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Home My WebLink About26925-Z 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. 26925 Z Date NOVEMBER 15, 2000 Permission is hereby granted to : LAWRENCE W KING 73 PRIMROSE AVENUE FLORAL PARK,NY 11001 for DEMOLITION OF AN EXISTING DWELLING AS APPLIED FOR. at premises located at 2205 MILL RD SOUTH/PEC County Tax Map No. 473889 Section 067 Block 0007 Lot No. 007 . 001 pursuant to application dated SEPTEMBER 11, 2000 and approved by the Building Inspector. Fee $ 69 . 80 ,r- Authori d Sign ure ORIGINAL Rev. 2/19/98 f F ', g SEP I 1 200 g_ ! BOARD OF HEALTH :. . . . . . . . . . . . . . 0 FORM NO. 1 3 SETS OF .PL•ANS TOWN OF SOUTHOLD SURVEY . . . . . . . . . . . . . . . . . . . . . . . . CKC_55F,'R BUILDING DEPARTMENT CHECK TOWAJO; SOUT _�_ TOWN HALL SEPTIC FORM. . . . . . . . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 DEC . . . . . . . . . . . . .. . TEL: 765-1802 TRUSTEES NOTIFY: . F " 7 ��' A CALL . . . Rj�. . 'S Exanined.../i ... ., 2(�.��' MAIL TO: . . . . . . . . . . . Approved.. .F.�f.., Peimit No. 4��.1. �. ... ..................... Disapproved a/c .................................. ........................ liding Insp or) .-•. APPLICATION FOR BUILDING PERMIT Date. . : 2. . 2G� . . . . . INSTRUCTIONS a. ;,This application must lie ca-pletely filled in by type'wr'iter or in inkand submitted to the Building Inspector wi 3 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 toi?djoining premises or public. streets or areas, and giving a-detailed description of layout of property must be this application. drawn on the diagram which is part of 1 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 permit shall bekept on the premises available for inspection throughout the work. A e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATICN IS HMMY MATE 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 regulattipns, and to admit authorized inspectors on premises and in building for necessary inspections. lk— .. ...................... (Signature of applicant, or name, if a corporation) 73 M9Ps9--AV, .. =sal:-_. K - (Mailing address of applicant) NY Iloaf r State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder .......... .................................................................................................... Name of owner of premises ...1.A > N r✓F.-vJ.•„!�..MqI�/ ...[C_11•yCs.......APP Oq p AS NOVO.. (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. _ NOTIFY BUILDING DEPAR E AT (Name and title of corporate officer) •-••-- .••..... 765.1902 9 AM'JO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO. REQUIRED Builders License No. ......................... FOR'P0URED'C0NC§0t 2 ROUGH - FRAMING & PLUMBING Plumbers License No. ......................... a INSULATION Electricians License No. ..................... 4 FINAL - CONSTRUCTION MUST BE COMPLETE R :O. Other Tram's T..ice:..se *a. ALL CONSTRUCTION SHALL MEET -•.................. THE REOUIREMENTS OP THE N.Y. 1. Location of land on which proposed work will be done.......................STA19 CONSTRUCTION & ENERGY -2205 MILL. P OAD .. ...................................... . _ COD NOT,-ftESP®NSI' LE -rriSR- . .......... ..... ......... DESII��C�96�5TRUCTION ERRORS House Nuaber Street ....Harslet .......................... Comty Tax Map No. 1000 Section ..... ....... Block ....7.......... Lot .......7.4.. Subdivision ......... ......................... Filed Map No. ............... let ............... (Name) 2. State existing use and occupancy of premises and intended use and occupancxof proposed construction:. a. Existing use and occupancy ....... )�g_LL10 ............................... ..............:....... b. Intended use and occupancy ....... M O L(�;Ip .