HomeMy WebLinkAbout25004-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No~ Z-26610
Date: 08/04/99
THIS CERTIFIES that the building INGROUND POOL
GREENPORT
Location of Property: 345 SNUG HARBOR RD
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 35 Block 6 Lot 7
Subdivision Filed Map No. -- Lot No. --
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JUNE 23, 1998 pursuant to which
Building Permit No. 25004-Z dated JULY 8, 1998
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate is issued
is ACCESSORY INGROUND SWT~TNG POOL WITH FENCE TO CODE IN REQUIRED REAR
YARD 'AS BUILT' & AS PER CONDITIONS TO THE ZBA #4459.
The certificate is issued to CHRISTOPHER PLIACONIS
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
N/A
N-468433
N/A
10/16/98
Bu~P~ng In spe~ror
Rev. 1/81
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 25004 'Z Date JULY 8 98
Permission is hereby granted to:
CHRISTOPHER PLIACONIS
20 BANTRY COURT
HUNTINGTON~NY 11743
for :
CONSTRUCTION OF AN ACCESSORY INGROUND SWIMMING POOL WITH FENCE TO
CODE IN REQUIRED REAR YARD "AS BUILT" & TO THE CONDITIONS OF ZBA #4559.
at premises located at 345
County Tax Map No. 473889 Section 035
pursuant to application dated JUNE
Building Inspector.
SNUG HARBOR RD GREENPORT
Block 0006 Lot No. 007
23 98 and approved by the
Fee $ 150.00
Building' I~pector ~z'
ORIGINAL
Rev. 2/19/98
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter OR ink and submitted to the buildinl
inspector with the following: for new building or new use:
I. Final survey of property with accurate location of all buildings, property lines.
streets, and unusual natural or topographic features.
2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of 1% lead.
5. Commercial building, industrial building, multiple residences and similar buildin
and installations, a certificate of Code Compliance from architect or engineer
responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements..~
For existing buildings (prior to April 9, 1957) non-conforming uses, oK ~uildings an
'!pre-existing" land uses:
1. Accurate survey of property showing ail property lines, streets, building and
unusual natural or topographic features.
2. A properly completed application and a consent to inspect signed by the applicant
If a Certificate of Occupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant.
C. Fees
1. Certificate of Occupancy - New dwelling $25.00~ Additions to dwelling $25.00,
Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00,
Additions to accessory building $25.00, gusinesses $50.00.
2.Certificate of Occupancy on Pre-existinK Buildin~ - $100.00
3.Copy of Certificate of Occupancy - :
4.Updated Certificate of Occupancy - $50.00
5.Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
H - 5o-~q
Date
New Construction ........... Old Or Pre-existing Building.._, ...............
Location of.. .....
House NO. Street Hamlet
.... 12 ii A.'.'511... ii...
Su vision ...... Filed Map ............ Lot .........
No ~..~..(~..~..~..
.... Date Of Permit...~.l.~..l.~.~.Applicant...~.~..~..C~.~.~.j.C~......_
Permit
Health Dept. Approval ......................... · Underwriters Approval.. !.~..'. ,~.~..--..C~ ........
Planning Board Approval ......................
Request for: Temporary Certificate ........... Final Certicate ...........
Fee Submitted: $ ............................. ....~.~.
<~c, $¢~? ...............
THE NEW YORK BOARD OF FIRE UNDERWRITERS
1195099 BUREAU OF ELECTRICITY
~-- 40 FULTON STREET, NEW YORK, NY 10038 ~
Date OCTOBER 16,1998 Applicatio, No. on file 162734,98/98 ~1 468433
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of
CHRISTOPHER PLIACOHS, 345 SNUG HAP~OR ROAD, GREENPORT, NY
in the following location; [] Basement [] 1st Fl. [] 2nd Fl. OUT Section Block Lot
was examined on OCTOBER 08,1998 and found to be in compliance with the National Electrical Code.
