Loading...
HomeMy WebLinkAbout1000-55.-5-9.1 i • s 0 00 ` 3 " 17'-6 1/2" 6r • OOH EXISTIN DRIV ;5`0Ew o ENTRAN ® ©�� \2--1 P Ab w o EXISTING UTILITY POLE TO BE I o ,�-�O REMOVED RELOCATED Q ® R,23i r.< NEW SIGN - �� 24 5,1.ft. 8'-0" ht. _ ® z p EXISTING DRI EWAY °L 0 0 ENTRANCE- �\ G� ° r D o NEW UTILITY \\ VAC �,;,a � 4 o POLE LOCATION 4 O N AIR ® I O ® Q ® o �L # 12 " MONUMENT \ �� �\ 0 © ® 0 ©® FOUND �, I ` # 1 1 O Q • \\ 'L I N j, Q • Ex15rING CONCRETE 10'-0"0x8'-0" DEEP DRAINAGE UTILITY BOX ASPHALT PA ED POOLS, TYPICAL ALL; 8"0 PVC 17RIVING SU ACE PIPING BETWEEN EACH P B Ali �-`v`'�O� ,a 4 . :♦ I � '' PROPERTY LOCATION ! f _ , CONNECT TO F -O o� �.� AREA OF BURIED FUEL TANKS ADJOINING '' l ! TANKS TO SIT ON CONCRETE SLAB °0 PARKING LOT `',F 44' *�. �` ' COVERED BY POURED CONCRETE SLAB PI � 8 LU L9 o O N ® `: ASPHALT PAVED 3 Ic'-c° —+ ouTut�E OF IXISTING : DRIVING SURFACE ` PROPOSED PUMP ' w O BUILDING *STRUCTURES ..',, U , ' m TO BE NbVED iCANOPY w/ FIRE I LU z I ` ` ;SUPPRESSION; 1 �` 1�1CRETE S o Q g W U - 1- tu #9 / o Q SITE PLAN Lu O i z 0 <o SCALE: J-, = 1'-0" i z ILj W SCTM: 1000-55-5-9. 1 Q ® I 2 Information taken from surveyp repared by Peconic Surveyors, P.C. Southold, New York #8 O dated January 13, 2015 J 65'-0" '. 41'-0" SITE DATA: DRAINAGE CALCULATIONS: Final Plot Size: 37, 123 sq.ft. Based on 2" Rainfall Event = 8"0 P'✓C PIPING Building Area: I ,5 16.04 sq.ft 3.38% Parkin 2180 I .9G sf X 3633 c.f. U, '#7 0 ! BETWEEN DRAINAGE O 1 Paving * Curbing: 21 ,801 .9G sq.ft. 57% g' z I POOLS 0 Sidewalks: 740 sq.ft. 2% Sidewalk: 740 sf X = 123 c.f. LU -; 50.2 i/r' Landscaping: 13055 sci.ft. 35% I s ' Roof: 1516.04 sf X? = 252.67 c.f Landscape: 13055 sf X = 435. 16 c.f '' ' p #6 a Q / z 77777777 Q : �-ti's ZONING INFORMATION: I w EXISTING BUILDING TO SCTM # 1000-55-5-9. 1 8'-0"0 Leaching Pool = nr2 = 3. 14 X 4foot2 = 50.3 cf/ft io'-s" cn N Street Address: 46770 Route 48, Southold Roof 25267/ 50.3 = 5.02 ft.deep- Use 8'-0"0XG'-0"deep o # 1 OI REMAIN; PROPOSED Zoning District: B General Business / j Parking, Sidewalk * Landscaping Total = 4191 .16 c.f. #S n A 13 I ALTERATIONS Front Yard Setback Required: Variable 10'-0"0 Leaching Pool = nr2 = 3. 14 X 5foot2 = 78.5 cf/ft ® i Front Yard Setback Proposed: 71 feet Area 4 15 1 . 1 G/ 78.5 = 53.4 ft,deep - Use (7) 10'-0"0x8'-0"deep l C - C O Side Yard Setback Required: 25 / 25 feet \ - 1 Side Yard Setback Proposed: GG.5'/ 19.G' (pre-existing) I ' ' uP o 4i-0" POURED CONCRETE Rear Yard Setback Required: 35 feet GROUNDWATER MANAGEMENT ZONE IV #4 U m o SIDEWALK CONTINUOUS z Rear Yard Setback Proposed: 52 feet Density: .03 GPD/SQ.FT. ASPHALT PAVED Kitchen: .02 GPD/SQ.FT. DRIVING 5t JP �. b #2 FRIDGE AROUND STRUCTURE J PARKING ANALYSIS: Hydraulic: 05 GPD/SQ.FT. G F E D . Total Building: 1 ,5 1 G.04 sq.ft. #3 I O � . ,. _ .....> 7 w ZOResidential (2 units): 2Re uit d 2 Proposed Spaces SANITARY DESIGN CALCULA IONS Convenience tore: 8 Required 12 Proposed S aces- DE91GN FLOW DE91GN FLOW DE91GN FLOW TOTAL FLOW MPLOYEE P I GPlus2 Handicap Accessible AREA NAME AREA 912E 9ANRARY GREY TOTAL b SPACE I \'. �.� I O O Gas Station: 3 Per Que 36 Proposed Spaces \ ; Employee: 1 Per I Space provided Corrrentenoe store 600 5q.ft. 0.03 o.02 Loadm Berth: 19'-0"wide X 14'-O" height X 45'-0" long I Proposed 2a GPD i 6 GPo 2k GPD RESIDENTIAL O \O .D��G' } g l .x. �_ I 0 3 Aportmente 750 xt.tt.each SPACES (2) ; k \� � � � p z � z BUILDING INFO: 150 GPD each 300 GPD OUTLINE OF BUILDING ENVELOPE f DUM PSTER W/ CL/ U First Floor: I \ A - Convenience Store: G50 sq21'-3".ft. �' o W FENCE ENCLOSURE z i � i S • B - Attendant: 150 s ft. C - Access to Second Floor Vestibule: 220 sq.ft. ® ® U D - Mechanical Room: GG 5q.ft. 6"0 PVC PIPING O Z q TO ROOF DKYWELL lLl E - Office: 30 s .ft. F - Employee Restroom: 30 sq.ft. G - Handicap Accessible Restroom: 104 sq.ft. N GRASS PRIVACY AS PER I z �i Second Floor: Residential Unit 1: 750 sq.ft. +/- N LANDSCAPE PLAN z Residential Unit 2: 750 sq.ft. II o U 1 o o�-0 0 0 0 0 0 01 BRICK MONUMENT NEW G'-O" TALL PRIVACY FENCEPIPEFOUNff'o—o—o—o—o—o—o- FOUND 581°15'50"W 150.00 1 EXISTING STOCKADE FENCE L� JAN 2 5 2017 I i l , PAGE: Southold Town I Planning Board 1 5F I ` UNAUMOR/ZED AL TERA TION OR ADDITION TO TH/5 DFA WING AND RELATED DOCUMENTS 15A VIOLA rIOV OP SEG 7209 Of THE N.Y.5.EDUCA TION LAW i I v I i 4 ! . i i j V z 5 ! LU (L i Q U s cn r z o 1 T-G 1/2" GVH Or �5 1 T-6 1/2" 5 — �c GVHQcC� z Lu �0P EXISTIN DRIV 5\ I �O P EXISTING DRIV W PQ� ENTRAN �(� Q P�l ENTRAN Ab Ab 0 � Lu EXISTING UTILITY POLE TO 5E REMOVED RELOCATED6p GESS II \12 V-- 2\Iz" V-\ SIGN QS.z 50\ SIGN a5 p� _ ,232 � I � R-2325 .•o•0::. �, .. c9/ I z Q / O' EXISTING DRI EWAY / o o O EXISTING DRI SWAY U ENTRANCE- I CD ENTRANCE- EX I �o z 4 `� z NEW UTILITY o00 0 °° `'mss ,�; -j 23 t0 VAC p � N POLE LOCATION 1 `� oo,oo vac s C \. 4 O ~ N o AIR O' Q m O \ I b # 12 \ �° \\ #12 MONUMENT o \\ \\ , MONUMEDT O \\ 0 0 \ I 5\C�Wp\ FOUND G \\ \\ # I I c>7 c,\OEvLPi, ., FOU�gfp�po °DRABS �L \,\ \.\ # 1 1 \ N EXISTING CONCRETE EXISTING CONCRETE oOo Ooo 10-0"Ox !-O° DEEP DRAINAGE ! uTYeox UTILITY p AREA OF BURIED FUEL TANK5- urlASPHALT PAVED POOLS, TYPICAL ALL; 8 O PVC PAVED DRIVING DRIVING SURFACE PIPING BETWEEN EACH POOL TANKS TO SIT ON CONCRETE SLAB COVERED BY POURED CONCRETE SLAB ; SURFACE PLANT SYMB LS: ' CONNECT TO CCNNECT TO O !— — . . —. . _ : Ln I 1 ADJOINING I ADJOINING \ I: •': :''" I y PARKING LOT I PARKING LOT – t i • 1`.• . . ,p I III 11 ORNAIAl AL CHERRY, I - 2 CAL. p[ U D 1�^ I o apo 00 w o C5 p WHITE OAKI, 2� - 3" N N ; ASPHALT PAVED o j PROPOSED P05T LAMPS DRIVING SURFACE I w o j o I FOR PARKING LIGHTING TO PROPOSED PUMP z CANOPY w/ FIRE Lu BE:iN AbCC RDANCE WITH LO u- co # I 0 co # I C DARK 5KIE5 REGULATIONS SUPPRESSION; O 1 I } ORNAMtNTAL GRASS, '-4'ht., z a a 16 ICRETE SL� QU CL I � w ' 6 I JvJ / GRAss Ia-- GROUND COVER JUNIPER, 18" -240 ht. CL #9 w #9 I = o z I w GRASS I W I Q ® iz LZE > JAPANESE 6LACK PINE 1 T-U ht. p- #8 #8 I 8"0 PVC PIPING ° LELAND CYPRE55, G' - 7'ht., DOUBLE ROW #7z � O I#7 z I BETWEEN DRAINAGE • 1 POOLS UL— .. . . .:.:.... Lu #6 U ,. I #6 U �: z ,: Eu Q NG BUILDING Lu Q EXISTI B DING TO EXISTING U B ILDN I G TO , � REMAIN; PROPOSED oREMAIN; PROPOSED # I # I ALTERATIONS Aoo o LTERATION5#5 t#5 A g O C \ C ° 11 #4 UP 4'-O" POURED CONCRETE r #4 -� OF r. 4'-0" POURED CONCRETE ! SIDEWALK CONTINUOUS SIDEWALK CONTINUOUS I ASPHALT PAVED o #2 G FRIDGE F E D AROUND STRUCTURE DRIVING SURFACE #2 G FRIDGE F E D I AROUND STRUCTURE # 3 I 0 i z O 4 MPLOYEE PARKING •,.MPLOYEE•'P ING, LOADING I 1 LOX�DIN�! RESID N L �;><:/ RESIDENTIAL l �;X:� I Z 5P I I SPACES (2) \I ° O DUMPSTER w/ lu Y 0no- ° FENCE ENCLOSUREZO O I GRASS G"0 PVC PIPING D o W E TO ROOF DRYWELL O Z o0 0o I d GRASS � 0� z LANDSCAPING O o � I 'I Q) ° 0 0 0 0 0 0 0 oI BRICK II MONUMENT PIPE FOUND MONUMENT 4 6 NEW -0 TALL PRIVACY FENCEPIPEFOUN60—o—o-0-0-0-0- FOUND $8 10 15'50"W 150.00' FOUND 581015'50"W 150.00' I EXISTING STOCKADE FENCE I � SITE E PLAN - QUEUING ! P = ! SITE iPLAN - LANDSCAPE SCALE: ' r-o' ! PAGE: SCALE: ' = I'-0' ! 5 I j UNAUTHORIZED AL TERA TION OR ADDITION TO THIS ORA WING AND RELA TED DOCUMENTS/S A VIOLATION OF SEC. 7209 OF THE N.Y.S.EDUCATION LAW I ! I FORM NO. 3 1 tA LT TOWN OF SOUTHOLD � ° BUILDING DEPARTMENT FE B 0 6 2 017 SOUTHOLD, N.Y. � W utF9marauw NOTICE OF DISAPPROVAL Rannhi Board � DATE: February 2, 2016 TO: Jemcap SD LLC 46770 Route 48 Southold,NY 11971 Please take notice that your application dated January 17, 2017 For permit to const. rict additions and alterations to cgvq[t iLi existipg_b ildi,n to a xas stst o with cc>ru e i r ca store and a,a t!p nt at Location of property:46770 OR Southold,NY County Tax Map No. 1000 -Section 55 Block 5 Lots 9_1 Is returned herewith and disapproved on the following grounds: °Cheo aos�l o str action in the�u ingas s� st i t i no rmit�te I ursua t t°a Article�1 e tion BCI . which states, "No lrnildi.n x or remises shall'kae used and no buildin or art th eof shall be erected or altered in the B District unless the sat a cont<arr�s to l Bulk Scla d l and Par'n and Loading,Schedules moor orated into this clan to r lay r fcr as c v tl tl e same ftarce and effect as if such re alations were set Scarth hereinin full!' AccoLding to Scledul ., _licn. itx icl yard setback tf ,fcet is re ure "l"he existin altered,buildig notes .sj gle side and setback of 19.7 feet. Faartlreranore flee ro Deed faro"ect d a. uq r s i .l_ c w can royal fr the Southold Town onin Beard of�Lreas zdsit 1?1 aafpryal l"ron tle Southold own.IIan Board,, Authorise Sig Cc:File,ZBA, Planning Note to Applicant: Any change or deviation to the above referenced application may require further review by the Southold Town Building;Department. '�>Llp k- FOR INTERNAL USE UNLI EM,V � J,�1��d 2 5 2017 IT PLAN USE ET E RM I V K�10 Soutnoid Town Planning Board initial petermination Date ent:_.- Date:J_JW, , Project project Address: �:_-:-...-..,-.._µ. .�.... .�._....�......�..-__- ---... Zoning Dlstrft:� �` Suf€olk County Tax Map-No.:1'000 _ 5 �-- . w � S �-- . Request, docurcIeIliation-ais to of ildirtTg letrnit Oplication and su). ierting (Note: Copy proposed use or uses should tae s, hm tted.) Initial Detern"iii ation as to whether use is Pei�ed' •Deters !nation as to whether site plan isrequired: l nitiat . Signature g . Departrnent ( .D.) Referral: Planning �� !7 a / D ate of Cot'xjrnent:� -, �ivied: t . �---- ornrnH ts: ►" e t.-Staff Reviewer - .. Signature of planii ! , r- nal D et6errnjna` ion D Decisi_on: ___ . .. .., c:�nafiµirP ofrtilciina insnec:tnr FOR INTERNAL USE UNLI . _ .. SITE PLAN USE DETER[VI[NATIOr� row.rNQ��syrnru Fllanm ng IBoard t rmination - initial p .F Date Sent' Project Nara e: _. Project Address: otk County Tax Map NO-A000 _ S ��Zoning Dtstc(:� Sufi Regust' �� c 3 - � lication and supporting documentatiern a to (Note: of Bmuildii�ig Perit App ." ���-oPo�ed use or uses sl�outd he su �rnitted.) " . ernittod: � � . Deter It at as to whether use is initial De s required: termination as to whether site Oat' i iced terrn -5k- Initial-De ar Signature of Building n Planning Dep artment (P.D.) Referral: a / 0 -D ate of COMM erit: f_L7 P.D. Date Received:=----� " Signature of Pl nni epi, Staff Reviewer !nation Final Date:�.....�. .�"...�....�..�.��-- " c;„nat, rP of Rrriilclina Insnec=tnrµ w TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 4 sets of Building Plans TEL: (631)765-1802 Planning Board approval FAX:(631)765-9502 Survey SoutholdTown.NorthFork.net PERMIT NO. Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application Flood Permit Examined 120 Single&Separate Storm-Water Assessment Form Contact: Approved 20_ ail to 1 Disapproved a{c _ Phone: ✓� Expiration 20 IECIEDIV `ding In ec r PLICATION FOR B ING PERMIT JAN 1 8 2017 Date 20 BUILDING DEPT. INSTRUCTIONS aT i r 1 e-completely filled in by typewriter or in ink and submitted to the Building Ins_ 'th 4 sets of plans,accurate plot plan to scale.Fee according to schedule. b.Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or publl or areas,and waterways. 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 issue a Building Permit to the applicant.Such a 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 what so ever until the Building Inspector issues a Certificate of Occupancy. f.Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date.If no zoning amendments or other regulations affecting the property have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an addition six months.Thereafter,a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,Suffolk County,New York,and other applicable Laws,Ordinances or 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 to admit authorized inspectors on premises and in building for necessary inspections. Lz� , (Signa ire of applicant or name,if a corporation) (Mailing address of apphcant) State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder f Name of owner of premises e IS Z) 6(—C ® (As on the tax roll or latest deed) If appli nt i- cor tion,signature duly authorized officer (N - n i orpor e officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on whi4 proposed work will be done: House Number Street llHamlet County Tax Map No. 1000 Section �' Block - J Lot j Subdivision Filed Map No. Lot 2. State existing use and occupancy of premisef anq intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy, v 3. Nature of work(check which applicable):New Building® Addition Alteration Repair Removal Demolition Other Work 4. Estimated Cost_ �5rOC�,C� Fee (Description) (To be paid on filing this application) 5. If dwelling;number of dwelling units _Number of dwelling units on each floor If garage, number of cars 6. If business,commercial or mixed occupancy,specifyna�t�u and extent of each type of use. 7. Dimensions of existing structures,if any:Front_ Rear -Depth Height , Number of Stories Dimensions of same structure with alterations or additions: Front il. .Rear, Depth Height Number of;Sto e 8. Dimensions of entire new construction:Front Rear Depth Height 4 Number of-Stories tr 9. Size of lent front 1 Rear o Depth X 16-19-5 10.Date'of wchase Name of Former Owner }1 11.Zonvr use district in which premises are situated 12.Does proposed construction violate any zoning law,ordinance or regulation?YES_NO 13.Will lot be re-graded?YES_NO; Will excess fill be removed from premises?YES_NO 14.Names of Owner of premisesaw cGr7 SC>Z LC Address' Phone No. t (3 9i.53 Name of Architect }S< r Ca __ Addresses � \Phone Nom Name of Contractor Address ' Phone No. 15 a.Is this property within 100 feet of a tidal wetland or a freshwater wetland?*YES NO *IF YES,SOUTHOLD TOWN'TRUSTEES&D.E.C.PERMITS MAY BE REQUIRED. b.Is this property within 300 feet of i tidal wetland?*YES NO'> * IF YES,D.E.C.PERMITS MAY BE REQUIRED. 16.Provide survey,to scale,with accurate foundation plan and distances to property lines. 17.If elevation at any point on property is at 10 feet or below,must provide topographical data on survey. 18.Are thereany covenants and restrictions with respect to this property?*YES No *IF YES,PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF —LL- being duly sworn,deposes and says that(s)he is the applicant Am in�ividualsigning c(Nameabove named, (S)He is the --Al l (Contractor,Agent,Corporate Officer,eta) of said owner or owners,and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief;and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this day of 20_0 CONNIE D.BUNCH Notary Public r4olary vubftcTte of New Yo nature t No.OI BU6185050 PP Qualified In Suffolk County Commission Expires April 14,2 TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11471 4 sets of Building Plans TEL:(631)765-1802 Planning Board approval FAX:(631)765-9502 Survey SoutholdTown.NorthFork.net PERMIT NO. Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application Flood Permit Examined .20 Single&Separate Storm-Water Assessment Form Contact: Approved .20 Mail to: Disapproved a/c Phone: F Expiration ,20 IECUIVE Building Inspector PLICATION FOR BUILDING PERMIT JAN T 8 2011 Date ?+! ,20�_ INSTRUCTIONS BUILDING DEPT. aT nipApumme completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans,accurate plot plan to scale.Fee according to schedule. b.Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or areas,and waterways. 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 issue a Building Permit to the applicant.Such a 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 what so ever until the Building Inspector issues a Certificate of Occupancy. f.Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date.If no zoning amendments or other regulations affecting the property have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an addition six months.Thereafter,a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,Suffolk County,New York,and other applicable Laws,Ordinances or 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 to admit authorized inspectors on premises and in building for necessary inspections. y (Signa ure of applicant or-name. a corporation) (Mailing address of applicant) State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder Ped 1' Name of owner of premises ~ Ix, �C r (As on the tax roll or latest deed) If appli nt i cor tion,signature duly authorized officer orpor�fe officer) Builders License No. Plumbers License No. Electricians License No, Other Trade's License No. 1. Location of land on which proposed work will be done: House Number Street Hamlet County Tax Map No. 1000 Section Block Lot Subdivision Filed Map No. Lot 2. State existing use and occupancy of premise- and intended use and occupancy of proposed construction: a. Existing use and occupancy 12:, b. Intended use and occupancy 3. Nature of work(check which applicable):New Building Addition Alteration_ Repair Removal Demolition l Other Work (Description) 4. Estimated Cost 5<<X L7, Fee (To be paid on filing this application) 5. If dwelling,number of dwelling units----,��Number of dwelling units on each floor___ If garage, number of cars t 6. If business,commercial or mixed occupancy,specify natur/ee and extent of each type of use. , 7. Dimensions of existing structures,if any:Front Rear 5�� Depth cC all Height -3,4 Number of Stories—�L Dimensions of same structure with alterations or additions: FrontRsAAF-Rear, Depth Height Number of Stone _ of 8. Dimensions of entire new construction:Front Rear Depth Height Number of Stories 4. Size of lot:Front t Rear Depth All t06 10.Date of Purchase Name of Former Owner 11.Zone or use district in which premises are situated -< 1 - 12.Does proposed construction violate any zoning law,ordinance or regulation?YES_NO� 13.Will lot be re-graded?YES_NO Will excess fill be removed from premises?YES_NO 14.Names of Owner of premises t 466 Address'? r ' _Phone No. 573 Name of Architect :'S_ _ Address - \Phone No 1 19 At Name of Contractor Address Phone No. 15 a.Is this property,within 100 feet of a tidal wetland or a freshwater wetland?*YES NO *IF YES,SOLF'1 HOLD'TOWN TRUSTEES&D.E.C.PERMITS MAY BE REQUIRED. b.Is this property within 300 feet of a tidal wetland?*YES NO > *IF YES,D.E.C.PER-HITS MAY BE REQUIRED. 16.Provide survey,to scale,with accurate foundation plan and distances to property lines. 17.If elevation at any point on property is at 10 feet or below,must provide topographical data on survey. 18.Are there any covenants and restrictions with respect to this property?*YES NO� *IF YES,PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF,&(.rift ) a+ C1 i , I being duly sworn,deposes and says that(s)he is the applicant (Name ofinividual signing contract)above named, (S)He is the (Contractor,Agent,Corporate Officer,etc.) of said owner or owners,and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief;and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this day of v 207 } d CONNIE D.BUNCH Notary Public �' tate of New Yo ature pp. t No.O1 BU6185050 Qualltled in Suffolk County Commission Expires April 14,2 to