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TOWN OF S Ol.>T D
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n ~:';J;);;i, !;:'i ::r;IALf TO THE
.id,.~ CO,;',,",,"" "f, ,,;)~';:r:I~J,'3:i.II,L AGENCY , I:)
~~~'~~ciG ~;;:;~;:;:~~:J ~~j" 1._:.~~~~~:~,~~,'~~~;~~~ I
1unON. GUAItAN,.HS M.i, t'i,'::; 1 lIRAN$FEItAJ!
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/, G...a l'<In+<j CO",~Qn::l and fo t~,., North
/, Fol'lc. ,eCllnk t TrIllST Co"'r"'n~ CIS
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{/ Licet'15.~ Land SU'."fr~.oI~;S
"'reetlro$"1', N.Y.
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Southold,N.Y.11971
HENRY E. RAYNOR, Jr., Cluzirman
JAMES WALL
BENNETT ORLOWSKI, Jr.
GEORGE RITCHIE LATHAM, JI.
WILUAM F. MULLEN, JI.
TELEPHONE
765.1938
November 11, 1982
Mr. Gary Flanner Olsen
Main Road
Mattituckr New York 11952
Re: Marguerite R. Wasson
Dear Mr. Olsen:
The following resolution was passed by the Southold Town Planning
Board, Monday, November 8, 1982.
RESOLVED that the Southold Town Planning Board approve a set-off
(106-13) as designated on the map of Marquerite R. Wasson. located
at Mattituck, dated October 6, 1966 and amended August 24, 1982
subject to the applicant receiving approval from the Zoning Board
of Appeals for a variance.
Please forward four (4) copies of the above map to our office for
signature when the above condition has been met. Two copies will
be returned to your office for your records.
If you have any questions concerning the above, please feel free to
contact this office.
Very truly yours,
HENRY E. RAYNOR, JR., CHAIRMAN
SOUTH OLD TOWN PLANNING BOARD
By Susan E. Long, Secretary
cc: Zoning Board of Appeals
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~N OF SOUTHOLD ~
SHORT ENVIRONMENTAL ASSESSMENT FORM
INSTRUCTIONS:
(a) In order to answer the questions in this short EAF it is assumed
that the preparer will use currently available information concerning the
project and the likely impacts of the action. It is not expected that
additional studies, research or other investigations will be undertaken.
(b) If any question has been answered Yes the project may be
significant and a completed Environmental Assessment Form is necessary.
(c) If all questions have been answered No it is likely that this
project is not significant.
(d) EnvIronmental Assessment
1. Will project result in a large physical change
to the project site or physically alter more
than 10 acres of land?.......................___Yes~No
2. Will there be a major change to any unique or
unusual land form found on the site?......... Yes X No
3. Will project alter or have a large effect on
existing body of water?...................... Yes X No
4. Will project have a potentially large impact ~ ---
on groundwater quality?...................... Yes X No
5. Will project significantly effect drainage --- ----
flow an adjacent sites?...................... Yes X No
6. Will project affect any threatened or ------
endangered plant or animal species?.......... Yes X No
7. Will project result in a major adverse effect --- ---
on air quality?.............................. Yes X No
8. Will project have a major effect on visual --- ---
character of the community or scenic views or
vistas known to be important to the community? Yes X No
9. Will project adversely impact any site or ------
structure of historic, prehistoric or
paleontological importance or any site
designated as a critical environmental area
by a local agency?............;.........~,... Yes X No
10. Will project have a major effect on existing --- ---
or future recreational opportunities?........ Yes X No
11. Will project result in major traffic problems --- ---
or cause a major effect to existing
transportation systems?...................... Yes X No
~2. Will project regularly cause objectionable --- ---
odors, noise, glare, vibration, or electrical
disturbance as a result of the project's
operation?.......... .. ..... ........... . ...... Yes X No
13. Will project have any impact on public health --- ---
or safety?................................... Yes X No
14. Will project affect the existing community by --- ---
directly causing a growth in permanent
population of more than 5 percent over
year period or have a major negative
on the character of the community or
neighborhood? ... .. .. . . . . . .. .. ..... .......... Yes X No
15. Is there public controversy cancer' t e --- ---
project? . . . . . . . . . . . . . . . . . . . . . . . .
PREPARER'S SIGNATURE
Gary Flanner Olsen.
REPRESENTING Marguerite R. Wasson
August 11, 1982
.
