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SITE PLAN OR ZONING REFERRAL TO COUNTY OF ERIE, N.Y. AND REPLY TO MUNICIPALITY DO NOT WRITE IN THIS SPACE Submit this form with full statement of proposed action www.Erie.gov/IRonline, R mail hard copy (retain a copy for your files) Case No.: to: Erie County Division of Planning, 95 Franklin Street, Room 1053, Buffalo, N.Y., 14202 Postmark/Delivery Date: The proposed action described herein is referred in accordance with the provisions of NYS General Municipal Law Description of Proposed Action 1. Name of Municipality: 2. Hearing Schedule: Date Time Location 3. Action is before: Legislative Body Board of Appeals Planning Board 4. Action consists of: New Ordinance Rezone/Map Change Ordinance Amendment Site Plan Variance Special Use Permit Other: 5. Location of Property: Entire Municipality 5a. S.B.L. of Property: Referral required as State or County Municipal Boundary Farm Operation located in an Property/Institution Agricultural District Expressway County Road State Highway Proposed State or County Road, Property, Building/Institution, Drainageway 7. Proposed change or use: (specify the action, such as the scope of variances or site plans) 8. Other remarks: 9. Submitted by: Email: 10. Return Address: Reply to Municipality by Erie County Division of Planning Receipt of the above-described proposed action is acknowledged on ________________. The Division herewith submits its review and reply under the provisions of applicable state and local law, based on the information submitted with this referral. 1. The proposed action is not subject to review under the law. 2. Comment on proposed action is attached hereto. 3. The proposed action is subject to review; Recommendation on Proposed Action is attached hereto. 4. No Recommendation; proposed action has been reviewed and determined to be of local concern. By the Division of Planning: Date: Revised