-.-Q _•A l►JL{yJr ...................... 3. Nature of work (check which applicable): New Building . // ... Addition .......... Alteration .......... Repair ............ Remwal ............. Demolition ....Y...... Other Work .............................. (Description) . , 1 Qv4.�_...... fee ........ I-_ Esti�r>ated Cost .... ......... (to be paid on filing this application) i. If dwelling, dumber of dwelling units ....I. ... Llunber of dwelling units on each floor .....I.......... Ifgarage, number of cars ......... (.......................... i.. , If,lxbsiness, cownerojal or mixed occupancy, specify nature and extent of eachtypeof use......N/A ....... `Dimensions of existing structures, if any: Front...../._.... Rear ....... ..... Depth ....Z�. ....... Height .........jig ............ Number of Stories ......�............... Dimensions of same structure with alterations or additions: Font ......iia/h... Rear ............... Depth .................... Height .................... Number of Stories ............... 3. Dimensions of entire new construction: Font .......1-/A.... Rear ............... Depth .............. Height ....................... Number. of Stories .:.. .............. 1. Size of lot: Front .........5 ........ ......... Rear .......sC.Q........: Iept}1 ......On.......... 10. Date of Purchase ....0/-40/11..... Name of Former Owner ......5 1w)K......................... Il. Zone or use district in which premises are situated ................................. ........................... 12. ' Does proposed, construction violate any zoning law, ordinance or regulation: .....NA............. 13. Will lot be regraded ......4Q.......... Will excess fill be removed from premises: YES. 14. Names of Owner of premises ..L-A!A%PE P' ..�!� Y-1M&Ad dress ..rl!: ..F91(V".S AVE .. Phone No. 6M �FLOM u. PK t,Ny 11001 Name of Architect .................................... Address .............................. Phone No. .............. Name of ContractorS,0t..... .. Address Z�l�...�lw►J!�:: �,�,C�??�dK?fthone No. .73!>'l".�W.. 15. Is this property within 300 feet of a tidal wetland? * YES .......... ......... *IF YES, SOUIIUD IU4N MJSIPE.S PM41T MAY BE REQUIRED. i PLOT DIAGRAM t Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bark dimensions Cram property lines. Give street and block number or description according to deed, and show street names and indicate Qhether interior or corner lot. fryn 2%i�'.v.M°• q'b C'•°'yil�%'yf^�•y—A si VA i E ylk(•pa eY•.w.TMe.n r��4:S. >.rnlr cg"N;1W_ ..._.......�:••>...- .. ..: K: :`:`�..................being duly sworn, deposes and says that he is the applicant ,Name q i.'ri iVldlkll;sigpiug,.contract)• a above n?�amed, le is the ,•v_�1y .. .. . ............................................................. `an_ent.