FIXTURES RANGES )KING DECKS OVENS DISH WASHERS EXHAUST FANS
FIXTURE RECEPTAC!.ES SWITCHES
OUTLETS FLUORESCENT OTHER
1 1 1
)RYERS FURNACE MOTORS FEEDERS TIME CLOCKS UNIT HEATERS MULTI-OUTLET DIMMERS
SYSTEMS
NO. OF FEET
SERVICE DISCONNECT S E R V I C
NO. OF CC COND
PER ~
NO. OF HI-LEG
OTHER APPARATUS:
SWIMMING POOL-1
GFCI- 1
PANEI~BOARDS: 1-4 CIR. 125
*(SWI~ING POOL) This certificate
covers compliance at the date of
inspection only. Because of unusual
%%lvironments it is advisable to
have frequent test/and or repairs
made by a qualified person.
<<< Continued on Page 2 >>>
OFCC. COND.
OF HI-LEG
NO. OF NEUTRALS
OF NEUIRAL
GENERAL MANAGER
This certificate must not be altered in any manner; Feturn to the office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
THE NEW YORK BOARD OF FIRE UNDERWRITERS PA E2
1195099 BUREAU OF ELECTRICITY
~ 40 FULTON STREET, NEW YORK, NY 10038
Date OCTOBER 16,1998 AppllcaHon No. onfile 16273498/98 M ~68433
THIS CERTIFIES THAT
only the electrical equipment as described below and introdt~ced by the applicant nizmed on the above applicatt'on number is in the premises of
CHRISTOPHER PLIACOHS, 345 SNUG HARBOR ROAD, GREENPORT, NY
in the following location; [] Basement [] 1st Fl. [] 2nd FI. OUT Section Block Lot
was examined on OCTOBER 08,1998 and found to be in compliance with the National Electrical Code.
FIXTURES RANGES COOKING DECR$ OVENS DISHWASHERS EXHAUST FANS
FIXTURE RECEPTACLES
OUTLETS FLUORESCENT OTHER
DRYERS
SYSTEMS
NO. OF FEET
S E R V I C
NO. OT CC COND, A, W. G, NO, OF HI-LEG A, W. ~, A, W, G,
PER ~ Og CC, COND. OF HI-LEG NO. OF NEUTRALS OF NEUTRAL
OTHER APPARATUS:
JIM SAGE ELEC. INC.
PO BOX 38
GRF, ENPORT, NY, 11944-0038
LIC.#3635
GENERAL MANAGER
Per.
This certificate must not be altered In any manner; return to the office of the Board if incorrect, Inspectors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
765-1802
BUILDING DEPT.
INSPECTION
] FOUNDATION 1ST
[ ]ROUGH PLBG.
[ ] FOUNDATION2ND [ ] IN/SULATION ,
[]FRAMING [ L,~INAL ~-).~' ~
[ ] FIREPLACE & CHIMNEY
REMARKS: ~ ~
DATE ~///~/~
INSPECTOR
~ 765-1802
J BUILDING DEPT.
INSPECTION
[ ] FOUNDATION I ST
[ ] FOUNDATION 2ND
[ ] FRAMING
ROUGH PLBG.
~FINAL
[ ] FIREPLACE & CHIMNEY
FIELD i~SUECT!ON
FOUNDATION (1st)
FOUNDATION
2.
(2nd)
ROUGH FRAME &
· PLUMBING·
e
INSULATION PER N. Y.
STATE ENERGY
CODE
FINAL
ADDITIONAL COMMENTS'
11'
14'
UNDERWRITERS CERTIFICATE
REQUIRED
"IMMEDIATELY"
ENCLOSE POOL TO CODE
UPON COMPLETION
BEFORE "WATER"
\\ /
/
4' 8'
8'
t USE IS UNLAWFUL -~."';~"
qu~UT C£RTIFIC~[,,~ ,, -
' ~OCCUPANCY "'"~"'--'~
-NOTE-
_. I
APPEALS~ BOARD MEMBERS
Gerard P. Goehringer, Chairman
James Dinizio, Jr.
