Loading...
HomeMy WebLinkAboutTR-5619Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson 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 January 23, 2003 Mr. Robert Krudop PO Box 1042 Mattituck, NY 11952 RE: SCTM#122~4-34 4650 Ole Jule Lane Mattituck, NY Dear Mr. Krudop: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, January 22, 2003. RESOLVED, that the Southold Town Board of Trustees Approve an Amendment to Permit #5619 to build a two story home with garage and in-ground (32x16) pool with the condition drywell for pool backwash - leaders and gutters for roof-run-off. If you have any questions, please call our office at 765-1892. Albert J. Krupski, Jr. President, Board of Trustees cc: Building Department AJK:cjc 2005 Field Inspi~l~on 2005 2005 Field Insp~on 13 IO:20AM 2005 Field lnsp~on Albert J. Krupski, James King, Vice-Preside~t Art[e 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 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: FROM: DATE: RE: Building Dept. Board of Trustees February 14, 2005 ROBERT KRUDOP 4650 OLE JULE LANE, MATTITUCK SCTM#122-4-34 With regard to the above-referenced property, an inspection was made and it was determined the single-family dwelling and garage were constructed in compliance with Wetland Permit #5619. Please be advised that the hay bale line must be re-established prior to construction of the in-ground swimming pool. If you have any questions, please do not hesitate to contact us. Albert J. Krupski, President James I~ing, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765~1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE ~//Pre-construction, hay bale line - constructed C//Project complete, compliance inspection. Telephone (631) 765-1892 Town H'~. 53095 Ma.ia Road P.O. Box 1179 Sour, hold. New Yot-k 11971 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Wednesday, January 15, 2003, the following recommendation was made: WARREN ULMET (Robert Krudop) to Amend Permit #5619 to construct a two-story ' dwelling with garage and 32'X 16' in-ground swimming pool. Located: 4650 Ole Jule Lane, Mattituck. SCTM#122-4-34 The CAC did not make an inspection, therefore no recommendation was made. Board Of $outhold Town Trustees SOUTHOLD, NEW YORK PERMIT NO. ~""1~1 q DATE: Sept. 25, 2002 ROBERT KRUDOP ISSUED TO .................................... Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1893: and Chapter ~ of the L~ws of the State of New York 1952: and the Southold ToWn Ordinance en- titled ."REOULATING 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 afa meeting held on .... ?~?~ ..~th, 2002 and in consideration of the sum of $ 200.00 paid by . P,-obert ..K~u.dop of ...... ~!~.~m.S.~5? N.Y. and subject to the Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and rmrmi~ fha- f*all~wlnn. Wetland Permit to construct a two story dwelling with garage, in ground 16 x 32 swimming pool with the condition that drywetls and gutters for roof run offand drywell for the backwash of the swimming pool. all in accordance with the detailed specifications as presented in the originating application, IN WITNESS WHEREOF, The said Board of Trustees kere~ by causes ifs Corporate Seal fo be affi. txed, and these I~.resenfs fo be subscribed by a majority of the satd Board as of this date. Trmtees TERk4S end CONDITIONS Tbe Permk,~ Robert Krudop' zesidi~ at 4650 Ole J~,le l,~. r~ttituck N.Y. ~s p~t of d~e conside~oa fo~ ~he is~'mmce of the 1~'~ does ~ ,md p~:Hbe to the fo1- L That the said Boaz'd ~ Trustees and the Town e~ Sou&old zre ~Jessed fz,~, ~ny md 2. That thls Permit h valld ~o~ a pesiod of 24 mos. ~nlch h comklem~ lo be dsc es~mat~ tlme'requized ~o comple~ the ~ involsed, but should ckcumstsaces watr,~. ~ for an ex~'~on may be made to the Board at a I.t~- d~_ ~. That this Permit should be ret*i~d inde~mltely, or as loo~ as the said F~ wish~ to mai~i~ the structure oz project involved, to provide es~lence to anyone concerned tl~ auth- orization was originally obtainecL 4. That ~he work iavolved will be subject ~o the inspection ami ~ of the Boazd ~ its agents, ami non-comp~;~,,ce with the p~ovislom of the o~inating application, may be cause fm s~ocadon of this Permit by ~esolutioa of d~e said Boanl. 5. That there will be no un~easonable inte~fez~ce with m~v/gation as · ~ of the herein -,,'thorked. 