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HomeMy WebLinkAboutTR-4931Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 May 21, 2003 BOARD OF TOWN TRUSTEES TOWN OFSOUTHOLD Ms. Judy Teevan Ms. Paula DiDonato 325 Willow Point Rd. Southold, NY 11971 RE: 325 WILLOW POINT RD., SOUTHOLD SCTM#56-5-26 Dear Ms. Teevan & Ms. DiDonato: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, May 2 l, 2003: RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to Permit g4931 to include the existing docking facility consisting of a 4'X 4' platform, a 14' ramp, and two (2) 6'X 20' floats, and as depicted on the survey prepared by Joseph A. Ingegno, dated June 5, 1998. This is not a determination from any other agency. If you have any questions, please call our office at (631) 765-1892. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK:lms Telephone (631) 765-1892 Town H',dl, 53095 ~ Road P.O. Box 1179 Sour. hold, New Y~xk 11971 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Tuesday, May 13, 2003, the following recommendation was made: Moved by Melvyn Morris, seconded by Bill Cook, it was RESOLVED to recommend to the Southold Town Board of Trustees DISAPPROVAL of the Amendment Request of JUDY TEEVEN & PAULA DIDONATO to Amend Permit fl4931 to include the existing docking facility. Located: 325 Willow Point Rd., Southold. SCTM#56-5-26 The CAC recommends Disapproval because the diagram submitted does not match what exists. The float should be reduced to 6'X 20'. Vote of CounciL: Ayes: All Motion Carried Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Tmvn Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD March 19, 2003 Ms. Judy Teeven 325 Willow Point Road Southold, NY 11971 SCTM#56-5-26 325 Willoxv Point Road Southold, NY 11971 Dear Ms. Teevan: The following action was taken at the Southold Town Board of Trustees Regular Meeting on March 18th, 2003. RESOLVED, that the Southold Town Board of Trustees Approve the request for a Transfer of Permit # 493 l dated June 25, 1998 from Clifford C. Comell to Judy Teeven for a 110' bulkhead. If you have any questions, please contact our office at 765-1892. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK:cjc Board Of $outhold Town Trustees SOUTHOLD, NEW YORK PERMIT NO. q931 DATE: ..,JZune 25,. 1998 ISSUED TO .. Clifford ..C. Cornell ,utl rt atta. Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1893; and Chapter 404 of the Laws of the State of New York 1952; and the Southold Town Ordinance en- titled "REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;" and in accordance with the Resolution of The Board adopted at a meeting held on 6: 24 ...... 19 98, and in consideration of the sum of $ ...... paid by .. based on application of March .1972 ........ of ............. N.Y. and subject to the Terms and Conditions listed on the reverse slde hereof, of Southold Town Trustees authorizes and permits the following: Grandfather permit onll0' bulkhead based on application and letter of 1972 at 325 Willow Point Road, Southold. SCTM #1000-56-5-26 all in accordance with the detailed specifications as presented in the originating application. IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporate Se. al to be affixed, and these presenf~ to be subscribed by a majordy of the sdd/8oard as of thJs.dat~.. ,. / ../~ /----~ -47 .. '> ..... >' Tr~slees ,Tudy Teeven 325 Willow Point Rood $outhold, NV 11971 February 20, 2003 Lauren Standish, T stopped in a few times as T was searching for permits rel appreciate your help and advice. As you suggested, I am taking the first step and enclosed written to the Southold Board of Trustees requesting that foot bulkhead on my property (Permit # 4931) be transfen requested that the permit be amended to include the floati has been attached to the bulkhead for many years. Enclosed is some supporting documentation as well including: ~' A copy of Permit #493! ~' A copy of the property survey for my home which includes the floating dock facility (I have the original survey in the event someone needs to see it) v' A copy of my most recent tax bill that links my address to the property and to the enclosed survey ! am hoping that this can be resolved in a relatively short time frame. If you need anything further, please feel free to reach me at (631) 765-5043. Again, thanks for your help. Judy Teeven 325 Willow Point Road Southold, NY 11971 February 20, 2003 Southold Town Hall 53095 Main Road Southold, NY 11971 Attention: 8oard Of Southold Town Trustees Dear Board Members: I am writing to request the transfer of an existing permit to my name. T purchased a home in Southold at the above referenced address in June, 2000. I am writing to request that the existing permit #4931 be transferred into my name as I am now the owner of this property. Tn addition, I would like to request that the permit be amended to include the floating dock facility that is and has been attached to the bulkhead (see attached property survey). For your convenience and review, T have attached three documents that may be helpful: Attachment I - Board of Southold Town Trustees Permit # 4931 dated June 25, 1998 Attachment 2 - A copy of the property survey (Lot 24, 56-05-26) dated June 5, 1998 prepared by Joseph A. Ingegno, Land Surveyor Attachment 3 - A copy of my most recent tax bill indicating the Suffolk County Tax Map Number and property location [f ] can answer any questions or provide any additional information, please feel free to contact me at (631) 765-5043. T thank you in advance for your consideration and attention to this matter. Sincerely,~,~ Enclosures: Copy of Southold Town Permit #4931 Copy of property survey for Lot 24, 56-05-26 (325 Willow Point Road) Copy of 2002-2003 Town of Southold Property Tax Bill Board Of Southold Town Trustees SOUTHOLD, NEW YORK PERIvlIT NO. iJ~d~l DATE: '"3~ne ?'5 "" 1998 ISSUED TO Cllffor.d...¢.- · Gor.nell. · ................... Pursuant to the ·provisions of Chapter 6lB of the Laws of the State of New York. 18931 and Chapter 404 of the ,L.a. ws of the State of New York 1452: and the Southold Town Ord,nance en- titled ."REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and REIvIOVAL OF SAND, GRAYEL OR OTHER MATERIALS FRONI LANDS UNDER TOWN WATERS:" and in accordance wlth the Resolution oJ The Board adopted at a meeting held on . ~.. 7. 24 .... 19....9.8, end in consideration of the sum of $ ........... paid by ..~ased .gn.. application of. March...19.~.Z ........................ "' N.Y. and subject to the f'Terms and Cond_i . ~L-.:.~. ~nd oermtts the foJlowmcJ. of ............. i~io~, li'ded'0~ "the rev?e side h.~re.o of Southold Town/rus~ees au,-~, ...... Grandfather permit onll0' bulkhead based on application and letter of 1972 at 325 Willow Point Road, Southold. SCTM ~1000-56-5-26 ell' in accordance with the detailed specifications es presented in the oricjinatin9 application. ,..W.,TNESS or orate ~eal TO De aTr~Xt~'g, is by causes Its ~ P · '- ~ the said/Board as of t~is/cl . be subscribed bYa mal°r"y O T ~~~. CANAL LEADING S 88'26'20" 473889 56.-5-26 325 WILLOW PT RD TOWN OF SOUTHOLD I IF THE WORD 'ARREARS" IS PRINTED HERO'SEE ,4¢¢elRak NUMBER I BILL NUMBER COUNTY TREASURER'S NOTICE ~ 610 ON REVERSE SIDE. 08 6466 0.41 295,457,299 1,598,350 TA08433 210 1 FAMILY RES ........... AUTOCR*'R-002 TEEVEN JUDY & DIDONATO PAULA 325 WILLOW POINT RD SOUTHOLD NY 11971.1404 I,,,ll,,,lll,l,,l,,,I,,,ll,,,ll,l,,lll,,,,I,,I,,I,l,l,l,,I,l,I 12/5/02 TEEVEN JUDY & FJrst Haiti 5433 SUFFOLK COUNTY TAX $OUTHOLD TOWN TAX NYS REAL PROP TAXLAW SOUTHOLD FIRE DIST . SOUTHOLD PARK DIST. WASTE WATER DISTRICT STHLD SOL WASTE DIST 2,200 10,800 2001-2002 TAX PAYMENT INFORIVIATIOIXI LEVY % TAXABLE VALUE ~T~UNT