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APPLICATION FOR APPROVAL OF PLAT
To the Planning Board of the Town of South old :
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The undersigned applicant hereby applies for (tentative) (final) approval of a subdivision plat in
accordance with Article 16 of the Town Law and the Rules and Regulations of the Southold Town
Planning Board, and represents and states as foil ows :
1. 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 shall state his interest in said
land under application.)
2. The name of the subdivision is to be ....................................................
3. The entire land under application is described in Schedule "A" hereto annexed. (Copy of deed
suggested. )
4. The land is held by the applicant under 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 Testament of .......................................
or as distributee ........................................................................
5. The area of the land is .., /1-. .rb. . . . . . .. acres.
6. All taxes which are liens on the land at the date hereof have been paid except ............
7. The land is encumbered by . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
mortgage (s) as follows:
(a) Mortgage recorded in Liber .............. Page.................. in original amount
of $. . . . . . . . . . . . .. unpaid amount $ ..... . . . . . . . . . . . .. . .. held by ......................
. . . . . . . . . . . . .. address ................................................................
(b) Mortgage recorded in Liber ......... Page ....................... in original amount
of .............. unpaid amount $. . . . . . . . . . . . . . . . . . . . .. held by ......................
.............. address ....................
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(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 ....N Q'NG.. . . . . . . . . . . .
9. The land lies in the following ;zoning use
districts... .a:\~t.t:'\~\.. A................
10. No part of the land lies under water whether tide water, stream, pond water or otherwise, ex~
cept .... f\.! P rY.~. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11. The applicant shall at his expense install all required public improvements.
12. The land (does) (does not) lie in a Water District or Water Supply District. Name of Dis-
trict, if within a District, is ....... ,>p~~. . f\l. !'I:".. . . . . . . . . . . . . .. . . .. . . . . . . . . . . . . . . . . . .
13. Water mains will be laid by ....... N P. ~~.. .. .. .. . .. . .. .. .. ... .. . .. .. .. .. .. .. .. .. .. .
and (a) (no) charge will be made for installing said mains.
...... /..//c.9..........................
14. Electric lines and standards will be installed by
lines.
and (a)
(no) charge will be made for installing said
15. Gas mains will be installed by . . . . . . . . .IV .C!~tF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
and (a) (no) charge will be made for installing said mains.
16. If streets shown on the plat are claimed by the applicant to be existing public streets in the
Suffolk County Highway system, annex Schedule "B" hereto, to show same.
17. If streets shown on the plat are claimed by the applicant to be existing public streets in the
Town of Southold Highway system, annex Schedule "e" hereto to show same.
18. There are no existing buildings or structures 011 the land which are not located and shown
on the plat.
19. Where 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 said
existing maps at their conjunctions with the proposed streets.
20. In the course of these proceedings, the app licant will offer proof 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",
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22. The applicant estimates that the cost of grading and required public improvements will be
$. ~.~...'~ as itemized in Schedule "E" hereto annexed and requests that the maturity of the
Performance Bond be fixed at ... . . . . . . . . . . . years. The Performance Bond will be written by
DATE
a licensed surety company unless otherwise shown on Schedule "F".
. .JP!F1 r:eeh... /6........, 1971 ... ChR./s.. .0,'.. {;>~.CJ.(jr:'.'.Q.......
(Nam,0>>~pIiN " (]
By .~..\A....~.. ...........
(Signature and Title)
;?'(7....J.~.~kj... .. !..G~.
(Address) 0
5/J rre>L..lc:...
STATE OF NEW YORK, COUNTY OF . . . . . . . . . .. . . .. . . . . . . . . . . .. . . . . ., ss:
On the.. 1.~. n....... day of... 0.1.l't .R-.t;.. ~........, 19"). t.., before me personally came
. .~. k R!.s . . D..1. .G.u.. ~ 7 ~(l,.., (.'P . . . . .. to me known to be the individual described in and who
executed the foregoing instrument, and acknowledged that #~-:.... execnted the same.
GuY T. POVEROMO
Notary Public. State of New YerIi.
.No. 52-8422425, Suffolk ~~
l'erm Expires March 30. f9~
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 t he foregoing instrument; that ............ knows
the seal of said corporation; that the seal affixed by order of the board of directors of said corporation.
and that. . . . . . . . . . .. signed.............. name thereto by like order.
..... ......................................
Notary Public
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PRELIMINARY -SUBDIVISION ~
DIAGRAM OF PROPE.RTY
SITUATED AT
PECON/C
TOWN OF 50UTHOlD
SUFFOLK COUNiY ,
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