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STATE OF NEW YORK
DEPARTMENT OF STATE
ALBANY, N.Y. 12231-0001
GAlL S, SHAFFER
SECRETARY OF ~TATE
May 21, 1993
Ms. Susan Long
Costello Marine Contracting Corp.
P.O. Box 2124
Greenport, NY 11944
Re: F-93-122
U.S. Army Corps of Engineers/NY
District Permit Application #93-02560-L2
Robert L. Stott, Jr.
Town of Southold
Request for Additional Information
Dear Ms. Long:
Pursuant to 15 CFR 930.58, the following data and information is necessary to enable the
Department of State to adequately assess the coastal zone effects of this proposed project.
The Department of State is concerned with the lower platforms proposed to be installed on
the north and south sides of the dock. This reviewer considers the 5'x 24' and 5'x 39' lower
platform docks as non-water dependent uses of the coastal zone. Therefore, within your
response to this request for information, piease indicate your intention to eliminate the
proposed lower platforms.
Please provide the information requested above to the Department of State within thirty
days from the date of this letter. Pursuant to 15 CFR 930.64(d), if the necessary data and
information is not provided, the Department of State may object to your consistency
certification on the grounds of insufficient information.
Any additional information which you believe will facilitate our consistency review of this
project would be appreciated.
Ms. Susan Long
Page 2
A copy of this letter has been sent to the U.S. Army Corps of Engineers.
Please call me at (518) 474-6000 if you have any questions.
Sincerely,
Walter Meyer
Coastal Resources Specialist
WFM/jtb
cc: COE/NY District - Sophie Ett'mger
NYS DEC/Region 1 - Robert Greene
Town of Southold
U.S. Fish & Wildlife - Bob Murray
STATE OF NEW YORK
DEPARTMENT Of STATE
AlbaNY. N.Y. ! 2231-0007
GAll S. SHAFFER - -
SECRETARY Of STATE
March 31, 1993
Ms. Susan E. Long
Costello Marine Contracting Corp.
P.O. Box 2124
Greenport, New York 11944
Re: F-93-122
U.S. Army Corps of Engineers/New York
District Permit Application -
Robert L, Stott, Jr.
Town of Southold
Acknowledcement of Federal Consistencv
Assessment Form and Request for
Additional Information
Dear Ms. Long:
The Department of State received your Federal Consistency Assessment Form
and supporting information on March 29, 1993 and has determined that the
submitted documentation is adequate to commence our review of your proposed
project.
However, pursuant to 15 CFR 930.58, the following data and information is
necessary to enable the Department of State to adequately assess the coastal
zone effects of this proposed project.
It appears that the requirements for docking of the owner's vessels could
be accomplished without the use of the "L" shaped extension. Please discuss
possible modifications of this design which utilize the existing structure.
Please provide the information requested above to the Department of State
within thirty days from the date of this letter. Pursuant to 15 CFR 930.64(d),
if this necessary data and information is not provided, the Department of State
may object to your consistency certification on the grounds of insufficient
information.
Any additional information which you believe will facilitate our . ' "
consistency reVie~-~f thi~ ~ro~ ~6~d be ~ppreciated~ ~ ~'~l~
Ms. Susan E. Long
Page 2
You and the Corps of Engineers will be notified of our decision when we
have completed our review of this project for its consistency with the New York
State Coastal Management Program. The Corps of Engineers cannot issue a permit
for this project unless the Department of State concurs with yCu~ consistency
certification.
A copy of this letter has been sent to the U.S. Army Corps of Engineers.
Please call me at (518) 474-6000 if you have any questions.
Walter F. Meyer
Coastal Resources Specialist
WFM/mm
cc: COE/N¥ District - Sophie Ettinger
NYS DEC/Region I - Robert Greene
Town of_Southold
TELEPHONE
(516) 765-1892
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 728
Southold, New York 11971
APPLICATION NO.__ DATE OF APPLICATION March 30, 1988
IDENTITY OF APPLICANT__ Robert L. Stott PHONE NO
ADDRESS Or APPLICANT Paradise Point Road
Southold, NY 11944
~vAx MAm NO. 1000-g~ -2-24
AGENT Costello Marine Contracting Cor__p. mHONE NO.
