Village Of Dansville, New York:

Application for Review of Preliminary Plat Approval

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Application is hereby made for conditional approval of the Preliminary Plat of a subdivision hereinafter more particularly described

Name or Identifying Title:
		Name/Profession		Address		City, Town, State		Telephone Number
Applicant
Owner (if different)
Plans Prepared by
Location of site:
Tax map description		Section		Block		Lot
Number of Existing Lot(s):			Number of proposed lot(s):		Area of entire tract:		Portion being subdivided:
Current Zoning Classification:
Intended use for subdivision:
Deed Restrictions or Protective covenants that apply or are contemplated (if no restrictions, state “NONE,” if there are restrictions attach copy):
Names of abutting owners and owners directly across adjoining streets:
Requested Exceptions: The Planning Board is hereby requested to authorize the following exceptions to or waivers of its regulations governing subdivision (attach list of such exceptions with the reason for each exception set forth)
List proposed improvements and utilities and intentions to install or post performance guarantee prior to approval of Subdivision Plat:
1. 2. 3.	Improvement				Intention
List of maps and other material accompanying application and number of each:
a. b. c.	Item				Number
The undersigned hereby requests approval by the Planning Board of the above identified subdivision:
DATE		(SIGNATURE OF APPLICANT)
		Applicant:				Owner (if different)
Date

Plan Review Form