GERMANTOWN APPLICATION: SUBDIVISION

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: SUBDIVISION
Applicant Name

First NameLast Name
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Are you the owner of this Parcel?

YesNo
Date Acquired?

MonthDayYear
Date
Owner name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Attach Owner Consent Letter

Cancelof
Tax Map Number
Zoning District
Total Acreage

List proposed subdivisions and acreage (attach sheet if needed)


Parcel 1
Parcel 2
Parcel 3
Parcel 4

Land is in an Agricultural District?

YesNo
Within 500’ of an active farm?

YesNo
Date and description of prior subdivision:
List any easements or other restrictions on this parcel:

Please list any representatives who may speak on behalf of this application:

	Name	Address	Contact Phone	Email
Land Surveyor
Engineer
Attorney
Realtor
Other

Applicant Signature OR Representative Signature (Applicant Letter required to authorize representative.)

Clear
Date

MonthDayYear
Date
Should be Empty: