
APPLICANT(S)*
Name Derby stallion LLC
Address PO BOX 139, Clifton Park, NY 12065
Phone 917a96-8478
Email
OWNER(S) (If not applicant) ATTORNEY/AGENT
Identify primary contact person: ❑ Applicant ❑ Owner ® Agent
D. Brien Ragone, EnWroneretal Design Partnership
900 NY-146, Clifton Park, NY 12065
(518)371-7621
* An applicant must be the property owner, lessee, or one with an option to lease or purchase the property in question.
Please check the following to affirm information is included with submission.
l09 Environmental Assessment Form:
All applications must include a completed SEQR Short or Long Form unless the project has already been given a
"Negative Declaration" SEQR Forms can be completed at http://www.dee.ny.gov/permits/6191.html.
0 Application Fee: Make checks payable to the "Commissioner of Finance".
REFER TO THE CURRENT FEE WORKSHEET INCLUDED IN THIS DOCUMENT,
I I1 hard copy w/original signature(s) and one electronic copy (PDF) of ALL documents (all maps, drawings, or
image documents as separate files to maintain their original scale and image resolution).
0
Plans: (1) copy: 24"x36" and (1) copy 11 "x17".
Check City's website (www.saratoga-springs.org) for meeting dates.
Does any City officer, employee or family member thereof have a financial interest (as defined by General Municipal Law Section
809) in this application? YES_ NO X . If YES, a statement disclosing the name, residence, nature and extent of this interest
must be filed with this application.
Revised 8/2022
I, the undersigned owner or purchaser under contract for the property, hereby request land disturbance activity permit
approval by the Planning Board for the identified property above. I agree to meet all requirements under Article 13.7 of
the Unified Development Ordinance of the City of Saratoga Springs.
Furthermore, I hereby authorize members of the Planning Board and designated City staff to enter the property
associated with this application for purposes of conducting any necessary site inspections relating to this application.
Applicant Signature: c' Z a Date:
If applicant is not currently the owner, the owner must also sign.
Owner Signature: Date: