TOWN OF CLERMONT
1795 ROUTE 9
GERMANTOWN, NEW YORK 12526

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Dear Sir:

The location of your farm operation has been identified to be within 500 feet of a proposed project in an agricultural district. You have the right to give comment about the project effecting your farm operation. Enclosed is a copy of the Agricultural Data Statement.

***************************STATE LAW*********************************
In accordance with Section 283-a of the New York State Town Law, the Town of Clermont will use the data in this statement to assist in evaluating the impact of proposed development projects on farm operations in Agricultural Use Districts.
Effective changes to NYS Agriculture & Markets Law, now require submission of an “Agricultural Data Statement” by an applicant for a special use permit, site plan approval, use variance or subdivision, which is on property in an agricultural district or is within 500 feet of a farm operation located in an agricultural district.
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TOWN OF CLERMONT

AGRICULTURAL DATA STATEMENT REVIEW

REVIEWING BOARD:
(Check One)

[ ] TOWN BOARD: Town meeting on the first Monday of every month:
Next meeting ___________________________
[ ] PLANNING BOARD: Meeting on the second Wednesday of every month:
Next meeting ___________________________
[ ] ZONING BOARD OF APPEALS: Meeting on the fourth Wednesday of every month:
Next meeting ___________________________

___________________________________ Date: ___________________________
Name of Official Completing Form

Other Comments: ______________________________________________________
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TOWN OF CLERMONT

AGRICULTURAL DATA STATEMENT REVIEW

NAME_________________________________________________________________

MAILING ADDRESS_____________________________________________________
CITY_________________________________STATE____________ZIP_____________
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LOCATION OF SITE______________________________________________________
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TAX NUMBER OF SITE___________________________________________________

ZONE DISTRICT (RA) (LDR) (H) (RJC) (RLB) (RLB/3) (FAO) (PID) (PUD)

COMMENT_____________________________________________________________

AUTHORIZED REPRESENTATIVE_________________________________________

********************************REVIEW********************************
In accordance with Section 283-a of the New York State Town Law, the Town of Clermont will use the data in this statement to assist in evaluating the impacts of proposed development projects on farm operations in Agricultural Use Districts.

Effective changes to NYS Agriculture & Markets Law now require submission of an “Agricultural Data Statement” by an applicant for a special use permit, site plan approval, use variance or subdivision, which is on property in an agricultural district or is within five hundred (500) feet of a farm operation located in an agricultural district.

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If so, how much _________________________________Acres.
F. Does this person ( ) Own ( ) Rent the land?
G. Does this project site benefit from an agricultural assessment ( ) Yes ( ) No
Date_______________ Length_________________

Page 2 CPB

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Please include information about the existing land cover of the site, any known impacts on existing storm water drainage (including field tiles) or other significant plant materials. _______________________________________________________
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( ) Positive Effect ( ) Negative Effect ( ) No Effect
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