HomeMy WebLinkAboutPolywoda, Joseph TOWN OF SOUTHOLD
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
SINGLE TRAILER OR HOUSECAR
LOCATION PERMIT
Date ......... Deo~l~l~e~,...ll%v...],9~)~ ............
Street ...... Baff...~.iew...Raad ........................................................................................................
Tow n ....... ~..0..~...t.h~>.]: .d.,.. ~ ,..~, ......................................................................................................
Your application for a (single trailer) (~1~ permit was reviewed by the Town 8oard
on ................... ]lec~ml~e~'...ll ........................ , 19.6~.., and (was) (I~I:F~I~ approved.
A permit is hereby issued to locate a (single trailer) (h~l:~ll~ license number ............................
or serial number..~'6Og.~.~[.~-.P.a~et~ak~', at ....... E/~.....Bay...Vi~w...R(~ad.t...~o,,~l~,~)].~,/
pursuant to application dated .................... De~embe.~.....']-O,~...],96~, ........... and the following
conditions: .pe~.mi~...e~.t~e~de~..~a-~d...~e~%ewe~...f~.~P..o~9e..yea~...~'~..De(~.*....~.~-.~h~
TOWN BOARD, TOWN OF SOUTHOLD
TOWN OF SOUTHOLD
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ...~...e.?...,...~.~?. .............. , 19..~.2...
Approved .................................... , 19 ........ Permit No ......~...~.~. °
Supervisor
APPLICATION FOR LOCATION OF SINGLE AUTOMOBILE TRAILER OR HOUSE CAR,
OUTSIDE OF TOURIST CAMP.
Date ~..('.:Z~J ........................... , 19.~,
Application No ...................................
Instructions
a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to
the Town Clerk.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or
public streets or areas, and giving a detailed description of layout of property and proposed location
of trailer must be drawn on the diagram which is part of this application.
c. Upon approval of this application, the Town Board will issue a trailer permit to the applicant. Such
permit shall be kept on the premises available for inspection:
d. No trailer shall be occupied or used in whole ar in part for any purpose whatever other than specified
in permit.
Application is hereby made to the Town Board for the issuance of a Trailer Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws.
Ordinances or ~Regubtions. The applicant agrees to comply with all applicable laws, ordinances and
regulations. ' i "' c~"~ ~-~' '4/ ,~,/~(~% ~/~x ~,.'z'~;: ~._
......... .................................
, ' -
(Addr~?s,
State whether applicant is owner, lessee or agent....~...~....~.2r,,~.:.~. ...................................................
Name of Owner of premises ...... ~ ...... .-. ................................
If applicant is corporatl, signature of duly authorize~c~x//c)fficer. (] /
(Name and title of corporate officer)
1. Location of land on which proposed trailer will ~e located ....................................................................
2. State existing use and occupancy of premise, s and intended use and occupancy of prop~,~ed traiter'
b. Intended use and occupancy ..... ~ ..............................................................................
c.: Period of time trailer is to be Iocatelii~n premises~ ~ .~:,r~/~...~/~ .......................
(T~ be Paid on f lng appl,cat,on)
3. Fee ............. ~ .............................. ~
4.
Dimensions
of
trailer,
TOWN OF SOUTHOLD
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined .. ~.<~ ... '1'! ~ .............. , 19.62.. Application No ..................................
Approved .................................... , 19 ........ Permit No .....~.,-~..~i',:X.
................................................................................... .....
Supervisor
APPLICATION FOR LOCATION OF SINGLE AUTOMOBILE TRAILER OR HOUSE CAR,
OUTSIDE OF TOURIST CAMP.
Date :' 19. .
Instructions
a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to
the Town Clerk.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or
public streets or areas, and giving a detailed description of layout of property and proposed location
of trailer must be drawn on the diagram which is part of this application.
c. Upon approval of this application, the Town Eoard will issue a trailer permit to the applicant. Such
permit shall be kept on the premises available for inspection:
d. No trailer shall be occupied or used in whole or in part for any purpose whatever other than specified
in permit.
Application is hereby made to the Town Board for the issuance of a Trailer Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws.
Ordinances or_Regulations. The applicant agrees to comply with all appliaable laws, ordinances and
regulations.
(Signature of applicant)
Stat h ther ' (
e w e appl cant ~s owner, lessee or agent ................. ; ......................................................................
Name of Owner of premises ...~..!~:.~........~.:~~..c..~z......:.. ~..~.~..~_~ ..................