•-.'oOiry 'rate )f.Ficer,'. etc.) v. �3j•1 of said�,o! r,or.owners�'and is duly-authozized to perform or have performed the said work and to make and file this ipplicatiot; ahat*all;.statements, ccmtai_ned, in this application are true to the best•.of,his knowledge and.belief.;,and hat then work;i�,l l';lie;',pe:i fgtT ie21 in,�t_he mamber set- forth in the application filed'then eWith. worn to before me this ........5..........day of ... (=PTP n4rl?A -2000 Notary Pub .........J.. ........ ... .._... ...... ..... ... :....... / Si ture of ,A li.cant 8A11E3AR,�tllt.IItiATZEaATH ( ? .PP. . ) Notary Public,State of New York No.30-7788125 Qualified in Nassau County. Commission Expires April 30,�3 a > ' ...♦ - ...v�:-`a:.�4slr�'yla'.-.4•uLZ-4Y�IaMwJVw4...aawaaCat'Us•.Ls.✓....w.v`_�y.`�..' - �d.sl.n Yya.v..ar aH..vJ.a•.a�a•a'e'tYas• - a"uh_ _ �za.�.-.=�.am iSt '�1••a +n11 �.r.i .KYJ 7- 7- �7, t TOWN OF SOUTHOLD PROPERTY RECORD CARD 'L�>�- OWNER STREET 2''� � ': V G� DIST.: SUB. A --'L OT6 . C- a r► F RMW OWN,�R E ACR. o -460 r77e S ; j W TYPE OF BUILDING Y1 ;ES. i SEAS. �kVi 1 VL. FARM COMM. CB. MISC. Mkt. Value !' � LAND IMP. TOTAL DATE REMARKS � a1100 d I / 700 / O 2ZOC> 13 16 7 e -'A. I 7o'o /yoo 1 21 o o- `711191 NEW NORMAL I BELOW ABOVE FARM Acre Value Per Value ! Acre I Tillable 1 Tillable 2 fillable 3 i Noodland >wampl.and FRONTAGE ON WATER 3rushland FRONTAGE ON ROAD 7, -louse\P•�0t DEPTH y� p BULKHEAD iDOCK f otal , o: ' -. NOON■■■ ■■■■■■■■■■■■■■■■■■■ it ■■■■■■■■■■■■■■■■■■■■■■■■■i■ tsi �, !L vcj�' r1`rb raUt�g4�'`',•a, ` �4t..; ,'t l,r,e , NOON■■■ No No n � .r 6f4ei Fl c. Air iF, y ii , " .: MEMO so NOON■■■ .� SS,I¢+y. ik..•�Y. ilIi / - xx 1 f• ■■■IC�. tr;1+1 ��■■■■■■■■■■■ ■■■■■■Er/ 1B■� �� ■n■ ME ■■■■■■ ■■ - - `. MEMO■■■ ■Il1�O■�E■■■■■■■■■ ■■ '. a�' gra• £ - - - :. : ■EM■MME ■(rG ■■■ ■■NOME■ NOON■■■■NONE■■■■■■■ :=R EN■■MEM EMM■■M■NM■NEMMMENEM ■EEE■■ ■■■ MME■■■■■■ 7 j oil Foundation Basement Ext. Walls v interior • TOWN OF SOUTH D'`Pikm.RTY RECORD CARD )�VNER STREET VILLAGE DIST. SUB. V LOQ" C"Z, Y) � 0 Tee' S� e � JGl1� '4 FORMER OWNER N E ACR.R' S W TYPE OF BUILDING v) c e ca )i I C ; ES. SEAS. j VL. FARM COMM. CB. MISC. Mkt. Value LAND i IMP. i TOTAL DATE REMARKS AGE ! BUILDING CONDITION NEW NORMAL ! BELOW ABOVE FARM Acre Value Per Value i Acre Tillable 1 Tillable 2 I "illable 3 Voodland iwampl,and FRONTAGE ON WATER FRONTAGE ON ROAD 3rushland louse Plot DEPTH ! �� i BULKHEAD f otaI DOCK COLOR TRIM M. Bldg. Foundation Both Dinette Extension Basement Floors K. Extension Ext. Walls Interior Finish LR. Extension Fire Place Heat DR. Type Roof Rooms lst Floor BR. Porch Recreation Roorr Rooms 2nd Flooi FIN. B. Porch Dormer Breezeway Driveway Garage Patio 0. B. Total x • • NOON■■■ NOON■NONE■■■■■■■MEN EEE■NN■ NOON■EMEN NN■■N■■MEN .>� ■■NN■■ON■■■■■■E MEN EE■EEEMEN u ■NNO■NESE■■■■■EEE■■■■NNE■■■ rL A , t , } r, ► NEON■■■ NOON■NN■ ONO mom ■NEEM■ .' 1 !,'f, i `"T.. i1 � � 4f iEy-3,tiih' 'rf�itii -• •■�.�� EE■■ tf _-- Y atmom NONE ■N■EEN■EN OEEON'J�N ■■■ i� aNN■■EEO■■■ ■■■ENIn NONE NONE■■NNE ENNRON1■EEENENNNEON 4 ; NONEEE■ ■Il►�■■■■EEE■■■EENONE u " ` rteY " "Y ■■■NEE■ ■■■■EEEN■■NN■NENONE MMMEME In In In ■E■■EN ■■SEEM■■■■■■■■E■■■ Foundation Interior Fin a■� ._ Floor... .. . r . . . .. Dormer Driveway Celebrating James J.Norman 50 years 1914-1988 of Service JAMES J. NORMAN, INC. INSURANCE Since 1947 516-352-4774 P .O. Box 9 718-347-8877 14 Verbena Avenue FAX: 516-352-3286 Floral Park,N.Y. 11001 November 15, 2000 Town Of Southold Main Road Southold,NY 11971 ATT: Building Dept. Enclosed