Lydia A. Tortora
Lora S. Collins
George Hornlng
Southold Town Hall
53095 Main Road
P.O. Box 1179
Southold, New York 11971
ZBA Fax (516) 765-9064
Telephone (516) 765-1809
BOARD OF APPEALS
TOWN OF SOUTHOLD
FINDINGS, DELIBERATIONS AND DETERMINATION
REGULAR MEETING OF JUNE 23, 1998
N - CHRISTOPHER PLIACONIS PARCEL 1000-35-6-7
STREET & LOCALITY: 345 Snug Harbor Road, Greenport
DATE OF PUBLIC HEARING: April 16, 1998 and May 14, 1998
FINDINGS OF FACT
PROPERTY FACTS/DESCRIPTION:
The above-identified property is located on the southeast side of Snug
Harbor Road, Greenport and contains a total area of 12,780 sq. ft.
The survey map submitted under this application shows that tho subject
premises is impreved with a single-fomily residence with deck addition,
and the subject "as built" pool located in rear yard at approximately
four feet from the rear property line and at least 10 feet from the side
property lines. The lot coverage for the dwelling is confirmed to be
2,193 sq. ft., the present wooden deck addition at 360 sq. ft. for a
total of 2,553 sq. ft., which is under the 2556 sq. ft. code limitation.
The pool area consists of 576 sq. ft. as exists. A brick patio area is
proposed at or just below ground level.
BASIS OF APPEAL: Building Inspector's January
Disapproval, disapproving a building permit for a
sw~mmlngpool structure in the rea~ yard area,
reasons:
30, 1998 Notice of
proposed aecessor~r
for the following
~Under Article IliA, Section 100-30A.3 of the Bulk and parking
Schedule in the R-40 Zone: Proposed construction will exceed the
allowable 20% lot oovevage, the lot area is 12,780+- sq. ft.; at
20% the allowable area would be 2,556 square feet. Present
cevelmge with dwelling and deck is 2,553 sq. ft. Swimming pool,
as pl~posed, is 568 sq. ft., bringing total lot coverag~ at 3,121
sq. ft. or approximately 24.4+- percent."
AREA VARIANCE RELIEF REQUESTED BY APPLICANT: Applicant
requests approval of an "as built" inground swimmingpool located in the
rear yard and an 8 x 10 ft. deck that he intends to build adjacent to
the pool. The coverage of applicant's lot was already at exactly 20%
prior to construction of the pool, and therefore a variance allowing lot
coverage of 25.1% is sought.
Page 2 - June 23, 1998 ZBA Meeting
Appl. #4559:1000-35-6-7 (Pliaconis)
Southold Town Board of Appeals
REASONS FOR BOARD ACTION~ DESCRIBED BELOW:
Applicant has constructed a 16 x 36 ft. in-ground swimming pool for
which no building permit was obtained. Applicant intends to place an 8'
by 10' deck next to the pool. Prior to the construction of the pool, lot
coverage was exactly 20%, including a wood deck of 360 sq. ft. attached
to the rear of the house. Applicant requests a variance allowing an
additional 656 sq. ft. of coverage for the pool and its associated deck,
resulting in total lot coverage of 25.1%.
On the basis of testimony presented and personal inspection, the Board
makes the following findings:
(1) There is no feasible way for applicant to enjoy the benefit of a
pool other than through grant of a variance allowing lot coverage greater
than 20%.
(2) A variance allowing 25.1% lot coverage, where the Zoning Code
allows 20%, would be substantial, and that degree of lot coverage would
be detrimental to the neighborhood eharaeter.
(3) Applicant's difficulty is serf-created.
The Board concludes that the following actions are the minimum
necessary and adequate to enable applicant to have the benefit of a
sw~mmlng pool while at the same time preserving and protecting the
character of the neighborhood and the health, safety and welfare of the
community.