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Southold, N.Y. 11971
HENRY E. RAYNOR, Jr., Chairman
JAMES WALL
BENNETT ORLOWSKI, Jr.
GEORGE RITCHIE LATHAM. Jr.
WILUAM F. MULLEN, Jr.
TELEPHONE
765-1938
JANUARY 28r 1983
Mr. Gary Flanner Olsen
Main Road
Mattituckr New York 11952
Re: Marguerite R. Wasson
Set-Off
Dear Mr. Olsen:
Enclosed please find one copy of the above survey
stamped and approved by the Chairman of the Planning Board.
Please be advised that one copy has been referred to the
Building Department as per your request.
Very truly yours,
~~~~"
Southold Town Planning Board
Ene.
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Southold Town Board of Appeals
MAIN ROAD - STATE ROAD 25
SOUTHOLD. L.I.. N.Y. 11971
TELEPHONE 15161765-1809
APPEALS BOARD
MEMBERS
GERARD P. GOEHRINGER. CHAIRMAN
CHARLES GRIGONIS. JR.
SERGE DOYEN, JR.
ROBERT J. DOUGLASS
JOSEPH H. SAWICKI
January 5, 1983
Gary Flanner Olsen, Esq.
Main Road
Box 38
Mattituck, NY 11952
Re: Appeal No. 3015 - Marguerite Wasson
Dear Sir or Madam:
Attached herewith is a copy of the formal findings and deter-
mination recently rendered and filed this date with the Office of
the Town Clerk concerning your application.
In the event your application has been approved, please be sure
to return to the Building Department for approval of any new construc-
tion in writing, or for other documents as may be applicable.
If you have any questions, please do not hesitate to call either
our office (765-1809) or that of the building inspector (765-1802).
Yours very truly,
GERARD P. GOEHRINGER
CHAIRMAN
Enclosure
Copy of Decision to
Building Depar~e~
Planning Board~
By Linda F. Kowalski
Secretary
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MAIN ROAD - STATE ROAD 25
SOUTHOLD.
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L.I.. N.Y. 11971
It:Lr::rMUl'H: 1:JIO} Irr::FTOU~.
ACTION OF THE ZONING BOARD OF
RECEIVED AND FILED BY
PPE S
OUTHOLD TOWN CLLRK
DATE j.sj,FS HOURc?",,"p'AI{
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Town Clerk. Town of Southold
Appeal No. 3015
Application Dated July 15, 1982
TO: Gary Flanner Olsen, Esq. as Attorney for
Mrs. Marguerite Wasson
Main Road, Box 38
Mattituck, NY 11952
At a Meeting of the Zoning Board of Appeals held on December 22, 1982
the above appeal was considered, and the action indicated below was taken
on your Request for Variance Due to Lack of Access to Property
New York Town Law, Section 280-a
[ Request for Special Exception under the Zoning Ordinance
Article , Section
[x]
Request for Variance to the Zoning Ordinance
Article III, Section 100-31
[] Request for
The public hearing on this application was also held on December 22, 1982.
Upon application of MARGUERITE R. WASSON, by Gary Flanner Olsen, Esq.,
Main Road, Mattituck, NY for a Variance to the Zoning Ordinance, Article
III, Section 100-31 for permission to establish each existing house on a
legal building parcel, having insufficient area and width. Location of
Property: Great peconic Bay Boulevard, Laurel, NY; County Tax Map Par-
cel No. 1000-126-09-013.01.
The board made the following findings and determination:
By this appeal, appellant seeks permission to set apart from other
property she owns the house parcel located on Bray Avenue, which have
become merged due to common ownership. It is stated in the record that
each house was built prior to zoning and have been in common ownership
by the appellant, with each house being entirely independent of each
other with private wells and cesspools serving each house. Parcel No. 1
is to be set off with an area of 8,799 square feet and established road
frontage of 74.38 feete. Parcel No.2 will have 28,953 square feet and
established road frontage of 96 feet. Parcel No. 1 is improved with a
one-family frame house; Parcel No. 2 is improved with a one-family frame
house and three accessory structures. It is the opinion of the board
that Parcel No.1 should contain more area from Parcel No.2; however,
under the circumstances, particularly the character of the premises, it
would be most unfeasible. For the record, this project has received
the approval from the Southold Town Planning Board as a set-off on
November 8, 1982.
