Plandome Heights, NY · Nassau County
Short Environmental Assessment Form
Applicants or project sponsors complete this form to provide project information for environmental review connected with an approval or funding application.
At a glance
- Issued by
- City of Plandome Heights · Plandome Heights, Nassau County, New York
- Notarization
- Not required: file this form without a notary.
- Official source
- plandomeheights-ny.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
The applicant or project sponsor completes Part 1 with project details and information about site conditions, land use, utilities, and potential environmental effects. The lead agency completes Parts 2 and 3 to assess impacts and determine whether an environmental impact statement is required. The form says Part 1 responses become part of the application for approval or funding and may be subject to public review and further verification.
Who needs it
An applicant or project sponsor seeking approval or funding for a proposed action completes Part 1; the lead agency completes Parts 2 and 3.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This form is signed and dated without a notary; the applicant or sponsor affirms that the information provided is true and accurate.
How to submit this form
- 1
Download The Form
Download the Short Environmental Assessment Form PDF.
- 2
Complete Part 1
The applicant or project sponsor completes all Part 1 items using information currently available.
- 3
Gather Supporting Information
Attach a location map and any additional pages or materials needed to supplement responses.
- 4
Submit To The City
Submit the completed form to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- Who completes the Short Environmental Assessment Form?
- The applicant or project sponsor completes Part 1 with project information. The lead agency is responsible for completing the impact assessment in Part 2 and the determination in Part 3.
- What information does the form ask for?
- Part 1 asks for project and sponsor details, site acreage, nearby land uses, and information about potential effects such as traffic, water, wetlands, and hazards.
- Do I need a notary for the Short Environmental Assessment Form?
- No. The form is signed and dated without a notary; the applicant or sponsor affirms that the information provided is true and accurate.
- How do I submit the Short Environmental Assessment Form?
- The form does not give submission instructions. Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This Short Environmental Assessment Form doesn’t need a notary, but if you have another Plandome Heights form that does, a commissioned online notary can help.