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Town of Dover Planning Board <br />Does the project parcel cover applicant's entire bolding? <br />[]yes Eno <br />Deed Reference: Iaber 22013 <br />Page 4186 Date <br />Filed Map Reference: Lot # Map # <br />Does the property contain a farm operation located within an <br />agricultural district or is the property boundary within 500 feet of <br />a farm operation located in an agricultural district: O <br />Q yes ❑no <br />If yes, submit an Agrncultural Dwte S7aternent, available from the <br />Planning Office. <br />WW the development be phased? Yes X No <br />Is there an existing Special Permit and/or Site Plan approval for <br />the property? Yes X No <br />The undersigned hereby makes application in accordance with all applicable laws and other <br />requirements of the Town of Dover, Dutchem County, New York All owner of record must sign. <br />Signature of Record caner <br />Date: f . l 2,0 I <br />Signature of Applicant (ediffereno <br />Date: <br />.Signature of Record Owner <br />Date: <br />