7. That Lf future operations of tl~ Town of 5outhold re~ite ~ z~m~'sd sad/or aliet'~m~ in the location o~ the work he.rein authorized, or iir, in fl~e oplni0o d th~ Board of Tms~e~ d~·' wozk d~.ll cause unrestsonable obsh-uc~on to f~ee navigatio~ the said ]Pemfittee will be ~ upo~ due notice, to ~move or alte~ this ~k o~ proje~x herein stated without ezpemes to the Towa 8. That the said Board will be notified by the Permittee ot ~he completion 0~ the watk ~ odzed. 9. That the P~mittee will obtain aH other permits ~nd consents that may be tequlted sup- plemental to this permit which may be subject to revolve upon f~!hLee to obtain same. Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson 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 September 30, 2002 Mr. Robert Krudop PO Box 1042 Mattituck, NY 11952 RE: SCTM#122-04-34 4650 Ole Jule Lane Mattituck, NY Dear Mr. Krudop: The following action was taken by the Board of Town Trustees during a Regular Meeting, held on September 25, 2002, regarding the above matter. WHEREAS, RobertKrudop applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated September 3, 2002. WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on September 25, 2002 at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standard set forth in Chapter 97-18 of the Southold Town Code. 2 WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approved the application of Robert Krudop for a Wetland Permit to construct a two story dwelling with garage, in-ground 16 x 32 swimming pool with the condition that drywells and gutters for roof run offand drywell for the backwash of the swimming pool. BE IT FURTHER RESOLVED that this determination should not be considered a determination made for any other Department or Agency, which may also have an application pending for the same or similar project. Fee must be paid, if applicable and permit issued within six months of the date of this notification. If inspections are required, at a fee of $5.00 per inspection (See attached schedule). FEES: $10.00 Very truly yours, Albert J. Krup§k'l, Jr. President, Board of Trustees AJK/cjc cc DEC Building Department 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 TOltrN TRUSTEES TOWN OF SO[FI~IOLD TO: Robert Krudop Please be advised that your application, dated September3, 2002 has been reviewed by this Board, at the regular meeting of and the following action was taken: gcpt~,b~ 25, 2002 ( X) Application Approved (see below) (__) Application Denied (see below) (__) Application Tabled (see below) If your application is approved as noted above, a permit fee is now due. Make check or money order payable to the Southold Town Trustees. The fee is computed below according to the schedule of rates as set forth in the instruction sheet. The following fee must be paid within 90 days or re-application fees will be necessa~j. COMPUTATION OF PEPZ~IT FEFS: T~vo inspec~io.s ~$5.u0 ~ ' TOTAL FEES DUE: $ 10.00 PRESIDENT, BOARD OF TRUSTEES BY: CLERK, BOARD OF TRUSTEES 4~98 - - Albert J. Krupsl~, President James K~ng, Yice~President Artie Foster Ken Po]/woda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0969 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED AVIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. ROBERT KRUDOP X INSPECTION SCHEDULE Pre-construction, hay bale line 1st day of construction ¼ constructed x _ Project complete, compliance inspectiop. Telephone (631) 765-1892 Town H',dl, 53095 ~ ~ P.O. Box 1179 Southold, Ne~ Yo~k 11971 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Monday, September 23, 2002, the following recommendation was made: Moved by Melvyn Morris, seconded by Bill McDermott, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH A CONDITION of the Wetland Permit Application of ROBERT KRUDOP to construct a two-story dwetli~g with garage and in-ground pool. Located: 4650 Ole Jule Lane, Mattituck. SCTM#122-4-34 The CAC recommends Approval of the application with the condition of a 25' non- disturbance buffer and drywells for the pool. Vote of Council: Ayes: All Motion Carried Z ,44 ,,91~,69.9/ 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 LE~FER OF REQUEST FOR AN AMENDMENT DATE . ADDPmSS %0 C 0~ -~d_~/~ A~SS~_~ ~ PROPERTY LOCATION TAX MAP NO. [oo0- l/We'-~_ o~-~ ~.~,_) ) Q request an Amendment to Permit #.~(o } q i~[: ~Z~-r ~- ~/V-~X~ o._~,~.~.,~') eo~. Signed By: PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS NalTle; Address: STATE OF NEW YORK COUNTY OF SUFFOLK I ~ day of , residing at Iq~> &'~ ~ _ / ~&o.~: _ , being duly sworn, deposes and says that on the ,20 o--,,.