TAX LEVIED FOR SCHOOL TAX LEVIED ~ FOR COUNTY  21.92% 10,800., ( ~73 0~2 6.90% 1,869.29 TAX LEVIED ~ FOR TOWN 0.33% 10,800 2.629 -45.00% 28.39 4.75% 10,800 37.483 3.30% 4~.82 1.69% 10,800 13.361 4.50% 1~.30 0~.22% 10,800 1.706 27.90% 18.42 TAX LEVIED ~ FOR FIRST HALF TAX 4,263.88 SEcoND HALF TAX 4,263.89 ISIDE FOR PENALTY SCHEDULE AND COUNTY TREASURER S NOTICE OTHER TOTAL TAX LEVY · 8,527.77 THIS TAX MAY BE PAID IN ONE OR TWO INSTALLMENTS BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD April 10, 1972 Southold Town Board 16 South Street Greenport, New York 11944 Gentlemen: The Board of Town Trustees waive objection to the applications of George K. Dornauer and Clifford C. Cornel1 for a Wetlands permit on the grounds the property was filled to several feet above the highest high tide a number of years prior to the passage of the Wetlands Ordinance. All of this property was excavated from private land, and none of it is now, nor ever was under the jurisdiction of the Town Trustees. The Board of Town Trustees feel the proposals of George K. Dornauer and Clifford C. Cornell do not conflict with, nor have any detrimental affect on any Wetland Ordinance provision. Very truly yours, Alvah B. Goldsmith, Chairman Board of Town Trustees /jb -, TOWN OF SOUTHOLD TOWN CLEPd<'S OFFICE S OUTHOLD, N.Y. APPLICATION FOR WETIJiNDS PERMIT Application No. Identity of Applicant Address of Applicant INSTRUCTIONS FOR PERMIT A. This application is to be completely filled in by typewriter oz- ink and submitted to the Town Clerk in quadruplicate, accompanied bv written permission from the owner of the property if not the same as the applicant. B. Pilot Plan must ]De drawn to scale on the reverse side of this application showing the location of property, the names and locations of owners of adjoining properties, and a detailed description of proposed project. (Note: Copies of the Pilot Plan may be made by a copy machine and attached to the Permit Application.) C. No operations shall be initiated by the applicant until all permits that are required are issued. D. A detailed statement of the rehabilitation and proposed conditton of the premises after the work is completed must be given, including a survey if required. E. If permit is being sought for a more sizeable excavation than the construction of a private single dock or jetty, then this application must be accompanied by a survey and topographical map certified by a registered land survey or Professional Engineer. The horizontal control of surve~~ shall be based upon an approved local coordinate system. The vertical control for elevation and soundings shall be based upon United States Coast and Geodetic Survey and.'or United States Geological Survey datum. F. A statement must accompany the application describing any known prior operations conducted on the premises in question and whether any prior licenses or permits have been issued ~o erect structures or to dredge or deposit fill on said premises and whether any such permits or licenses were ever revoked or suspended by a governmental agency. G. A filing fee of $25.00 shall accompany the application. This filing fee includes one inspection, there is a $5.00 fee for each additional inspection. H. The Town Board upon request of the applicant for a permit, may waive in whole or in part, the provisions of Article II, Section 210, subdivisions (d) and (g) where it finds that the nature of the proposed operations are such that the requirements of such provisions are not necessary for a proper considertion of a permit application. I. Upon approval of this application the Town Clerk will issue a permit to the applicant. Such permit shall be available for inspecO tion at any time, upon request. Page 2. Examined Approved Disapproved Conditions, 19 if any Examining Body. Signature of Chairman APPLICATION IS HEREBY ~5~DE to the Town Board of the Town of Southold, Suffolk County, New York, for the issuance of a permit pursuant to the Laws, Ordinances and Regulations governing the Coastal and Interior ~tlands, Flood Plains and Drainage Areas of the To%~ of Southold: Permit requested to Location of property for which permit wanted Home address of permit applicant if different from aforesaid location Creek, Bay or Harbor fronting property Size of proposed work: Lengnh I[© Width ] ~ Height Above High Water Depth Below Low Water Yards to be Excavated Yards to be Filled Width of canal, creek or bay property ~--~ I fronting Depth at Low Tide Average Rise in Tide FORM NO. 1 TOWN OF SOUTHOLD BOARD OF TOWN TRUSTEES TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ................................ 19 ..... Application No ................... Approved ............................................. Permit No ............................. Disapproved a/c ............................................................................................. ..................................................... cbairman, Board of Trustees APPLICATION FOR PERMIT INSTRUCTIONS A. This application to be completely filled in by typewriter or in ink and submitted to the Town Trustees in dup- licate. B. Plot plan showing location of lot and buildings on premises, relation to adjoining premises, public streets, parks. etc., and giving detailed description of proposed layout of project must be drawn on diagram which is part of this application. C. The work covered by this application may not be commenced before the issuance of a permit. D. Upon approval of this application, Town Trustees will issue a permit to applicant. Such permit shall be kept on the premises and available for inspection at all times. E. Applicant shall notify the Board of Trustees upon completion of the work covered by permit. APPLICATION IS HEREBY MADE to the Board of Trustees of the Town of Southold, Suffolk County, Nexv York, for the issuance of a permit pursuant to the laws, Ordinances and regulations governing construction of: docks, piers, bulkheads, jettys and dredging in, under, and over the waters of Town of Southold. The applicant agrees to comply with all applicable laws, ordinances, regulations and conditions specified by said trustees, and to hold the Town of Southold, and all Town off~,'als/g/./~///~/~//~r~e frpn~l~bility anql damages~_.~_~ ~°f any kind. ~ Name of Owner of Premises ..... (--x//./~ c)...~.~. ~.~-L~//ff.~. ./. /. ...... ~q~.~.}h../~ .(.~lDlff.~q.. ~,~.[~ .................. Street Address of Property ...~._~, .~7.,.t,.i&t~ .~.O~..-~.O.hp,~[_...~..0o~' ..... .~O'a-'lr~ o l~ ...................... Home Address If Otber Than Location ....... .-~xv~. ~. ...................................................... Creek, Bay or Harbor Fronting Property ...~..%.T-. t...°..~7../?~ ¢*.t~.0.'~... ~..©..~.[3. ........................... Permits Requested To: . ~..~.~..C, .~.../?.pLa:Tr~/. !4. ~ ¢~ ~.~ ..................................................... Size of Proposed Work: Length . ~./.~..~i~ .... ~Vidtb ... ~..~... Heighth Above High %Vater .............. Depth Below Low Water .............. Average Rise In Tide ...'23.. C?.t.( .... Yards to Be Excavated ........... \Vidth of Canal, Creek or Bay Frontin~g__~opert3i.....~'. (D.'. .............. Depth at Loxv Tide ...(..o. { ........... Is This For Private or Business Use? . ~ ./7/~.~ .c~..~..~. .......................... Area Zoning .......... Complete plot plan to be drawn on reverse side of this application. STATE OF NEW YORK ) )s.s. COUNTY OF SUFFOL~ ) ...~..~.~..~.~..O~d....~....~'~..]...