In considering this appeal, the board determines that the variance
request is not substantial; that the circumstances are unique; that by
allowing the variance no substantial detriment to adjoining properties
will be created; that the difficulty cannot be obviated by a method
feasible to appellants other than a variance; that the relief requested
will be in harmony with and promote the general purposes of zoning; and
in view of the manner in which the difficulty arose and in consideration
of all the above factors, the interest of justice will be served by
allowing the variance.
On motion by Mr. Douglass, seconded by Mr. Goehringer, it was
RESOLVED, that Appeal No. 3015, application of MARGUERITE R.
WASSON for approval of insufficient area and width of two proposed
parcels, be and hereby IS APPROVED SUBJECT TO THE FOLLOWING CONDITION:
(Continued On Page Two)
DATED: January 4, 1983. CHAIRMAN, SOUTHOLD TOWN ZONING BOARD
OF APPEALS
Form ZB4 (rev. 12/81)
Page 2 - Appeal No. 3015
Matter of Marguerite R. Wasson
Decision Rendered December 22, 1982
No further subdivision shall be permitted of either parcel.
Vote of the Board: Ayes: Messrs. Goehringer, Doyen, Grigonis,
Douqlass and Sawicki. This resolution was unanimously adopted.
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APHUvf:.D
~~~
/- -.,I--f? f
Chairman Board 01 Appeal<
OTTO W, VAN TUYL
Reg, Professional Engineer
Licensed Land Surveyor
Phone 477-1487
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RODERICK VAN TUYL
Licensed Land Surveyor
Phone 477-1608
RODERICK VAN TUYL, P. C.
FRONT STREET AT MAIN
GREENPORT, NEW YORK 11944
if
PHONE 477-0170
Sept. 21, 1';32
Gary Olsen, Eeq.
./flam Road
~latt1tuck,:fY 11952
SEP 23 1982
Re: \y'asson
Dear Oary:
l'nrsuant to JOur requus'.:, ,f(3 anl this date
::'oX'\1aniing to the 1'Oiffi :.oning 'Joard find Town Planning
llnurd six COllies \:iuch of the proposed "Illl1lnor suouivieion"
Hall of l[,nd o:f Lurgue:ci te ''''; :.8S011 in Lwuoel, since the
suggestGd clivision meHts generally with your all}lrovaJ.
and inoorporates SODlS former deRd lines.
YOtlrt3 truly,
Roderick Van T~rl, PC
.
.G 16 REC'D.
GARY FLANNER OLSEN
COUNSELLOR AT LAW
P. Q. BOX 38 . MAIN ROAD' MATTITUCK. LONG ISLAND, NEW YORK 11952 . PHONE 516 298-4844
August 12, 1982
Re: Marguerite R. WassQn - Variance
File #3281
Dear Susan:
Enclosed please find an application for a minor sub-division. I have a
Zoning Application pending before the Zoning Board and I would appreciate
the Board considering this as a "set off", since the houses are already
in existence and Mrs. Wasson is under contract to sell the Bray Avenue
house after approvals from the Planning and Zoning Boards have been
obtained. The purchaser would like to close title on epte ber I, 1982,
so I would appreciate your scheduling this for Au st 18, 982 meeting.
My attorney's check in the sum of $50.00 is als enclose.
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GFO/emj
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Enclosure
Susan Long
Secretary of Southold Town Plaming Board
Main Road
Southold, NY 11971
cc:
Zoning Board- of Appeals
Main Road
Southold, NY 11971
.
.
Southold Town Board of Appeals
MAIN ROAD - STATE ROAD 25
SOUTHOLD, L.I.. N.Y. 11971
TELEPHONE (516) 765.1809
APPEALS BOARD
MEMBERS
GERARD P. GOEHRINGER, CHAIRMAN
CHARLES GRIGDNIS, JR,
SERGE DOYEN, JR.
ROBERT J. DOUGLASS
JOSEPH H. SAWICKI July 21, 1982
Gary Flanner Olsen, Esq.
Main Road, Box 38
Mattituck, NY 11952
Re: Appeal No. 3015 - M. R. Wasson
Dear Mr. Olsen:
Please be advised that the following action was taken by
the board at a Special Meeting held last Saturday, July 17th
concerning the variance application for Marguerite R. Wasson
seeking to set apart two parcels having insufficient area
located at Bray Avenue and Peconic Bay Boulevard, Laurel:
RESOLVED, that Appeal No. 3015, application for Marguerite R.