RESOLUTION/ACTION: On motion by Member Collins, seconded by
Chairman Goehringer, it was
RESOLVED to GRANT a variance authorizing the pool as built, subject to
the following CONDITIONS:
(1) The existing wooden deck attached to the rear of the house shall be
removed.
(2) Any surfacing installed around the pool, other than the 8 x 10 ft.
deck applied for, shall be flush with the ground and not elevated in any
way.
(3) Based on the certified data submitted by applicant, after removal of
the existing deck (360 square feet) and including the pool and 8 x 10
ft. deck (total of 656 sq. ft.), lot coverage will be 2849 square feet or
22.3%. No further increase in lot coverage shall be permitted on this
property.
(4) Applicant shall plant a screening line of trees along his easterly
property line. In accordance with the landscape drawing submitted at
the Board Hearing on May 14, 1998, such trees shall include at least 16
arborvitae of five to six feet in height along the easterly side of the
pool and Eastern Red Cedars of 10 to 12 feet in height at the northeast
corner (at least three trees) and the southeast corner (at least eight
Page 3 - June 23, 1998 ZBA Meeting
Appl. #4559:1000-35-6-7 (Pliaconis)
Southold Town Board of Appeals
trees). Such trees shall be continuously maintained, including
replacement if necessary.
(5) The Board reserves the right, at a time no less than three (3)
months and no more than six (6) months from the date hereof, to inspect
the property and to reopen the hearing in the event of noncompliance
with these conditions.
VOTE OF THE BOARD: AYES: MEMBERS GOEHRINGER, DINIZIO,
TORTORA, COLLINS, AND HORNING...../~s
/~Approved for Filing 6~24~98
***************************
35-6-7
.~REA VARIANCE
Amendments ~267b-3 Effectiv~e July 1, 1992:
AREA VARIANCE is authorization by the ZBA for the use of Iand in a manner
w--6~h is not '~llowed by the dimensional or topographical requirements of the
applicable zoning code regular.ion. ~267(1) of Town Law.
The new Statute a0 longer includes the term "practical difficulty" o=.any
particular test, and now provides that ZBAs 6onsider two basic things:
1. the benefit to the applicant if the v~riance ia granted; and
2. the detriment to the health, safety and general welf~r~ of
the neighborhood or con, unity that would occur if the ,ariance were to
be granted.
In balancing the interests above, Z~As must also consider the following five
factors for an AREA VARIAMCE:
1. whether an undesirable change will be produced in the character of
the neighborhood or a detriment to nearblr properties, if granted;
2. whether ~he benefit sought by the applicant can be achieved by some
method, feasible for ~he applicant to pursue, other than an area?ariance;
physical or environmental conditions
5. whether the alleged difficulty was self-created, which consideration
shall be relevant to the ZBA's decision but shall not preclud~ the gr~nting
of an area variance.
Also, as part of the "balancing concept," the new Statute provides that:
6 .' the ZBA shall grant the minimum variance that it shall deem
and adequate, and at the same time preserve and protect the character o~ the
neighborhood and the health, safety and welfare of the community.
$267-b(3-c) of Town Law.
, lL ·
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
$OUTHOLD, N.Y.
NOTICE OF DISAPPROVAL
DATE: January 30, 1998
To . P~p~z ~A!~qqq!~ .................
20 Bantry Court
Huntington, New York 11743
PLEASE TA1Eg NOTICE that your application dated ..... P~P~.~? ..... 19.~l...
for permit to build accy. I/G swim. pool in rear yard of single lam. dwelling at
345 Snug Harbor Road Green orr
Location of Property ............................................... P ............
House No. Street Hamlet
County'Tax Map No. 1000 - Section ...~ ...... BLOCK ...~ ....... LOT .... ? ........