If applicant is corporate, signature of duly authorized officer.
(Name and title of corporate officer)
1. Location of land on which proposed trailer will ~e located ....................................................................
number ~,.'~..- ..~...~/'~c>~ ._~_,:.-~':~..~JZ ."~.~
Street and . ...... ~ ....................................................................................... ~ ......................
2. State existing use and occupancy of premises and intended use and occupancy of proposed trailer:
a. Existing use and occupancy ....~...~..:~'-.~ .......................................................................
b. Intended. use and occupancy ........ ~ ....................................
c. Period of time trailer is to be located on premises /
3. Fee ..... ..~..~.:'~ ......................... (To be paid on filing application)
4. Dimensions of trailer, length ...... ,..D~...~ ........... width ........... ./..~.;~'~./-. ........ height ......... ~.)~ ~z ...............
um r J'q 0~- ~ · '
Registration N be ............. ~ .............................. Serial Number s~. ~ .~?...~...~..~...5. ...... J:./.~.~...~....-k..-~....~cc~,
5. Size of lot: Front ............................................ Rear ................................ Depth ................................
6. Date of purchase or lease of land ..../...0....-..~-"_~....f:..~n.. .......
7. Zone or use district in which premises are situated ............................................................................
8. Does proposed use violate any zoning law, ordinance or regulation .......................................................
9. o. Method of Sewerage disposal ....... :~.~.'.~?~.'~.. ...... ~ .............................................................
b. Source of Water Supply ..../..~..~.....%/.~;:.'~..... '~].'.~:~'..~..%~'.'~..~.'¥~.'.'~.''~.'~.~..%`~.~....J~`.. ...................
c. Source. of Electricity .......... C~ ...............................................................................................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimen-
sions from property lines. Give street and block numbers or description according to deed, and show street
names and indicate whether interior or corner lot. Indicate clearly location of proposed trailer on prem-
ises, showing distances from all buildings and property lines.
STATE OF NEW YORK }ss.
COUNTY OF SUFFOLK
......... ~.~....~. ........... , ......................... : .......................................... ~ , sworn, deposes and says that
he is the applicont named above. He is the
...................... ~'~' '" "i~r 'o'r ' i e~'~ ~' ' ~ [" '~'r~¥i .......................
of said owner or owners, and is duly authorized to make and file this application; and that all statements
contained in this application are true to the best of his knowledge and belief; and that the trailer will
be located in the manner set forth in the application filed herewith.
.................. ......... ,
~--(Notary Public)
December 4, 1962
Mr Joseph Poliwada
Bay View Road
Southold, N.Y.
Dear Sir;
Your trailer permit is about to expire on December
enclosed please find applicsticn forms to renew same.
Thank you for yo~m cooperation
Yours truly
12th~
Building Inspector
Mrs Ida Poliwoda
Bay View Rond
Southold, 3. f.
January 18, 1962
Dear Mrs. Poliwoda$
At the time Joseph Poliweda made application to
the Town Bosrd for a trailer permit for his new trailer - December 6~
1961 - an affidavit was given that you were to transfer a lot 100 feet
wide by 200 feet d~ep to h~s daughter Donna Poliwoda~ and the trailer
was to be located on this lot. The permit was granted under these
conditions.
This week a deed came through this office whereby you have
deeded a lot 75 feet by 75 feet to Donna Poliwoda. The description
appears to be faulty as well a~ not being the size that was approved by
the Board. A copy of the deed photostat is attached to this letter.
Please be advised that it is illegal to ~ellgdivide or setoff
or transfer a lot of less than 100 foot width and 12~500 square feet in
area in the Town of Southold; - Article III, section 303 and Article X
section IOOOA of the Building ~one Ordinance of the Town of Southold.
Will you kindly have the deed correcte~ and the lot enlarged
to the proper minimum size as soon as possible.
Yours truly
Building Inspector
5. Size of lot: Front .......... ~!~...~..., ..................... Rear .....
6. Date of purchase or lease of land ....
7. Zone or use district in which premises are situated ............................................................................
Does proposed use violate any zoning law, ordinance or regulation?.....~.C'. ......................................
o. Method of Sewerage disposal .....~..M~....~.c..~;~:...c...~.. ......................................................................
b. Source of Water Supply ............/.........~..~.?.,... ........................................... /t.....~..,~h-- .......................
c. Source of Electricity .......... ~...c..c...~M...: .................................................................................................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimen
sions from property lines. Give street and block numbers or description according to deed, and show street
names and indicate whether interior or corner lot. Indicate clearly location of proposed trailer on prem-
ises, showing distances from oil buildings and property lines.