Wasson, be held in abeyance pending review and receipt of comments
from the Southold Town Planning Board concerning this proposed
division of property.
If you have any questions, please don't hesitate to call our
office.
Yours very truly,
/ I.
,::':kvV\o( y ~~
/ GERARD P. GOEHRINGER if O:tJ
CHAIRMAN ~
By Linda F. Kowalski
Secretary
cc: Planning Board ~
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APPLICATION FOR APPROVAL OF PLAT
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To the Planning Board of the Town of Southold:
The nndersigned applicant hereby applies for (tentative) (final) approval of a snbdivision plat
in accordance with Article 16 or the Town I....aw ancI the Rules and Regulations (f the Southold TOWIl
Planning Board, and represents and states as ioilo\V~:
L The applicant is the owner of record of the land under application. (If the applicant is not the
owner of record of the land under application. the applicant shan state his interest in said
land nnder application.)
2. The name of the subdivision is to be .. .JY.li!l.QJ;'.S~1;>:-:Ojy.i~.i.q!l... .M!l.:r:g!l.~:rH~. R.. w.~l?son
................................................................................................
3. The entire land under application is described in Schedule "A" hereto annexed. (Copy of
deed snggested.)
4. The land is held by the applicant nnder deeds recorded in Suffolk County Clerk's office as
follows;
Liber
........................
Page
. . . . . . . . . . . . . . . . . . . . . .
On
........................,
Liber
........................
Page
On
. . . . . . . . . . . . . . . . . . . . . . . . ,
Liber
. . . . . . . . . . . . . . . . . . . . . . . .
Page
......................
On
.........................
Liber
........................
Page
On
. . . . . . . . . . . . . . . . . . . . . . . . .
Liber
. . . . . . . . . . . . . . . . . . . . . . . .
Page
On
.........................
as devised under the Last Will and Testomellt of ........................................
or as distributee
.........................................................................
..............................................................................................
5. The area of the land is . .30. .QOD.. . . . . . :l(~ square feet.
6. All taxes which are liens on the land at the date hereof hove been paid except.. N.o.N.E
............................................................................................
7. The land is encumbered by ..................
mortgage (s) as follows:
NONE
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(a) Mortgage recorded in Liher ............ Page.................... in original amoum
of $................ unpaid amount $......... .. ..... held by ..........................
. . . . . . . . . . . . . . . . . . . . . . . . .. address .......
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(b) Mortgage recorded in Liber ............ Page............... ..... in original amoltnt
of $................ unpaid amonnt $................ held by ...........................
. . . . . . . . . . . . . . . . . . . . . . . . .. address .....
.................................................
.
.
, .
(c) Mortgage recorded, in Liber ............ Page .................... in original amount
of $................ unpaid amount $................ held by ...........................
. . . . . . . . . . . . . . . . . . . . . . . . .. address
..............................................
8. There are no other encumbrances or liens against the land except ........................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
NONE
9. The land lies in the following zoning use districts . Ag~~G\lJt\l.r:~J.:-. R\lI3.i.q\lf\t.i~~.....
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
] O. No part of the land lies under water whether tide water, stream, pond water or otherwise, ex-
NONE
cept ...................................................................................
11. The applicant shall at his expense install all required public improvements.
12. The land, (does) (does not) lie in a Water District or \Vater Supply District. Name of Dis-
trict. if within a District, is .. .q.q ~.~.. r.'? t. .l~.~. .i.t:l. .~.. Y? ~ ~.e: r.. .(H.~ .t.l:".i.c.~!.......
13. Waler mains will be laid by . . . . i.nd i.v id u.a 1. W .e LIs.. . . . . . . .. . . . . . . . . . . . . . . . . . . . . .
and (n.) (no) charge \\Till be made for installing said mains.
14. Electric lines and standards will be installed by .......... L l.t. C. Q. . . . . . . . . . . . . . . . . . . . .
lines.
....................................
and (a) (no) charge will be made for installing said
15. Gas mains will he installed by
and (a) (no) charge will be
............................................................
N A
made for installing said mains.
16. If streets sho\.vn on the plat are claimed by the applicant to be eXlstmg public streets m the
Suffolk County High\vay system, annex Schedule uTI" hereto, to show same.
17.
ff streets ShO\V11 on the plat arc claimed by the applicant to be existing public streets .k- the d
Town of Southold Highway system, annex Schedule "e" hereto to show sam~.lJ~;;6nicv~~'}e~{;,d.