PEmMIT REmWESTED TO replace inkind, i_n_place on existing dock
LOCATION OF PROPERTY FOR WHICH PERMIT WANTED__ Paradise Point Road
Southold, NY 11971
P.O. B2~_A_~__~reenaport, NY 11944
CmEEK, BAY OR HARBOm FRONTING PROPERTY Peconic Bay
SIZE Or PmOPOSED WOmK
LENGTH 160 feet bv 6 feet dock~ 5 feet by 24 feet lower platform
DEPTH BELOW LOW WATER N/A
YARDS TO BE EXCAVATED N/A
YARDS TO BE FILLED
DEPTH AT LOW TIDE
AVERAGE RISE IN TIDE
DISTANCE TO THE NEAREST CMANNEL_~/~ FT.
DISTANCE PROJECT EXTENDS BEYOND SIMILAR PROJECTS IN THE AREA FT.
IS THIS FOR PRIVATE OR BUSINESS USE? P~ivat~
AREA ZONING A-Residential
N/A
-- .....
_ N/A
STRUCTURES OR TO DREDGE OR DEPOSIT FILL ON SAID PREMISES AND WHETHER
ANY PERMITS OR LICENSES WERE EVER SUSPENDED OR REVOKED BY A GOVERNMENTALI
AGENCY .... N/AIi
DESCRIBE FULLY THE REHABILITATION AND PROPOSED CONDITION OF THE
PREMISES AFTER THE WORK 1S COMPLETED INCLUDE AN ADDITIONAL SURVEY OF
THE PROJECT SITE IF NECESSARY
WRITTEN CONSENT OF TME OWNER OF THE PROPEmTY, IF NOT TNE SAME AS THE
APPLICANT. ~closed
ARE THERE ANY COVENANTS OR RESTRICTIONS IN YOUR DEED THAT WOULD
PROHIBIT THIS PROJECT?
Frank A. Kujawski, Jr., President
HENRY P. SMITH, ~ TELEPHONE
JOHN M. BREDEMEYER, III
John Bednoski, ~Jr. (516) 765-1892
ALBERT KRUPSKI, JR., ¥ice-President
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 728
Southold, New York 11971
April 28, 1988
Ms. Susan E. Long
Costello Marine Contracting Corp.
Box AK
Greenport, New York 11944
Re: Robert L. Stott, Jr.
Paradise Point Road, Southold
Dear Ms. Long:
The following action was taken by the Board of Town Trustees
during their regular meeting held on April 21, 1988 regarding the
above captioned matter.
RESOLVED that the Southold Town Trustees approve the request
made by Costello Marine Contracting on behalf of Robert L.
Stott, Jr. to secure a permit number for a dock on property
located on Paradise Point Road, Southold as requested for the
purpose of repairing said structure.
Very truly yours,
Frank A~ K~jawski, Jr.
President~
Board of Town Trustees
FAK:ip
cc: Bldg. Dept.
file
HENRY P. SMITH TELEPHONE
JOHN M. BREDEMEYER, -: (516) 765-1892
ALBERT KRUPSKI, JR.
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 728
Southold, New York 11971
March 24, 1988
Ms. Susan Long
Permit Manager
Costello Marine Contracting
Box AK
Greenport, New York 11944
RE: Robert Stott, Jr. - Paradise Point Road, Southold
Dear Ms. Long:
Pursuant to your request for a d~termination on the need of
a permit for the above referenced property, please be advised
that the Board inspected the site on March 17, 1988. Ct-
The Board determined that the replacement of the deck and
pilings is considered a repair. However, it is suggested that
you submit an accurate plan depicting the size of the structure
along with an application to register same, so in the future,
repair work will be permitted. Should you have any questions
please do not hesitate to contact this office.
Very truly yours,
John M. Bredemeyer, Iii
President
Board of Town Trust~
JMB: ip
Attachment
The applicant does by the acceotance of this permit, assume all responsibility for operations under-
taken pursuant to this permit, and shall take all precautions for the prevention of injuries to persons
and property resulting from such operations. By such acceptance, the applicant also agrees to indemni-
fy and save harmless the Town, and its officers, agents and employees from any and all claims arising
from operations under this permit and any and all acm or omissions of applicant, his agent and
employees.
The applicant and the owner and occupants of the premises upon which the operations authorized by
this permit are being conducted, do, by the acceptance of this permit, give consent to the Town, and
-its officers and employees to enter upon the premises where such operations are being conauc~ed [o
make such inspections as the Town may deem necessary to insure that such operations are being con-
ducted in conformity with this permit.
This operation will not substantially: A, Adversely affect the wetlands of the town.
B, Cause damage from erosion, turbidity or siltation,
C, Cause saltwater intrusion into the fresh water resources of the town.
D. Adversely affect fish, shellfish or other beneficial marine organisms, aquatic wildlife and vege-
tation or the natural habitat thereof,
E. '1 ncrease the danger of flood and storm-tide damage.
F. Adversely affect navigation on tidal waters or the tidal flow of the tidal waters of the town,
Change the course of any channe or the natural movement or flow of any waters.
Weaken or undermine the lateral support of other lands i~ the vicinity.
Otherwise adversely affect the health, safety a,nd general welfare of the people of the town.
Signed . ~2s "'
.... ........ .. . .......
TOWN OF SOUTHOLD
BOARD OF: SOUTHOLD TOWN TRUSTEES
$OUTHOLD, NEW YORK
WETLANDS PERMIT
This Wetlands Permit No. ,.,~,?,,.3,.,,,G,,,.~.; has been granted by the Town Trustees according to
information furnished in Application No. 7,7,7,7.7,7,7,7,,,,, filed by Applicant ,,,C,,o..s,,~,e,,].l.,o.,.,M...a,~,~3~..~ .......
b...e.h..a~..f...R~...R.g.~e.~.t...S..t.g.t~n ...... ~..p.T.~J...2..l.~ ....... 19...8..8..... A map of the proposed work will be ke ut
on file in the Trustee Office under the application number given.
Approval ranted to re ister a doc..1S .~il;~ iJJ.%% $
Permit granted to do the following work ...................... ~ ........................ g ............................ D g
- property located on Paradise Point Road, Southold,
Location of property on which work to be done ..?..a..r..a.~i..s..e....P..o..5..n..t....R..o..a...d.,....S..o..u..l;~9~d~ ................. , ....
Creek. Bay or I~ar.bor fronting property ...... .P..e.c..o...n.i..q...B...a~ ................. ~ ..................................................
Size of work: Length '~60 £t. Z~. £t. ' ....................................................................................
Width 6 £t. 5 £t.
Height Above High Water .............
Depth Below Low Water ............................................................................................. .. ..
Yards to be Excavated ................................................................................ ... . . ..... . . .. . . .... .
Yards to be Filled ..
Manner in which material is to be removed or deposited .........................................................................
Intended use of property ..... ..R..e.s.~.d...e..n..t.i..a.1. ...............................................................................................
Conditions if any ...7.7.7.7.7.7.7.7. xT. 7. xxxxx ..................................................................................................
COSTEL O MARINE CONTRACTING CORPORATION
DOCK BUILDING ~ JETTIES - ~ULKHEADING ~ STEEL&WOOD PILING · FOUNDATIONS
BOX AK - GREENPORT, NEW YORK 11944 ~ (516) 477-1199 ~ (516) 477-1393
March 4, 1988
Southold Tomn Trustees
Southold ToWn Hall
Main Road
Southold, NY 11971
Re: Robert Stot~, Jr.
Paraoise Point Road
Southo!d, NY
Gentlemen:
me mould like to replace deteriorated piles, in-kind in--place
on an existing dock at ~ne aboce referenced property_
The existing piles are extremely morn and it is our ~ntention
to replace 38 piles and six (6) pzeces of decking. This dock
is ~ell over 25 years old and mas esnstructed prior ~o having
so submit applications to the Torn of Southold.
Ne consider this project to ce maintenamoe of an existing
structure and very minor in nature.. Would you please revie~
our oroposal eno advise if you determine this matter Lo De
a aormal and usual maintenance project.
] aave enclosed a ~ax ma~ of this property and photographs to
aid in your determination.
