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TOWN OF WALES
AGRICULTURAL DATA STATEMENT
Changes in NYS Agricultural Markets Law requires submission of an agricultu
ral data
statement by an applicant to the municipality for a rezone, special use permit, site
plan approval, use variance, or subdivision of parcel(s) in an agricultural district or
within 500 feet of a farm operation located in an agricultural district.
Applicant’s Name & Address: Owners Name & Address
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Type of Application: . Re-Zone/Map Change Special Use Permit
___ Subdivision approval * Use Variance Site Plan Approval
Project Name/Loeation and Description of Proposed Project:
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Tax Map Number:
Number of total acres involved with the project: oY
Current use of site: Re Crtertianw
Will there be any toxic hazardous, chemicals substances or combination thereof, stored or
used on the premises? If yes, indentify each and include all MSDS (Material Safety Data
Sheets)__ {(V©
Are there any drainage ways or features (ditches tiles, streams. gullies)
located on this
site?
<_YES NO
If yes, will this project alter existing drainage patterns? If yes, please describe
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Applicant’s Signature:
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Owner’s Signature:__|
Date:_I2 fel? tT