18. There are no existing buildings or structures on the land which are not located and shown
on the plat.
19. \i\There the plat shows proposed streets which are extensions of streets on adjoining sub-
division maps heretofore filed, there are no reserve strips at the end of the streets on sai(l
existing maps at their conjunctions with the proposed streets.
20. In the course of these proceedings, the applicant will offer proof of title as required by Sec.
335 of the Real Property Law.
21. Submit a copy of proposed deed for lots shO\ving all restrictions, covenants, etc. Annex
Schedule HD".
.
.
, .
22. The applicant estimates that the cost of grading and required public improvements will he
$...N ON.Eas itemized in Schedule "E" hereto annexed and requests that the maturity of
,
the Performance Bond be fixed at ........ . . .. years. Th
will be written
DATE.. August 11,.... ..........., 19..82
-".
.JYI.~~~. ~~. .'.. R~ 9:. ~?:X; .~~~. .JYI.~!!~~~<;~'" ~y 11952
(Address)
STA TE OF NEW YORK, COUNTY OF .... .SURF.OLK.. .... .. ... ......, ss:
On the .................. day of .....August............, 19.82..., before me personally came
. . . .Gl1.:U.F1l!.nner Ol$en, Esq.
. . . . .. to me known to be the individual described in and wh..,
executed the foregoing instrument. and acknowledged that. .. . .she. . . .. executed the same.
................................................
Notary Public
STATE OF NEW YORK, COUNTY OF .................................. ss:
On the .................. day .............. of ..... . . . . ., 19. . . . . " before me personally came
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . to me known, who being by me duly sworn did de-
pose and say that............ resides at No. ....................................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . that .......................... is the ..........
................ of ............................................................................
the corporation described in and which executed the foregoing instrument; that ............ knows
the seal of said corporation; that the seal affirxed by order at the board of directors of said corpor-
ation, and that ............ signed ............ name thereto by like order.
Notary Public
................................................
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.
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/'TO the Planning Board
APPLICATION FOR APPROVAL OF PLAT
t'-
of the Town of Southold;
The undersigned applicant herehy applies for (It'lllative) (final) appro\'al 'If a subdivision plat
ill accordance with Arliclt~ 16 of tht, Town Law and the Huks and IX<.'g'lllations , f the Southold Tow1I
Planning Board, and represents and states a.<:; f()i1()\V~'
1. The applicant is the owner of record of tl1<' land ullder application. (If tile applicant is not tlw
owner of record of the land 1111<1t'r applicati,m. the applicant shall state his interest in said
land under application.)
2. The name of the subdivision is to be
1Y,ljp.Q,.$J.1I;l:-my.i.s.~qp... .M!l.z:gJ.l.El~He. R.. w.a,~son
............................................
. . . . . . . . . . . . . . . . . . . . . . .
3. The entire land under application is deseribed in Schedule "A" hereto annexed. (Copy of
deed suggested.)
4. The land is held by the applicant under deeds recorded III Suffolk County Clerk's office as
follows:
Liber
. . . . . . . . . . . . . . . . . . .
Page
. . . . . , . . . . . . . . . . . . . . . .
On
........................,
Li ber
........................
Page
......................
On
........................,
Liber
........................
Page
Page
. . . . . . . . . . . . . . . . . . . . . .
On
.........................
Liber
........................
......................
On
........................,
Liber
........................
Page
...........
On
.........................
as devised under the Last Will and Tcstnmt:llt or
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
or as distributee
........................................................................
.................................................
S. The area of the land is . .30..QO'O....... :!(~ square feet.
......................................
G. All taxes which are liens on the land al II", date hereof have been paid except.. N.o.N.E
~
.................................................................................................
7. The land is encumbered by
mortgage (s) as follows:
..............................................................
NONE
(a) Mortgage recorded in Libel' ......
Page
.................
in original amourtl
of $.............
. unpaid amount $...
held by .
................
. . . . . . . . . . . . . . . . . . . . . . . . . . address
......................................
(b) Mortgage recorded in Libel' .
Page
.................
. .. in original amount
of $................ unpaid amount $.....
. . . .. held by
......................
....................
. . . . .. addre:'is ....
.....................
.
.
(c) l\1ortgage recorded, in Liber
.. Page ... . . . . . . . . . . . . . . . . . in original amount
of $..........