Subdivision ............................... Filed Map No .......... Lot No ........
is returned herewith and disapproved on the following grounds Under Article IliA,
.~o~ .lp97~9A,~.~.~.p~!~.~.Fe~.p~y!~.~.~.~7~p.~p?~L.yy?p?~ .............
construction will exceed the allowable 20I lot coverage. The lot area is 12,780-"
with dwelling and deck is 2,553 square feet. Swimming pool, as presented, is
568 square feet, ~ringing total lot coverage to 3,121 square feet or approximately
.Z~,~ .~L~.. .................................................................................
Action required by Zoning Board of Appeals.
BUILDING INSPECTO[Y/
RV 1/80
' ' 'r~vv~ o~ [OUTHOLII~
NaflonsBank®
JuLy 15, 19~7
Christopher P[iaconis
2B~ Indian H~ad Rd
~i~g~ Park NY
Loen Number,
Dear Cu~tomer~
1~754
Rear E~ta~e Tax Service to collect your t~x bills from the appropriate
taxing a~thorities and se~d them ~o oat Ot'~ice ~o'r paY~e~,
To be~Jn the proce~ ~ bav~ Your tax bi[[~ forwarded direct[~
to Na~ion~Ba~c ~ort~age Corporatio~ ~e as,k that you complete
si~n the e~c[osed muthorizatio~ form. Pis, asa see thai $he co-borrower
al~o sig~s ~he ~orm a~d mail ii i~ ~he enclosed, postage-p~id e~ve[~pe
before ~u[¥ 29, 1997.
may De malte~ to You~ You ~tt/ fhe~ be r~Pon~lb[e for forwarding them
our Customer Service Department
LINDA D'AN~ELO
' TAX
TX~tO TZP
OCT ~ 9 199'(
BLDG. DEPT.
TOWN OF SOUTHOLD
. . . ~ ~.~.~ o 9~/,-/~-~.~~ .
~'~ . . ~~.~ ·, .:~ ~:; -.,...
. .~,,.- . . ~-~-~.~
..'~,~..~f~-..~,~;~,, :.~' .' :-....:....;..-
, . - ~ - .
. . ~-~. g~,,~ ~ . .. -~. . .
'~o~ .'~- ~ . '. ~.. ~'_. .
· .(~)'~,~ -.. / ~ ~ ~
... ~:~... :..;(..'. :. : '~.. ' ,, .. -
t3, '. · .. , ~u~[O~.~:. .:~
.. ~ .... ~z~~g _. . ·.
- ' - ON~ RIZ~ERSg :
!~ ,, BLDG. DEPT.
TOWN OF $ou'rHOLO
Examined .... A ............ I9...
A~?m~d · .~ ........ ]9 .~~: ........
'FORM NO. 1
TOWN OF SOUTHOLD CHECK
BUll. DING DEPARTMENT SEPTIC
TOWN HALL
$OUTHOLD, N.Y. 11971 NO?TF¥
TEL.: 765-1802 CALL
MAIL
BOARD OF HEALTH ......
3 SETS OF PLANS .......
SURVEY .........
FORM ............. :
TO:
(Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date .......... ,
INSTRucTIoI~S ., '""
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of tot and of buildings on premises, relationship to adjoining premises or public streets
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
cation.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit
shall be kept on the premises available for inspection throughout the work.
e. No building shall be occupied or used in whole or in part for any purpose whatever uhtil a Certificate of Occupanc~
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for-the-issuance of a Building Permit pursuant to thc
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances oz
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and tc
admit authorized inspectors on premises and in building for necessary inspections.
"IMMEDIATELY" /2/~f applicant, ~.r. name, if a corporation)
BEFORE "WATER'* (Mailing address of applicant)
State whether applicant is owner, le'ssee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises C~'~?S~?.l~.~'.~rf-. R/Fq
(as on the tax roll or latest eed) ~h~'/~,~' ,~,.~,,~
If applicant is a corporation, signature of duly authorized officer. ~1~ ~' F_2'O
(Name and title of corporate officer) · ~.
ALL CONTRACTOR'S MUST BE~SUFFOLK- ~0UNTY LICENSED
Builder's License No. ~.., ....... ...... : ..... :...
~ll-~lll l ~ 11~4 PM ~ THE
8. ·
Must
BE COM~ FOR
ALL CONSTRUCTION SHALL M~ ~.T
Other Trade's License 0CCUPANC ........
. ~TATA~, ~TRUCTION & EN~iRr~Y
- 1.- -Location of land on which proposed work will be done .................... ~E~...N~. RESPGNSIBL~..r.QR..
.................................... ................ ........... .....................
House Num her Street Hamlet
County Tax Map No. 1000 Section . O.~.~qa ....... Block . .d{.00* ........ Lot fi0 .........
' Subdivision ..................................... Filed Map No. ,¢,~,~.~,, ,, Lot ...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy
a. Existing use and occupancy / ~e({¥ Ow Ic O -
b. Intended nsc and occa'F~ffe~ ...&gd~'k~;-. ~:~...~;
Nature of work 'check which a lieable' New Build ' · .~:/. ,~" ' A'te t'
:. ( ' PP ): ' ing ....... Additon. fY,; ~, 'I raron": ,.. ; ...
Repair .............. Removal~ .............. Demolition ........... [. · Other Work~..r~'!.,2~?. /;%~ .....
[ ' (to be~paidJ~n filing this applicahin~
:. If dwelling nmnber of dwelling units ............... Number of dwelling uni[s on o~h ~floor(%,~ ..... [ ~
g g ............................................................ ~ .....
,. If business, commercial or mixed occupancy, specify nature and extent of each type of use .....................
'. Dimensions of existing structures, i~any: Front ............... Rear .............. Depth ...............
Height
............... Nmnberlof Stories ........................................................
Dhnensions'o~0~e structure with alterations' or additions: Front ................. Rear ..................
Depth ..... ~(~ ............. Height ....... t ..... , .......... Number of Stories ......... ;, ............
;. Dimensions of entire new constmctCn: Front .. 1 ~.~'.~.{~ear ............... Depth .~ .q ...........
Height ............... Number]of Stories ........................................................
L Sizeoflot Front l(~ . .. Rear ~ Demh ] c/q .....
}. Date of Purchase .... ~..~ 2...~ .............. Name of Foyer Owner ... ~.~.qqC. ¢;~ ...........
· Zone or use district in which premises are situated
Does
proposed construction violate Cny zoning law, ordinance or regulation: .. ~.{ ........................
Will lot be regraded ...... ~ ..... I ................ Will excess fill be removed from premises: ~ No
Nme of Owner of premises~025. P[,}g**~ ...... Address OP.~q~l~{ Cf. ~ogt~h~a Phone No .~.?t~79~..
Nme of Architect ...................... Address .................. Phone No ................
Nme
Contractor
............ I .............. Address .... : .............. Phone No .................
;. Is this property located ~it~tn' 300 feet of a tidal wetland? *Yes ..... No ~.
· If yes, Southold To~ Trustees Permit maybe required.
PLOT DIAG~M
Locate clearly and distinctly ~1 bui d~gs, whether existing or proposed, and, indicate all set-back d~ensions from
operty lines. Give street and block num[ber or description according to deed, ~d show street names and indicate whether
cefior or corner lot. '
'ATE O.F I9E¥
..
n
oven~n ed. ~:
~O.Of.q~di~td~f~iffl~ cc
......... being drily s hat he is the applicant
atract) ~' tIlk'llt ti3 it,iOffi'lW'
,-~.,.;:,~j,q.'/:~_.,.f..~.4~.~[ (Contractor agent, corporate officer, etc~ ' '
smd owner or owners, ~a ~s ~my autl}ofized to perform or have perfomed the said work and to m~e and file t~s
ptication; that all statements contained m this application are tree to the best of his knowledge and belief; and that the
>rk ~fil be perfomed in the m~ner set f~Dth in the application filed therewith.
,om~o before me this ,
,ia. Public, ~~ ~<OZ~ ..... Count /
~i~ ~ ~-I I~ (Signature of applicant)