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HomeMy WebLinkAbout23941-ZI)1 ;mppr~v~M a/c .................................. iHJl~lUI tH' III',[H,III ..~-.,... ~ ...... ] SF.T,~ OF Pl.^NS ,~iUI(¥ F, ¥ ........................ CIIF.(]K ......... ~ .............. SF. irl' 1C F()RH .o,,'7 ................ NOTIFY: c^u. ©- .... tlAli, TO:..:..' ............ N.d ......... ............... ........ ...... :r.o_WN OF $OUTHOL.D_ ~J I NS'I'IUlCT 1 ON; ^I'I'I,ICATIOH FOI), IIIIII,I) ING I'I':IHIIT I)ate ................ ,19... a. 'lhi.~ nlqdicatitss.tmL I~ tx%~¥1etely rill¢~l in by tylKs.n'iter or in ink taxi m;Ixuitt~l to tim I~;ihllul~ hml~ctm' sets of IJlmm, nccurate plot: plan Lo ncale. I~ nccm'di,g t.o sclsmlule. b. I'lot plm; ~dKs*ing I~al:i¢~i of lot: n~KI of I~;ihli-Rn (m In'e~nlse~, ~elaLiouship Lo ~ljoinln8 sl.~eetn or m-cas, n,xl giving a {~tnJl*l ~m:ripti{s~ off Jn~x;l: o[ I.'Ol~rl.y mist I~ drm~i *~ the diogran OHch is Imrt thi~ nl~)l icatio.. d. Ilium :~l~rmoi o( tllJ~ nlBJlicaLi(m, the I~ihliul~ IIISI~(:(:()I' will e. ~) Ix~Jhlh~ !~lall I~ (~:CUl)J~l i)r m~l in ~h~ ()r in ImrL fi~r a~y IXUlXme ~ml~er until n (~rLJ[Jcnte Iff (~:(~ii~iiK:y rJmll have Iron I~[anL~l by tJ~ I~lJhlhq~ AI'I'I,I(~'I'[(~ IS Ifl[IU~IJY F~I& to tl~ I~lJhlJul~ I~l~llln~nt for the Jt~*ltlJlrlce ()[ a I~lJhlJlig I~etl~Jt Ixlrmlgllt ti) the I~dhling 7xa~ Ordllm~e off the '1[~ ~[ ~xdhohl, ~ffrolk (~mt.y, ~* York, taxi other al~tlcable 1~., Ordls~e~ ur I~tlgdal. j{~m, for I1~ c(~mtn~:l.i{~ .[ bdhli-lF~, mhlil_i~m ~r alle~atio-s, or for ~al or doral;rio., an herein ~kmcril~l. 'lhe applicant agr~ to ci~,ld7 with all al~d hmble Ir~s, ordhm~es, la~itdlng {xxle, I~xming c~le, taxi (Sil~;mt:ure of al)pi iota*t, or ;ulr~, ir a (Hal I hsf, IxIdtes~ of appl Stale ~helher nl~)licaut is~.~.~), lensee, nRenL, a]chiLecL, enl~h~er, t~? iJJ' ~ of j~l(~nJ~ ............................................................................................ (n~ ~ Ih[~ I.a~ ~)11 or Inlesl deed) If nl~l JcmJl in 'a COrl~Jal hm~ nilv~Jtme .[ duly m~lho~ b~l officer. (H.-,,x? m.I I il le c)l: (:O~l~rale orficer) I~,i hler:; I,icen.~a No .......................... Iqmi~rn I.Jt:eu.m~ fro .......................... I~lectr it;mm I.ice.se ~,.. ~77~. 7. F: ...... (lll~r 'l~J~b'~ l.lce, me ~ ...... ; .............. . .... ~,,,~.~ 'r,~ mp ~,. ,m ~,:t,~, ...~ ........ ,,~-~ ..~ .......... h,t ~.~ ........ , . . . ~.~ ~c~ .............................. hJXt v~. I(s ..~ .............................. Iril~l t~)l) I~). q~l~ It)t ~' J (~.~) ..................................... ;,. Exist h,g ~,~ ;,,si (x:CUl~,,~:y ~ ~ C I:~ ~)- J--O]' . ........... I'I.OT II I ^1;11^11 CLAIRE L GI. EW Notary Pul~lic, Stato of Now York ~ualifi~d in S Hotk Couc ty ~ C°mmis.. o ~ Expi,es O~co,nb~r 8, 1.) ..~ ~ II ,. X..-';;'~ %X ~ ~. ~ . ~ / ' ~ Suffolk County ~ ~ OCT g 9 1997 ~ Dept. Of Hoa~th ~emces ,,, , , ,., ,,,,,,..,, ,o?,