~ 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 Txown of Southold; that said Notices were mailed at the United States Post Office at ~ , that said Notices were mailed to each of said persons by (certified) (registered) mail. Sworn to before me this Day of ~ ,20 ~ t~ pu'~bli~ ~'~-~ [YNDA M. BOHN NOTARY PUBLIC, State of New York No. 01 BO6020932 Ouafified in Suffolk County Term Expires March 8, 20 ~ Albert J. Krupski, President James King, Vice-President Henry Smith Artie Fester Ken Potiwoda Town Hail 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 7654892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application Wetland Permit Applicationt~' Major Waiver/Amendment/Changes Received Applicatio~n: ,~[?~/0 Received Fee:$ ~ . . -- Completed Application ~ Incomplete SEQRA Classification: Type I Type II Unlisted .Coordination:(datesent) ~ t / CAC Referral Sent: Date of Inspection: c,[/[ Receipt of CAC Report: Lead Agency Determination: Technical Review: Public Hearing Held: Resolution: Name of Applicant Address ~-~C.) ~ ~C~),~t Minor Phone Number:( AGENT: (If applicable) Suffolk County Tax Map Number: 1000 - r~. Oq - ~q Property Location: (4t~C) Ole~ -~,.ke_ L~x, (provide LILCO Pole ~, distance to cross stre~s, and location) Address: Board of Trustees Application Land Area (in square feet): Area Zoning: Previous use of property: Intended use of property: GENERAL DATA Prior permits/approvals for site improvements: Agency Date ~No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspende~t~by a governmental agency? t/ No Yes If yes, provide explanation: Project Description (use attachments if necessary): ~0.~ ' ~~ Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area of wetlands on lot: ~ square feet Percent coverage of lot: l'%, (~ % 012 ~,2 ~ Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: · 5~ feet Does the project involve excavation or filling? No / Yes If yes, how much material will be excavated? (400 cubic yards How much material will be filled? ~ 400 cubic yards Depth of which material will be removed or deposited: ~. (o / feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): Board of Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity: Are wetlands present within 100 feet of the proposed activity? No ~///Yes Does the project invol~excavation or filling? No / Yes If Yes, how much material will be excavated?~ goo (cubic yards) How much material will be filled? ~'~ r'(oO (cubic yards) Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) 617.21 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I--PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 3. FROJECT LOCATION: 4. PRECISE LOCATION (Street aedress and road intersections, promi~pnt landmarks, etc., or ~rov,~e map) IS PROP D ACTION: 5. ~ [] Expansion [] Modification/alteration 6. DESCRIBE FROJECT BRIEFLY: 7. AMOUNT DP ~ND ~.~CTEO: urti~.t~'~~qg,?q I.z~Z a Initially 2 ~ q ~'~ acres res ~ ~ 3~ WILL ~ POSED ACTION COMPLY WITH ~ISTING ZONING OR OTHER ~ISTING ~ND US~ ~EST~TIONS? 8. ~ ~ NO If NO. descrabe briefly SEQ F-~ Agricuiture ~ P~r~<tForestlO~en space ~ Ott~er DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY PROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? L~ Yes L~e~o ff yes. fist agency{s) and Fermit/approvals 11. AS A RESULT OF PR SED ACTION WILL ¢_XISTING PERMIT/APPROVAL REQUIRE MODIFICATION? If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this as__.sessment OVER ! Albert J. l<rupski, President James King, Vice-President Henry Smith Artie Fester Ken Poliwoda Town 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 BOARD OF TRUSTEES: TOWN OF SOUTHOLD In/~he Matter of the Application COUNTY OF SUFFOLK) v STATE OF NEW YORK) AFFIDAVIT OF POSTING · residing at ~ ~ being duly sworn, depose and say: That on the day of , 200 , I personally posted the property known as ~Z~ ~-~---~,~--,n. [a~_~.~.~_ _ by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of ~, public ~earlng. Date of hearing noted thereon to be held~ ~4// .~.'urg Dated: I-I~';"~ Sworn to before me this /~ day of~. 2005 JOYCE M. WILKINS Notary Public, State of New York No. 4952246, Suffo!k County Term Expires .Jv~e The Town o~ S~u~hold's Code of Ethics Prohibits conflicts o~ tn~erest on the part of town officers and employees. The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary ho avoid same. ~ % ! ,...~ ~ .. ~ ~.. '., . (Last name, first name, m~dd.le~tntt~al, unless you ere applying ~n the name o~ someone else or other entity, such ~a a company. IE so~ indicate the other person's or company's name.) NAT~R~ OF APPhX~ATXON~ (Check all that apply.) Tax grievance Variance Change o~ zone ARp~val o~ plat , Exe~ption Erom plat or official map Other parent, or child) have a relationship with any o£~icer or ~mpXoyeo of tho Town of Southold? 