Bergen, NY · Genesee County
Agricultural Data Statement
Applicants seeking certain land-use approvals near a farm operation complete this statement for municipal review in the Town of Bergen.
What this form is
The Town of Bergen requires this statement with an application for a special use permit, site plan approval, use variance, or subdivision approval when the property is within 500 feet of a farm operation in a certified Agricultural District. It asks for applicant and owner details, project and parcel information, Agricultural District status, and nearby farm operations. Additional sheets may be attached if needed.
Who needs it
Applicants for the listed approvals complete this statement when their property is within 500 feet of a farm operation in a certified Agricultural District.
How to submit it
A copy must accompany the referral to the County Planning Department for county review. The form lists distribution to the Z.E.O., Planning Board, Board of Appeals, and applicant.
About notarization
This statement is signed and dated without a notary; the applicant and, if different, the owner sign, and a municipal official records review.
How to submit this form
- 1
Download The Statement
Download the Agricultural Data Statement PDF.
- 2
Complete The Form
Provide applicant and owner information, project details, parcel information, and nearby farm operations.
- 3
Gather Additional Sheets
Attach additional sheets if needed to list farm operations within 500 feet of the parcel.
- 4
Submit With The Referral
Submit a copy along with the referral to the County Planning Department for county review.
Frequently asked questions
- Do I need a notary for the Agricultural Data Statement?
- No. This statement is signed without a notary; the applicant and, if different, the owner sign, and a municipal official records review.
- Who must complete the Agricultural Data Statement?
- Applicants seeking a special use permit, site plan approval, use variance, or subdivision approval must complete it when the property is within 500 feet of a farm operation in a certified Agricultural District.
- How do I submit the Agricultural Data Statement?
- The form says a copy must be submitted along with the referral to the County Planning Department for county review.