Thank you fmr you£ assistance ~n th~s matter. I~ you have any
questions, please call our office.
very truly yours,
Sussn Long
Perm;.t Managez
ERe
PUBLIC NOTICE'
US Army Corps I. rep]xi~g t-et'el' to:
of Engineers Public Notice Number: 93-02560-L2
New York District Issue Date: 14 APRIL 1993
Jacob K. Javits Fed~al Building Expiration Date: 14 MAY 1993
NewYork, N.Y. 10278-0090
ATTN: Regulator~ Branch
To Whom It May Concern:
The New York District, Corps of Engineers has received an
application for a Department of the Army permit pursuant to Section
10 of the Rivers and Harbors Act of 1899 (33 U.S.Co 403).
APPLICANT: Robert L. Stott, Jr. 131 East 66th Street
New York, NY 10021
ACTIVITY: Replace storm damaged pier; construct extension;
install swim ladders and boat lift
WATERWAY: Shelter Island Sound
LOCATION: Town of Southold, Suffolk County, New York
A detailed description and plans of the applicant's activity
are enclosed to assist in your review.
The decision whether to issue a permit will be based on an
evaluation of the probable impact, including cumulative impacts,
of the proposed activity on the public interest° That decision
will reflect the national concern for both protection and
utilization of important resources° The benefits which reasonably
may be expected to accrue from the proposal must be balanced
against its reasonably foreseeable detriments. All factors which
may be relevant to the proposal will be considered including the
cumulative effects thereof; among those are conservation,
economics, aesthetics, general environmental concerns, wetlands,
historic properties, fish and wildlife values, flood hazards,
floodplain values, land use, navigation, shoreline erosion and
accretion, recreation, water supply and conservation, water
quality, energy needs, safety, food and fiber production, mineral
needs, considerations of property ownership and in general, the
needs and welfare of the people.
The Corps of Engineers is soliciting comments from the public;
Federal, state, and local agencies and officials; Indian Tribes;
and other interested parties in order to consider and evaluate the
impacts of this proposed activity. Any comments received will be
considered by the Corps of Engineers to determine whether to issue,
APR
CENAN-OP-RE
PUBLIC NOTICE NO. 93-02560-L2
modify, condition or deny a permit for this proposal. To make this
decision, comments are used to assess impacts on endangered
species, historic properties, water quality, general environmental
effects, and the other public interest factors listed above.
Comments are used in preparation of an Environmental Assessment
and/or an Environmental Impact Statement pursuant to the National
Environmental Policy Act. Comments are also used to determine the
need for a public hearing and to determine the overall public
interest of the proposed activity.
ALL COMMENTS REGARDING THE PERbIIT APPLICATION MUST BE PREPARED
IN WRITING AND MAILED TO REACH THIS OPFICE BEFORE THE EXPIRATION
DATE OF THIS NOTICE; otherwise, it will be presumed that there are
no objections to the activity.
Any person may request, in writing, before this public notice
expires, that a public hearing be held to collect information
necessary to consider this application. Requests for public
hearings shall state, with particularity, the reasons why a public
hearing should be held. It should be noted that information
submitted by mail is considered just as carefully in the permit
decision process and bears the same weight as that furnished at a
public hearing.
Pursuant to Section 7 of the Endangered Species Act (16 U.S.C.
1531) and based upon a review of the latest published version of
the threatened and endangered species listing, a preliminary
determination is that the activity under consideration may effect
sea turtles or their habitat.
Based upon a review of the properties listed or eligible for'
listing in the latest available version of the National Register
of Historic Places, there appears to be no sites included in the
Register within the permit area. Presently unknown archaeological,
scientific, pre-historic or historical data may be lost by work
accomplished under the required permit.
Review of activities pursuant to Section 404 of the Clean
Water Act will include application of the guidelines promulgated
by the Administrator, U.S. Environmental Protection Agency, under
authority of Section 404(b) of the Clean Water Act and the
applicant will obtain a water quality certificate or waiver from
the appropriate state agency in accordance with Section 401 of the
Clean Water Act prior to a permit decision.
