Municipal Referral Form

Chemung County Planning Board
Chemung County Commerce Center
400 East Church Street
P.O. Box 588
Elmira, NY 14902-0588
607-737-5510

www.chemungcountyny.gov/planning

planning@co.chemung.ny.us
Chemung County Planning Board Municipal Referral Form
Instructions For Filling Out This Form:

To begin, click on each of the tabs below (Referral Information, Petitioners, etc.) to enter your information. When done, click on the Preview Your Form button (in the "Full Statement" Checklist tab), and when satisfied, click the Submit Your Form button. You will receive a confirmation email of your Municipal Referral Form for your records.

* = Required Field

Proposed Action
Please select the proposed action(s) from the drop-down menu below.
Proposed Action(s):*
Other (please specify):
Description of proposed action (attach detailed narrative if available):
Upload Detailed Narrative?

NoYes
Upload detailed narrative file(s):

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The proposed action applies to real propery within five hundred feet (500') of the following:
(please identiyfy by filling in the appropriate blank after each item)
(a) Boundary of the (City), (Village), or (Town) of:
(b) Boundary of Any Existing or Proposed (County) or (State Park) or any (Other Recreation Area):
(c) Right-of-way of any existing or proposed (County) or (State Parkway), (Thruway), (Expressway), (Road) or (Highway); (Include (County) or (State Route) # and name of (Road):
(d) Existing or proposed right-of-way of any stream or drainage channel owned by the (County) or for which the county has established channel lines:
(e) Existing or proposed boundary of any (County) or (State) owned land on which a public building or institution is situated:
(f) The boundary of a farm operation located in an agricultural district, as defined by article twenty-five-AA of the agriculture and markets law (this subparagraph shall not apply to the granting of area variances):

Hearings/Meeting Schedules
Please Select Which Board(s):*

Town Board/Village Board of TrusteesZoning Board of AppealsPlanning Board/Planning CommissionCity Council

"Full Statement" Checklist
As defined in NYS General Municipal Law §239-m (1)(c), please make sure you have attached the following required information with your referral, as appropriate.
There is nothing to be filled out on this tab.
For All Actions:
Chemung County Planning Board – Municipal Referral Form

All application materials required by local law/ordinance to be considered a “complete application” at the local level (PDF preferred).

Part 1 Environmental Assessment Form (EAF) or Environmental Impact Statement (EIS) for State Environmental Quality Review (SEQR). If Type II Action, provide a statement to that effect.

Agricultural Data Statement, for site plan review, special/conditional use permit, use variances, or subdivision review located in an Agricultural District or within 500 feet of a farm operation located in an Agricultural District, per Ag. Districts Law Article 25AA §305-a, Town Law §283-a, and Village Law §7-739.

Municipal board meeting minutes on the proposed action (PDF preferred).

For Proposing or Amending Zoning Ordinances or Local Laws: The above requirements AND

Report/minutes from Town Board, Village Board or Trustees or Planning Board (PDF preferred)

Zoning Map

Complete text of proposed law, comprehensive plan, or ordinance (PDF preferred)

Form Submission
Submit this form with supporting documentation in PDF format to the Chemung County Planning Department via email if from webpage: planning@chemungcountyny.gov.

Please also e-mail to or notify lhotaling@chemungcountyny.gov and nmoss@chemungcountyny.gov.

Completed referrals must be submitted by close of business 12 calendar days prior to the Chemung County Planning Board meeting
Please Upload All of the Required Documents Here:

Click the Browse Files to Attach button to select the documents required for this referral form. You can add multiple files.
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Should be Empty:

Chemung County Planning Board