Germantown APPLICATION: LOT LINE ADJUSTMENT WAIVER

TOWN OF GERMANTOWN
50 Palatine Park Road
Germantown, NY 12526

Phone: (518) 537-6687 Fax: (518) 537-6001
Visit us on the web: www.germantownny.org Email us at: gtownny@valstar.net
APPLICATION: LOT LINE ADJUSTMENT WAIVER
Date of Application

MonthDayYear
Date
OWNERS OF PROPERTIES ADJUSTING LOT LINES
Applicant #1:
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Owner Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Property Location Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Tax Map Parcel #
Property Total Area (in acres) after Lot Line Adjustment
Applicant #2:
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Owner Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Property Location Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Tax Map Parcel #
Property Total Area (in acres) after Lot Line Adjustment
Other Required Information:
Applicant(s) must provide a plat or map of the parcels affects by the proposed adjustment, showing all existing buildings, the location of existing utilities or other easements or rights-of-way, of wells or septic systems. The map shall show the existing lot lines and the location of the proposed new lot line, and the existing and new setback distances to any buildings.

Certification:
I have personally examined and am familiar with the information submitted in this application, including all attachments, and I believe this information to be true, accurate and complete.
Applicant #1 Signature

Clear
Date

MonthDayYear
Date
Applicant #2 Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

APPLICATION: LOT LINE ADJUSTMENT WAIVER

OWNERS OF PROPERTIES ADJUSTING LOT LINES