Pursuant to Section 307(c) of the Coastal Zone Management Act
of 1972 as amended [16 U.S.C. 1456(c)], for activities under
consideration that are located within the coastal zone of a state
2
CENAN- OP - RE
PUBLIC NOTICE NO. 93-02560-L2
which has a federally approved coastal zone management program,
the applicant has certified in the permit application that the
activity complies with~ and will be conducted in a manner that is
consistent with, the approved state coastal zone management
program. By this public notice, we are requesting the state's
concurrence with, objections to, or waiver of the applicant's
certification. No permit decision will be made until one of these
actions occur. For activities within the coastal zone of New York
State, the applicant's certification and accompanying information
is available from the Consistency Coordinator, New York State
Department of State, Division of Coastal Resources and Waterfront
Revitalization, Coastal Zone Management Program, 162 Washington
Avenue, Albany, New York 12231, Telephone (518) 474-3642. Comments
regarding the applicant's certification should be so addressed.
In addition to any required water quality certificate, the
applicant has obtained or requested the following governmental
authorization for the activity under consideration:
Town of Southold Wetlands Permit
New York State Department of Environmental Conservation Permit
It is requested that you con~uunicate the foregoing info~r~tlon
concerning the activity to any persons known by you to be
interested and who did not receive a copy of this notice.
If questions should arise concerning this matter, you may
contact Sophie Ettinger, of my staff, at (212) 264-3912.
FOR THE DISTRICT ENGINEER:
~r~h J. Seebode
~ ~f, Regulatory Branch
3
CENAN-OP-RE
PUBLIC NOTICE NO. 93-02560-L2
WORK DESCRIPTION
The applicant, Robert L. Stott, Jr., has requested Department of
the Army authorization to replace a storm-damaged fixed timber
pier, construct an extension and lower platforms, install swim
ladders and a boat lift in Shelter Island Sound at the Town of
Southold, Suffolk County, New York.
The proposed work would involve the replacement of a storm-damaged
8 foot by 160 foot fixed pier with a 6 foot wide fixed pier of the
same length and construction of 6 foot by 35 fixed pier extension
with 5 foot by 39 foot and 5 foot by 24 lower platforms. The
applicant also proposes to install 3 swim ladders, a boat llft and
two 2-pile dolphins. Water and electric service would be supplied
for boat lift operation and a dock light.
The stated purpose of the proposed work is to provide adequate
recreational facilities.
COSTELLO MARINE CONTRACTING CORPORATION
PI*DTO VIEW SHEET
ELIZABETH A. NEVILLE' ~~1~ Town Hall, 53095 Main Road
TOWN CLEP~K ~~ P.O, Box 1179
Southold, New York 11971
REGISTP~kR OF VITAL STATISTICS Fax (516) 765-1823
MARPJAGE OFFICER Telephone (516) 765-1800
I~ECORDS MANAGEMENT OFFICER : '
FREEDOM OF INFORMATION OFFICER · '
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
APPLICATION FOR PUBLIC ACCESS TO RECORDS
INSTRUCTIONS: Please complete Section I of this form and give to Town Clerk's
Office (agency Freedom of information Officer). One copy will be returned to you
in response to your request, or as an interim response.
SECTION I.
(Department or Officer, if known, that has the information you are requesting.)
RECORD YOU WISH TO INSPECT: (Describe the record sought. If possible, supply
date, file Utle, tax map number, and any other pertinent information.)
Printed Name: ' ~/~ ~0 ~ /6
Mailing Address (if different from above):
[ ] APPROVED
[ ] APPROVED WITH DE~Y* [ ] DENIED*
El . .7 ~
Freedom of Information Officer
* If delayed or deni~ see reverse side for explanation.
TELEPHONE
(516) 765-1801
BOARD OF TOWN TRUSTEES
TOWN OF $OUTHOLD
Town Hall. 53095 Main Road
P.O. Box 728
Southold. New York 11971
PLEASE FILL OUT THE FOLLOWING FORM AND RETURN WITH YOUR SIGNED
STATEMENT:
1. Was the structure put in in accordance to the plan submitted?
Yes No
If no, please explain on the reverse side.
2. Was structure placed on the applicant's property according
to the plan submitted? ( The distance must be at least
15 feet from his neighbor's line. )
Yes NO
If no, please explain on the reverse side.