please find my check for$69.80 covering the demolition costs for the permit. Kindly forward to documentation to our home address at: Mr. &Mrs. Lawrence King, 73 Primrose Avenue, Floral Park,NY 11001. Thank you for your assistance in this matter. Sincerely yours, Marylou Norman-King /mlk. NOV 1 6 2000 f' Enc. ' BUILDING PERMIT REVIEW CHECK LIST Applicant/ Date Owners Name L. Reviewed: Jov Architect/ Date Engineer: Submitted: SCTM1I: �— District: 1,000 Section: 13 lock: Lot: Project 111`. - Subdivision Location: — 1 d Name: Single & separate Required certification: (Yes/No) Req. a Req. 7.oning District: (I,ot sizer Actual: / a„�(Lot coverage �Proposed Rey. Req. Req. [f=ront Yard Proposed: J (Side Yard Proposed: J [Rear Yard Proposed J Project Description: Dilyv � AGENOVERMITS Permit REQUIRED FOR REVIEW N.A. NO YES Number Suffolk County Health Dept. New York State D. E. C. v Town Trustees Town Zoning Board approval: Town Planning Board approval: Flood Plane Elevation ??? Flood Zone: 'Ate 6) :A� 7 e� r v� Ce I � I.ate Aa n P, R E:"5 _ - • Qc::,r i V5 (\ 74.80 ,Zb Do / o �. z s. zB`oo .dzb �,� _7o.B� i t ' LONG18"N'' 4 �IOYC/JLOYO!/GY!/fC g �t�ID LIGHTING c®,M,P,®,Nh� 550 Stewart Avenue, Garden City, NY 11530 March 23 1992 964-40-1715-18 . Peter J Sienk For Service At: Po Box 288 2205 Mill La Peconic NY 11958 Peconic NY 11935 Dear Mrs. Sienk: As requested, we have made tLe rcessary arrangements to close Your account with L'.^_. onr'03 -24 will be -" `'i1oi'ily thereafter, we 'Mailing your final~Lfi- bill folr your account. We would greatly appreciate mail your final payment to uit if you would take a moment and s as soon as. You bill. Your prompt payment helps lower electric bills eforvallour customers. We have enjoyed serving you and hope we , ,.serve- you -again' sometime .in the � future. - - can If we can be of any - - '- -' further assistance to 'You., hesitate to call us at (516) 727-2250, 24 a week. hourspaedae do not Y, 7 days Sincerely M. Halsey Customer Representative Lawrence W. & Marylou King 73 Primrose Avenue Floral Park, New York 11001 August 29, 2000 Town of Southold Building Dept 53095 Main Road Southold,NY 11971 Gentlemen: I am submitting an application for a building permit, which is attached to the letter. I am requesting approval to demolish a one story dwelling, which no structure will be built in its place. I will ensure that the following items are addressed: The foundation and all footings will be removed and any depressions backfilled to ground level. The cesspool will be located, the structure collapsed in and any depressions filled in. The structure utilized well.water. This pump will be located and rendered inoperable. A letter is attached showing that the previous owner closed out the electric service in 1992. The power has been disconnected from the structure. Lastly, I have enclosed my check for $189.50 to cover the fee for the -permit. Any questions,please contact me at(516)-775-9744. Sincerely yours, Lawrence W. Kang M i SHo 3 26G0 4 L I PA Long Island Power Authority September 12, 2000 Mr. Lawrence King 73 Primrose Road Floral Park NY 11001 RE: 2205 Mill Lane, Peconic LIPA Reference#88015-940 Dear Mr. King: Please be advised that LIPA removed the electric service to the above captioned-premises on March 22, 1999. Thank you for this opportunity to be of service to you. Very truly yours, Fred Vaupel Regional Supervisor Eastern Suffolk FV/mad r - /1/�/,4./VI/ �.� VENUE' •• ��'rv�r/� R oa c�) - _ . . SURVE YEO AOR h ' A7 VA— ? Lof 3 ° it , T A"&, ow /iic c d � sCQoe o � z Pam k Q97 ) $ L o f L/ vUH ya MAP m s. is ' oo W, zoo. o Ba /e- 0 a i/c y Pcr rF Guo royf�eo/ �v f/ic i�r6�se Ti'/% G�o`a'�r�y Corr+%vc�ry qs sUr�ey o 7` LJicA- i"-5c�f/ ./'i'/rd ire 07'-7470 W l�Gr/r 7ICi c e o f /Vo. V - �� .GiC��rs�a� La�rc/ Serve,yor: ��i�� /Vo. S; 3 ZZO e G r-�frvor�l /ve-w �r� FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. (THIS BUILDING PERMIT PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 26925 Z Date NOVEMBER 15, 2000 Permission is hereby granted to: LAWRENCE W KING 73 PRIMROSE AVENUE FLORAL PARK,NY 11001 for : DEMOLITION OF AN EXISTING DWELLING AS APPLIED FOR. at premises located at 2205 MILL RD SOUTH/PEC County Tax Map No. 473889 Section 067 Block 0007 Lot No. 007.001 pursuant to application dated SEPTEMBER 11, 2000 and approved by the Building Inspector. Fee $ 69.80 ORIGINAL Rev. 2/19/98 __ TOWN 0;: SOU'r~40~Lq ...... j FORi~ NO. I 'TORN OF SOUTHOLD BUILDING DEPARTHENT TOI~I HALL SOUTUOLD, N.Y. ]]97l TEL: 765-1802 Disapproved a/c .................................. APPLICATION FOR BUILUINO PER}tIT INSTRUCTIONS BOARD OF HEALTH ............... 3 SETS OF PLANS ............... SURVEY ........................ CHECK ......................... SEPTIC FORN ................... DEC ........................... TRUSTEES ...................... CALL ........ HAlL TO: ..................... . a. Tais al~lieatio~ ~ast 1~ empIete'~y filled in ~ ~iter or in i~ ~ ~itt~ to ~ Building Ins~ctor 3 ~ts of pl~, ~te plOt ~ to ~ale. F~ ~i~ to ~le. b. ~ot pl~ ~ l~ti~ of lot ~ of hildi~ ~ ~s, ~lat!~ip to ~joini~ pr~s or ~lic , st~ts or ~, ~ gi~ a ~tail~ &~ri~i~ of l~t of ~ ~t ~ dr~ m ~ di~ ~i~ is ~rt of ais ~li~ti~. c. ~ w~ ~ ~ ~is a~liati~ ~ mt ~ ~ ~fo~ is~ of ~ildi~ Pemit. d. ~ ~al of ~is ~liati~, ~ ~ildi~ l~ctor ~11 is~ a ~ildi~ Pe~t to the ~li~t. ~mit ~11 ~ ~ ~ ~ ~s ~il~le for i~ti~ ~t t~ wrk. e. ~ ~ildi~ ~11 ~ ~i~ or ~ in ~le or in ~ for ~ ~ ~at~r ~til a ~rtificate of ~ ~all ~ ~ ~t~ ~ ~ hildi~ I~t~. ~I~ IS ~ ~ to ~ ~ildi~ ~t for ~ isae of a hildi~ h~t ~at to t~ ~ildi~ ~ ~i~ of ~ T~ of ~ld, ~ffolk ~, ~ Yo~, ~ o~er a~li~le ~s, ~di~s or ~ati~, f~ ~ mt~tim of hildi~s, ~iti~s or alterati~, or for r~al or ~liti~, ~i~. ~ ~li~t ~s to ~ly ~ all ~li~le 1~, ordi~s, ~ilding ~, ~i~ c~e, ~, ~ to ~it m~i~ i~t~s m m~s ~ in hildi~ for ~s~ in~ti~s. ...... ....................... . ~~ ~-~ (Si~e of ~li~t, or ~, if a ~ration) State ~heflaer applicmat is a~rer, lessee, agent, arehite~t, engineer, ~ral c~tractor, el~trici~, pl~r or ~ilder ~ of ~ of ~, ...~'~.~..~... A.. ~.~... ~.t~ ....... ~P~ M~ ........... (~ m ~ t~ mi1 or latest ~) ~~~~ If ~limt is a ~ratim, siam of ~ly ~t~ri~ 6fficer. and title of corporate officer) Builders License No .......................... Phsubers LicenseN o .......................... Electricians LiceuseNo ...................... NOTIFY BUILDING 755-1802 9 AI/,TO 4 PM FOR THI FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE' 2. ROUGH - FRAMING & PLUMBIN~ & INSULATION 4, FINAL · CONSTRUCTION BE COMPLETE Other Trade's Li~o. se ~ ..................... ALL CONSTRUCTION SHALL MEET ~ti~ o~ ~ ~ ~i~ ~ ~ ~n ~ ~ .................... .~T~I~ GONSTfi~GTION & ENEflQY "COD/ ' '~t¥fl~dP~'g~E'FOR .... )F.