~... being duly sworn deposes and says that he is the applicant for the above described permit, and that all statements contained berein are true to the best of his knowledge and belief; that the xvork will be done in the manner set forth in the application and as approved by tbe Board of Trustees of the Town of Southold, and the applicant agrees to hold the Town of Southold and sa}d trustees harmless and free from any and all damages and claims arising under or by virtue of said permit. ...... .............. /~ (applicant) Sworn to before me this .. ~9~ ........ day of . .~*~ ............... 19.~... ......................... .......... JUDITH T. BOK[N TOWN OF SOUTHOLD BOARD OF TOWN TRUSTEES TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ................................ 19 ..... Application No ................... Permit No ............................. Approved ............................................ Disapproved aJc ............................................................................................ ................. chairman, Board of Trustees APPLICATION FOR PERMIT INSTRUCTIONS A. This application to be completely filled in by typewriter or in ink and submitted to the Town Trus'tees in dup- licate. B. Plot plan showing location of lot and buildings on premises, relation to adjoining premises, public streets, parks. etc., and giving detailed description of proposed layout of project nmst be drawn on diagram which is part of this application. C. The work covered by this application may not be commenced before the issuance of a permit. D. Upon approval of this application, Toxvn Trustees will issue a permit to applicant. Such permit shall be kept on tile premises and available for inspection at all times. E. Applicant shall notify the Board of Trustees upon completion of the work covered by permit. APPLICATION IS HEREBY MADE to the Board of Trustees of the Town of Southold, Suffolk County, New York, for the issuance of a permit pursuant to the laws, Ordinances and regulations governing construction of: docks, piers, bulkheads, jettys and dredging in, under, and over the waters of Town of Southold. The applicant agrees to co nply with all applicable laws, ordinances, regulations and conditions specified by said trustees, and to hold the Town o~ Southold, and all Town officials free from liahility and damages of any kind. Name of Owner of Premises .~ .J.~ .¢. ~.O. J~.~l...~ 0.~, .~/ff, ~.k-~ ............ ~L2 ............................... Street Address of Property ...... '"' Home Address If Other Than Location ................................. Creek, Bay or Harbor Fronting Property ....~ .5{.~.....Q..F:...I~¢L{~. ~..~'-'~.-.~.°. .~.~' ........................... Permits Requested To: ...'-~. O.. I~.~,-.a.C--.-[- .... ~ ~ 1.[~. l~.l.~. ~.l~ .......................................... Size of Proposed Work: Length ] l O \Vidth .... ]..~.T".. Heighth Above High Water ............. ................ It' Average Rise In Tide 3 O Yards to Be Excavated ........... Depth Below Lo~v Water .............. , / - O t Depth at Loxx Tide ....(,Ja ........... '~Vidth of Canal, Creek or Bay Fronting Prope.rty . . · ~- .................. Is This For Private or Business Use? ..../~./~.t.~.~l. ?/~---. ...... Area Zoning ................ Complete plot plan to be drawn on reverse side of tbis application. STATE OF NEW YORK ) )s.s. COUNTY OF SUFFOLK ) · orne].l bein~ duly sworn deposes and says that he is the applicant for the above described ...~]..l,~Q$'.d...(~ ............ -.~ ...... the ~)est of his knowledge and belief; that the work permit, and that all statements containea hereto are true [u will be done in the manner set forth in the applicatiou and as approved by the Board of Trustees of the Town of Southold, and the applicant agrees to hold 'the Town of Southold and said trustees harmless and free from auy and all damages and claims arising under or by virtue of said permit. ... · ' '~'~ .... ('~lii~;,;~i ..................... Sworn to before me this .. 3.0~h ........ day of . lCmr. ¢.h. ............ 19'7"'2"' .................... o, ........ Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES · TOWN OF SOUTHOLD LETTER OF REQUEST FOR AN Southoid Tow, Board of Trustees AGENT PHONE ADDRESS ?~o?~'r¥ ~oc^~nos 3~ ~lt~ ~&k ~ ~ ~ ~t~ ~ 4~ ~Pa~h ~ r~ucstan~endmenttoP~t~ ~l Signed By: ~4~'~?gt~A/X. April 14, 2_003 Judy Teeven 325 Willow Point Road Southold, NY 11971 Lauren Standish Town Hall 53095 Main Street Southold, NY 11971 Lauren, ! am requesting an amendment to' an existing permit for a 110 foot bulkhead (#4931~) to include a docking facility is and has been attached to the said bulkhead for over 20 years. This permit was recently transferred into my name at the March 18th Board of Trustees Meeting. My understanding is that the next meeting is tentatively scheduled for May 21~. Enclosed to support this request is the following: ,/' Check for $40.00 ~' Letter of Request for an Amendment ~' Copy of a land survey of above referenced property ~' Notarized Proof of Mailing of Notice with certified receipts attached ,f Notarized Board of Trustees Application ,f Photos of dock ramps from property ! believe that this is all that is required. ! am hoping this matter can be addressed at the May 21st meeting. !f you need anything further from me prior to the meeting, please feel free to contact me at (6311) 765-5043. Thanks in advance for your help. Judy Teeven Enclosures: $40 Check Letter of Request for an Amendment Copy of Land Survey for 325 Willow Point Road Notarized Proof of Mailing Notice (with receipts) Notarized Board of Trustees Application Photos of dock ramps at 325 Willow Point Road Albert j. Krupsld, President James I~ng, V/ce-President Henry Smith Artie Foster Ken Poliwoda BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall · 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone/631) 765-1892 Fax (631) 765-1366 BOARD OF TRUSTEEs: TOWN OF SOUTHOLD In the Matter of the~Application * I , J/ AFFIDAVIT OF POSTING ~, residing at being dul .... · ~ uu~y SWorn, deDo~ =-4 _ Fu~e ana say: That on the Dy placing the ~' ^~'~2 . f,~,.L~ ~u ,~ ted the easily be seen ~;~. rustees offici~] ..... ~ . has remained ~ublic hearing" ~x~ce for eight days D ~ u= Sure.the poster ~ ~7~%~f.~ear~n~ not-ed=~e~ ~he ~ate of.~he -- '-' /v~~ . =u. ~ be held ~, Dated: Sworn to before me this II day o~ ~ 200~, Il Notary Public I~ ~lC°m~on..w?~t~ o~ ~lasSa~usettsll II Y ~mmlss~on Expires Il PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS maine: STATE OF NEW YORK COUNTY OF SUFFOLK Address: 1 8 2O03 Southold Town Beard of Trustees , residingat '~/.<5 W;[IM i~h~ O00o~-, 3(I/~D!~-, }3'[ ~ , being duly sworn, deposes and says that on the registered)mail. ~tk day of ~.' [ ,20 07~, deponent mailed a tree copy of the Notice set forth, in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post , that said Notices were mailed to each of.said persons by Sworn to before me this "l ~ Day of p~ [ ,20 03 Nota~ublic II Notary Public' JlCom~onwssllh of Massachusettsl! II y Commission Expires ~...temb~r 6, 2007 Board of ~tees Application County of Suffolk state of New York DEPOSES AND A~IFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WoRK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE soUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANTAGREES TO HOLDTHETOWNOF sOUTHOLDANDTHETOWN TRusTEEs HAPd~.RSS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S)', IF GRANTED. IN cOMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESElqTATIVES(S), TO ENTER oNTO MY PROPERTY TO INSPECT THE pI~EMISES IN CONJUNCTION WITH REVIEW OFT HIS APPLICATION. -gh/akur~e~ SWORN TO BEFQ~RE ME THIS Nof~-publlc ] :7; ,LYM O)IZSI~IN¥~I AYM '¥ ¥ON,kq ONZSIqlNYH SV~IOHI : O u~ k,g L ."'g S m 0 0 · oD g[Y'O (INn dVn O]~l~ Oi) '~t 'bs Yo'gt~'gL = dzO~OL l ' (2NOd $,(~C[F18 0£ 3 ,,O~,9~.BB g DNIC[V~FI ~IVNVO APR 1 8 ~ ~