3. Is there easy access over or around the structure, so that
pedestrians can move along the public's right of way below
high water mark?
Yes NO
If no, please explain on the reverse side.
4. Is the structure high enough so as not to inhibit the growth
of the natural qrasses along or below the structure?
Yes NO
If no, please explain on the reverse side.
5. Additional comments:
Date
Signature of Trustee
AUT~OR~TZON L£~£R
located at ~~ 2r ~ 8.si.ess/Proporty ,ame
do hereby give Costello
Address
Marine Contracting Corp. the authority to act as as the agent in my behalf
in applying for all necessary permits in order for work to be done 'on m~v
property described above.
Signature
BOARD OF TOW~ TRUSTEES
TOWN OF SOUTHOLD
s~09o ~IMn Road Phoae ~ ' o
Soa~dd. N, Y. 11971
BO&RD OF TO~' ~RUSTEES
MARINE CONTRACTING CORPORATION
DOCK BUILDING " JETTIES " BULKHEADING ~ STEEL &WOOD PILING - FOUNDATIONS
BOX AK · GREENPORT, NEW YORK 11944 · (516) 477-1199 o (516) 477-1393
March 30, 1988
John M. Bredemeyer, III
President
Board of Trustees
Southold Town Hall
Main Roao
South:id, NY :1971
Re: Robert L. Stott, Jr.
Paradise Point Road, Southold
Dear Mr. Bredemeyer:
In reference co your letter of March 24, ~988, enclosed please
fin: applicatior an: additional information regarding the
aoove referenced property.
I trust t~is information comoletes your file and ~nan approval
to oommenoe nne re:airs on the srruo~ure will oe forth::ming
in the very near future.
Thank you for your Lime an: attention in this matter, an: if
you nave any questions :lease call.
Very truly yours,
Susan E. Long
Permit Manager
Enc.
PROJECT I.D. NUMBER 617.21 SEQF
Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART I--PROJECT INFORMATION ftc be ComDleted by ADDlicant or Project sponsor)
1. APPLICANT/SPONSOR I 2. PROJECT NAME
Costel~lo Harine Contractino Robert L. Stott, Jr.
3. PROJECT LOCATION:
Municipality ~out. ho]o County Suffolk
4. PRECISE LOCATION (Street address aha road m~ersec~ons. ~rom~nent lanDmarKs, etc. or provide map)
Paradise Point Road, Southold, NY 11971
See enclosed tax map.
5. IS PROPOSED ACTION:
[] New [] Expansion [] Mod[f[cationlalteration R 8 p a i r ' '
6. DESCRIBE PROJECT BRIEFLY:
replace 38 piles ano six (6) oieces of deckSng.
7. AMOUNT OF LAND AFFECTED:
Initially acres Ultimately acres
8. W'ILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? [] Yes [] No If No. describe briefly
9. WHAT iS PRESENT LA~4D USE IN VICINITY DF PROJECT?
[] Residential [] !nduslr,a [] Commerc,al [] Agr cu,lure [] Park/Forest/Open space [] Other
Besot/be:
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY FEDERAL,
STATE OR LOCAL)?
[] Yes ~ NO If yes, list agency(s) and permit/approvals
11. DOES ANY ASPECT OF THE ACTIOH HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [] Yes [] NO If yes, fist agency name and permit/approval
We have confirmation from NYS DEC that "No Permit Is Necessary'.'
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION?
[] Ye~ [] No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Susan E. Long, Permit Hanager for
Applicant/sponsor name: Costello Marine ContraotJ_ng Corp. Date: 3/30/88
If the action is in the Coastal ~roa, and ~ou are a state a~encg, complete the
Coastal gssossment Form before proc~odin~ with this assessment
COUNTY OF SUFFOLK )
STATE OF NEW YORK )SS:
Zn completing this application I hereby authorize the Trustees~
agent or representative to enter onto my property to inspect the
premises in conjunction with review of this application.
SWO~N TO B~FOR~ M~ THIS
DAY OF m~ ! 9 ~
~RY PUSLIC,~of~y~
NOTARY PUBL I C NO, 4~3~4
Qualified
~mm~ion
Approved 2/27/85 ~-