~. NOT ~'Z05 [dl ig.L. ROAD DES ~1~ ~)~i)lq6TR U CTIO N ~ ~r fit~t ~T~. I~ kti~ ...... ~. ...... BI~ ....7 .......... ~t ...... ~t~ ...... ~ivisim ...................................... Fil~ ~ ~ ................ I~ ............... (~) 2. State ~sti~ ~ ~ ~ of ~i~s ~ inte~ ~. ~,~i~ ~ ~ ~ ....... ~.<!-J.~ ........................................................ ~. ~t~ ~ ~ ~ ....... .~k.~. .... ~F..}.~k~ ............................ 3. F;~ture of ~rk (ct~ ~d~ich applicable): ~ Building "]7' .... Nlditiee .......... Alteration .......... Repair ............ Removal ............. Demolition .... .~ ...... Other Work .................................. Oleacriptiun) 4. Estimatnd Cost fee · ............ (to be paid un filing this application) 5. If &elling, nt~r of dwelling onlts ..... [ ...... l~r of ¢k~lling units oo each floor ..... I .......... If garage, nmber of cara ........ .~.. .......................... 6.. if ~i.~ss. ~re{al or ~i~ o~y. s~ify ~tu~e ~a exte, t o~ ~ad, ty~ of ,,~ ....... ~.~ ........... " ' ' .q~'. ' . Z0' ?. Dimen$iuns of existing structures, if any: Front ............ Rear ...... .1~. ..... Depth ................ tleiO~t ......... ....Ig! ............ Nt~r of Stories ...... { ............... Dinensions of sane structure with alteratiorm or additions: lh~nt ...... htt/~... Rear ............... Depth .................... lteight .................... Numl~r of Stories ............... 8. Dimensions of entire n¢~ construction: Front ....... ~.//~ .... Rear ............... Depth .............. Deight ......................... l~r of Stories ..................... 9. Size of lot: Frunt ....... ~9.'. ........ Rear Deptl, . ...... ............. ......... ~0. ,~te of ~a,~ .... .0.~/~.~.~ ..... .~ o~ Po~r O~r ...... ~.1.~.~.~. .......................... I I. ~ or u~ distrleC in ~dch premises are sltuat~d .............................................................. 12. Doee proposed constnactlun violate any zoning la~ ordi~mnce or regulation: ..... ..~. ................ 13. Will lot be regraded ...... .l~..O. .......... Will em:es,s, fill be removed ~ran premises: 'I~ FLM'~,I:. PK~I~ ll~ Nme of Arddtect .................................... /~tdress .............................. Phone ~ ............... 15. Is this property within 300 feet of a tidal ~tland? * YES .......... ~ ......... · iT ~ES, ~ ~ '111~-11~ ~ ~ 1~ 1~l~'~. ' PLOT DIAGRAH ~ l~cate clearly and distinctly all buildings, ~betlmr existing or proposed, and indicate all set-back dimensions fa-om property lines. Give street and block t~m~ber or description according to deed, and sho~ street nares and indicate whether interior or corner lot. .................................. ~.-.,.5~ .................. being duly s',~nl, deposes and ~ys tlmt ~ is tbe a~li~t De i~ tbe ............. ' ..... .:..; .... ~PSg ............................................................. o~ ~i~~a~.:~ is ~ ~th~ix~ to ~rfo~ or h~ ~rfo~ g~ ~id ~ ~ tu ~ ~ file this a~tic~; ~1~ e~~ai~ i, fids a~licati~ are t~ ka the ~sC of,his ~1~ ~ ~lief~ a~ that ~,~ ~1[ .~O~ in .~ ~a~r ~t forth in ~e a~licati~ fil~ t~. '* .9~orn to before me this ..... .. ~ .......... day o~ .... ~.E..P..1~:..~...~.. !~9.0. i~.... BARBAR~ M. MATZERATH Notary Public. State of New York No. 30-7768125 Qualified in Nessau County Commission Expires April 30, '1~ ~'~ .";.- (Sisnature of Appli,cant)