Jackson, NY · Washington County
Agricultural Data Statement
Applicants use this Agricultural Data Statement to provide project and nearby farm information when seeking certain municipal approvals in Jackson.
What this form is
The statement collects applicant and project details, parcel information, and information about farm operations within 500 feet. The instructions say it is required for certain special use permit, site plan, use variance, or subdivision applications requiring municipal review when the property is within 500 feet of a farm operation in a certified Agricultural District. The reviewing board considers potential impacts on farm operations.
Who needs it
Applicants seeking a listed municipal approval for property within 500 feet of a farm operation in a certified Agricultural District need this statement.
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 document is signed without a notary; the applicant and, if different, the owner sign the statement, and the municipal official records a review date.
How to submit this form
- 1
Download The Statement
Download the Agricultural Data Statement PDF.
- 2
Complete The Form
Enter the application, project, parcel, applicant, owner, and nearby farm operation information requested.
- 3
Gather Map Information
Provide a tax map or other map showing the project site relative to farm operations, as described in the statement instructions.
- 4
Sign And Submit
Have the applicant and, if different, the owner sign, then submit the statement to the city department named on the form.
Frequently asked questions
- What information does the Agricultural Data Statement ask for?
- It asks for applicant and owner details, the application type, project description and location, parcel information, and details about farm operations within 500 feet.
- When is this statement required?
- The instructions say it is required for listed municipal applications when the property is within 500 feet of a farm operation in a certified Agricultural District.
- Do I need a notary for the Agricultural Data Statement?
- No. The document has signature lines for the applicant and, if different, the owner; they sign without a notary.
- How do I submit the Agricultural Data Statement?
- Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This Agricultural Data Statement doesn’t need a notary — but if you have another Jackson form that does, a commissioned online notary can help.