... unpaid amollnt $. ..
... 11('1<1 by ..... _.....................
. . . . . . . . . . . . . . . . . . . , . . . . .. ad(lress
............................................
8. There are no other encumhrances or liens against the land except.....................,. .
.................................. .......
NONE
................................,
1I. The land lit.s in the following zuning' tls(' di~,(ri{'t...; . Ag.~~G\lJtl1r~}. 7. R~~J~~p-.t.i~~.....
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10. No part of the land lies under water whether tide water, stream, pond water or otherwise, ex-
ccpt
....................................
NONE
.....................................""'.........
11. Till' applicant ~hall at his eXIl('Il;,(' install aU relJuired j)l1hlie improvements.
12. 'I'll<' land. (does) (does not) lie in a \Va1("1" District or "Vater Supply District. Name of Dis~
lrict. if within a District. is .. .q.c> ~.I?. 11.9. t..1 i.e. .i.r:t. .a..)I'! ll: ~.~ r:..<:1 ~.E! .t.l:'I.c.~,.......
13. Wain mains \\ill he laid hy .... i.nd iv id u.al. w.e lIs....
...........................
and (a) (no) charge \vill he made for it1.o.;talling said mains.
14. Electric lines and standards "ill he installed by ..........LI.LC.Q.....................
lines.
....................................
and (a) (no) charge will be made for installing said
t 5. Cas mains \\"ill he installed hy
and (a) (no) charge will he
............................................................
N A
made for in;;tallillg said mains.
1(,. If streets shown on the plat are claimed by the applicant to be eXIstmg public streets in the
Suffolk County Highway system. annex Schedule "B" hereto, to show same.
11.
If streets shown on the plat are claimed bv the applicant to be existing public Weets W the
To"n of Sonthnld Hig-hway s)'sl('II1. ~nl]('~ Scheduk "C" IH'r<'!o to show satn~. pf~lnlcvf3'i~eIffv~.
18. 'rhere are no exbtillg- buildings or strUdl1lTS OIl the land which are not located and shown
on the plat.
]<1. \Vlwre. the plat shows proposed streets which are extensions of streets on adjoining sub-
division maps heretofon' filed. there are no resen'c strips at the end of the streets on said
existing- maps at their conjunctions with the proposed streets.
20. In t In' course of these proceedings, the applicant will offer prouf of title as required by Sec.
335 of the Real Property Law.
21. Submit a copy of proposed deed for lots showing all restrictions, covenants, etc. Annex
Schedule HD".
.,~."
../~'"
.
.
,
~-'The applicant estimates that the cost of grading and required public improvements will he
-",."
,,.-";
,
$,..N ON.Eas itemized in Schedule "E" hereto annexed and requests that the maturity of
the Performance Bond be fixed at ........ . . .. years. The Pe
By
( .
will be written
by a licensed surety company unless otherwise shown on 5
DATE ..,Auguatll................. 19.Jl2
'\
.JYl;~~':l. ~~""....~ 9:. )'!?~ .~~I. .JYl;~!!~~~~~'.. ~y 11952
( Address)
,
STATE OF NEW YORK. COUNTY OF .....SURF.OLK..................ss:
On the.................. day of .... .August............, 19.82.... before me personally came
. . . .Oll.r:YJ!'~nner O~'en. Esq.
. . . . .. to me known to be the individual described in and wh"
('xecuted the foregoing instrument. and acknowledged that.... .she..... executed the same.
................................................
Notary Public
STATE OF NEW YORK, COUNTY OF ..................................55:
On the .................. day .............. of .., . . . . . . .. 19. . . . . ., before me personally came
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . to me known, who being by me duly sworn did de.
pose and say that............ resides at NQ. ....................................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . that .......................... is the
................ of .................................................................
the corporation described in and which executed the foregoing instrument; that. .. . . .. . . '" knows
the seal of said corporation; that the seal affixed by order of the board of directors of said corpor-
atiol1. and that ............ signed ............ name thereto by like order.
Notary Public
................................................
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10 Tim SURVEY is ". VIOLATION OF
~~T10N 7209 or TH~ tiEW YO;:Y. STAn
J./UCATlON LAW
. "" tOPtES OF TK\S 'i'J~\':Y MM' NOT 8EARlHG
.... \ ,0 II' ~- HE LAND SUi,Vi. ''.':',':} h;~:~D ~'A.:' Oll
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