'Relationship' includes by blood, marriage, or business int~re~t. #Business interest# ~ean~ a business, including a partnership, in which ~he town of£{cer or employee has even a partial ownership of (or employment by) a corporation in which the torn officer or ~mployee owns moro than 5% O~ the YES NO Ir you answered ~YES,#,compXete the balane~ o~ ~hi~ ~orm and date and s~gn vhere ~ndicated. Name o~ person employed by the ToWn oE Southold Title or position oE that parson Describe the relationship between yoursel~ (the applicant) and the town oEficer or employee. Either check the appropriate line A) through D) and/or describe in the apace provided. The town officer or employee or his or her spouse, s~bling, parent, or child is (check all that apply}~ .A) the owner o~ greater tha~ §% of the shares o[ the corporate stock of the applic~nt (when the applicant is a corporation)l B) the legal or bhnsficial owner o~ a~y interest fns noncorporate'entity (when the applicant is net a corporation)~ C) an o~ioer, director, part,er, Or employee, o£ the app[iuantt or __D) the a~tua[ applicant. DESCRIPTION OF RffLATION$IIIP 'Print Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall · 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fs~x (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In/~he Matter of the Application ........ STATE OF NEW YORK) AFFIDAVIT OF POSTING I,~O~ ~f , residing at being duly sworn, depose and say: That on the /~day of~, 200Z, I personally posted the property known as ~°O ~'~1~, ~r~f/ by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of~_e t~;blic hearing. D_at~e_ of _hea_~ring _not_ed t~hereon to be held*~ Dated: s~e) ~ Sworn to befor~/_.me~ this ~k ~o day of ~e~r 200~ JOYCE M. WILKINS Notary Public, State of New York No. 4952246, Suffolk County T~m Exoir~ June 12, PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Ad.ess: STATE OF NEW YORK corr ¥ oF svrm/x '-~-~, ~'oo",3.~ ,r~idingat I~ ~ ~- ~'%~ ~ I ~ , being duly sworn, d~os~ ~d sa~ ~at on ~e ~~yof ~ ,2~Z ,d~onentm~l~a~ecopyof~eNotice set fo~ ~ ~e Bo~d dfT~tees App~cafio~ ~r~ted to each of~e above n~ pemons at ~e ad~ses set opposite thee red.five ~es; ~t ~e ad~esses set op~site ~e nines ofs~d p~o~ ~e ~e M&ess ofs~d ~o~ ~ sho~ on ~e c~mt ~s~sment roll of ~e T9~ of Sou~old; ~at s~d Notices were m~led at ~e Uffit~ S~t~ Post Office at ~ok~ , ~at s~d Notices were m~l~ to ~ch of s~d p~om by (certified) (registered) mail. Sworn to\before me this --~] Notary Public LYNDA M. BOHN NOTARY PUBLIC, State of New York No. 01806020932 · ' .~ Qualified in Suffolk Count~ Term Expires March 8, 20 ~ NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: SCTM#1000- YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: 2. That the property which is the subject of Environmental Review-is located adjacent to your property and is described as follows: 3. That the project which is subject to Environmental Review under Chapters 32, 37, or 97 of the Town Code is open to public comment on:~ ~2co~_ You may contact the Trustees Office at 765-1892 or ~n writing. The above referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal. OWNERS NAME: MAILING ADDRESS: PHONE #: Enc.: Copy of sketch or plan showing proposal for your convenience. Board of Trustees Application County of Suffolk State of New York )o¼4 BEINOD YSWO N DEPOSES AND AFFIRMS TI-~T HE/SHE IS TYIE 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 APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), lF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE i CON o wi 7; iON. Signature SWORN TO BEFO ME THIS D^YOF ,20OZ. LYNDA M. BOHN NOTARy PUBLIC, State of New Yom No. Ot B06020932 Oualified in Suffolk Courltv Term Expires March 8, 20<~ PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAlL RECEIPTS Nan~e: Address: STATE OF NEW YORK COUNTY OF SUFFOLK ~-~.~ ~-~'x~p , residing at t~c6-4~vb..~ ~ I~,~g'E , being duly sworn, deposes and says that on the -5 dayof ~ ,20OZ,deponentmailedatruecopyoftheNotice set forth in the Board df 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 Office at ~3r~c) , that said Notices were mailed to each of said persons by (certified) (registered) mail. Sworn to\before me this Day o_~f ~J~O ~* ,2~ 6/ Notary Public LYNDA M. BOHN NOTARY PUBLIC, State of New No. 01 BO6020932 Qualified in Suffolk Count~ Term Expires March 8, 20 ~.~.~ AUTHORI ZAP'ION (where the applicant is not the owner) (print owner of property) residing at (mailing address) do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf.