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Averill Park, Sand Lake and West Sand Lake
Town of Sand LakeRensselaer County, New York

Application - Planning Board

Minor Subdivision Application

The Planning Board's application for a minor subdivision of 1-4 lots, with the list of materials that must accompany it.

Type: Application form Pages: 3 Download the original PDF (426 KB) Listed on: Planning Board Application Forms

This is an accessible web version of the Town's PDF application. The original is a scanned image with no selectable text, so this version was transcribed by reading the scan. The wording is reproduced as published; dashes are shown as plain hyphens. On page 2 the three "Lots will be" choices run together in the original ("Sold with buildings erected ready for occupancy Not selling"); they are listed separately here. The original underlines the NYS DEC form title as a link, but a scan does not carry the link address, so it appears as plain text. The form revision code on every page is REV:250129. To apply, print the original PDF, complete it, and submit it with the required materials.

TOWN OF SAND LAKE
PLANNING BOARD
PO Box 273, 8428 NY Route 66
Sand Lake, NY 12153
(518) 674-2026 ext.117 ~ www.townofsandlake.us

MINOR SUBDIVISION APPLICATION

(1-4 Lots Only)
Please refer to the Code of the Town of Sand Lake, Section 225-4 for more detailed information.
https://ecode360.com/12326443

Applications and fees must be submitted at least 14 days prior to the next Planning Board meeting to be considered for that session. All applications will be reviewed for completeness before being scheduled on the next available Planning Board agenda. An application is considered incomplete until staff confirm its completeness and place it on the meeting agenda. If any issues are identified, staff will contact the applicant for clarification or additional information.

PLEASE REVIEW THE LIST OF REQUIRED MATERIALS ON PAGE 3 OF THIS APPLICATION.

APPLICANT:

Name:
Address:
Home Phone:
Work/Cell Phone:
Email:

PROPERTY OWNER (if not applicant):

Name:
Address:
Home Phone:
Work/Cell Phone:
E-mail:

PLOT ENGINEER/SURVEYOR:

Name:
Address:
Work/Cell Phone:
Email:

SIGNATURES: Applicant and all documented homeowners must sign

Applicant:
Date:

Owner (if not applicant):

Date:

OFFICIAL USE ONLY:

Date Application Received:

Date Payment Received:
Amount Received:
Received By:

ZONING DETERMINATION: Approved [ ] Denied [ ]

DATE
Initials

PROPERTY INFORMATION

Tax Map Number(s):

Location of Property/911 Address:

Zoning District where property is located:

If in subdivision:

Subdivision Name:
Lot Number:

Present Use of Property:

Date property was acquired:

Any previous of the following? Select all that apply.

  • Subdivisions:
  • Special Use Permits:
  • Area Variances:

If yes, please explain:

PROPOSED SUBDIVISION INFORMATION:

Total Acreage of Parcel to be Subdivided:

Number of Lots:

Please complete the following regarding the proposed lots:

Lot NumberProposed Lot SizeProposed Lot Frontage
 
 
 
 

Lots will be:

  • Sold with improvements
  • Sold with buildings erected ready for occupancy
  • Not selling

STATE ENVIRONMENTAL QUALITY REVIEW SHORT ASSESSMENT FORM

Please complete the attached SEQR Short EAF Part 1 ONLY as required by New York State. This form may also be downloaded and much of the information completed for you using the NYS Department of Environmental Conservation EAF Mapper Application program located at: http://www.dec.ny.gov/permits/6191.html.

If you wish to download the form without using the EAF Mapper - please use the attached link: Short Environmental Assessment Form Part 1 - Project Information

LIST OF MATERIALS THAT MUST ACCOMPANY THIS APPLICATION FOR IT TO BE CONSIDERED BY THE PLANNING BOARD:

  • Sketch Plan (OR Survey Plat) - - 5 Copies PLUS one digital or 11 x 17 - - NOT NECESSARY IF SUBDIVISION PLAT IS SUBMITTED containing:
    • Location of portion to be subdivided in relation to the entire tract and the distance to the nearest existing street intersection.
    • All existing structures, wooded areas, streams, and other significant physical features.
    • Names and addresses of the owner and of all adjoining property owners.
    • Tax Map sheet, block, and lot numbers.
    • As applicable, a latest revision date on the Plat.
    • All the utilities available and all streets which are proposed, mapped, or built.
    • The proposed pattern of lots, including lot size, width and depth, setback lines, street layout, recreation areas, systems of drainage, sewerage, and water supply within the subdivided area.
    • All existing restrictions on the use of the land, including easements, covenants or zoning lines.
  • AFTER Sketch Plan (OR Survey Plat) - - 8 Copies - - containing:
    • A copy of the covenants or deed restrictions for any part of the tract.
    • An actual field survey of the boundary lines, giving complete descriptive data by bearings and distances made and certified by a licensed land surveyor.
    • All on-site sanitation and water supply facilities shall be designed to meet the minimum specifications of the Rensselaer County Department of Health and a note to that effect stated on the plat and signed by a licensed engineer.
    • Proposed subdivision name with name of town and county.
    • The date, North point, scale, name and address of record owner and subdivider.
  • Signature(s) of Applicant and all documented owners.
  • Copy of section of applicable Tax Map showing location of property.
  • Completed subdivision/property information.
  • Completed State Environmental Quality Review Short Assessment Form.
  • Subdivision Application Fee.
    • See Fee Schedule
    • Make checks payable to the Town of Sand Lake.

Page 3 of 3 - REV:250129

Source: Minor_Subdivision_Application.pdf on townofsandlake.us, linked from the Planning Board Application Forms page. Copied November 11, 2026.