STATE OF NEW YORK '~ss.
f
COUNTY OF SUFFOLK
he ~ the applicant name~' above. ~le is~'th~ ...~..~x~....~,..,c.~,.~..*. .........................................
(; (owner or, lessee or agent)
of said owner or owners, and is duly authorized to make and file this application; and that all statements
contained in this application are true to the best of his kn,.owledge and belief; and that the trailer will
be located in the manner set forth in the a[~alica,tion filed hereCvith.
Sworn to before me this .........
..................... Z-~. ~x~Z.~'~.du......., 19. ~..?~ ....
................... ; ...-~.~.,.,.~.. ~r...: J.,..~..~ .-..~...~.~... ..........
, ~,m-~(Notary Public) '''
TOWN OF SOUTHOLD
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
SINGLE TRAILER OR HOUSECAR
LOCATION PERMIT
Date ......... Decembe=....13.~.....1961 ......
Name J(~se.ph.-.PolF~oda .......................................................................................................
St re et ..... Bay...~£ew.. R,~a~ .........................................................................................................
Town ....... So~tho!d ~...N.,.X, .....................................................................................................
Your application for a (single trailer) (~r) permit was reviewed by the Town Board
on ...................... ~eo.e~e~.....l~ ................... , 1~1..., and (was) (~) approved.
A permit is hereby issued to I~ate a (single trailer) (housecar), license number ............................
or serial number...~.~p~9~ ................... at ....... ~/~..Mal~..~a~...~ie~..~t..B~utholdt N.~.
pursuant to application dated .................. D.~c.e.~.e~.....~.~.....l~l ............ and the following
conditions: ..e~t..~r~te~..~or...one..~e=..~l~,...t~a21e~..~..=onf~=..to zonin8
.-~e~ui.~e~e~t~.. ~... setbaek.. ~ ~t.. ~r...~..&t~e...wtth..~he~..d.we&lSn~.s.. on.. same
"s~.~.~f...s.~r~et~..m~n~..s~de...~r~..~.~f.t..~n~..s&~..~d...1~..~.t..~n other
TOWN BOARD, TOWN OF SOUTHOLD
TOWN OF SOUTHOLD
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ..................................... 19 ........
Approved ..p..e..c..e..m..b.,e..r....1..2. ............ , 19...6.!...Permit No. ~] .............
Application No ..................................
~~xAppr. oued.. £o£.. on~..y~.~z... ~.l.y.......tx~i.].er...t o
be set back from road 35 feet, and at least ten feet
....................................................
Supervisor
APPLICATION FOR LOCATION OF SINGLE AUTOMOBILE TRAILER OR HOUSE CAR,
OUTSIDE OF TOURIST CAMP.
Instructions
a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to
the Town Clerk.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or
public streets or areas, and giving ,a detailed description of layout of property and proposed location
of trailer must be drawn on the diagram which is part of this application.
c. Upon approval of this application, the Town Board will issue a trailer permit to the applicant. Such
permit shall be kept on the premises available for inspection:
d. No trailer shall be occupied or used in whole or in part for any purpose whatever other than specified
in permit.
Application is hereby made to the Town Board for the issuance of a Trailer Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New 'fork, and other applicable Laws.
Ordinances or_Regulations. The applicant agrees to/comply with all aoplieoble laws, o,rdinances and
regulations. ~/~_~.,..~..[ ~~. ~. ~.~/~C,_~
......... ' .......... : ................
...................................................
(Address)
State whether applicant is owner, lessee or ogent....O.¥fTA~.~ .................................................................
Name of Owner of premises .... ..g..o.~..l!.~.....~).0..]-...i..~...~.c~f~ ................................................................................
If applicant is corporate, signature of duly authorized officer.
(Name and title of corporate officer)
1. Location of land on which proposed trailer will be located ..... ,~. ,/.~.......~...8:.~....¥..J:.,e.~...~.o...~..d. ....................
Street and number ....~ay...~rJ.e.~ .............. S~otzthold ...........................................................................
2. State existing use and occupancy of premises and intended use and occupancy of proposed trailer:
a. Existing use and occupancy ...... .i~.~.~t,J,~e~Z'...o~l.....l~...l~z'~,sexl::l;;.].~. ...........................................
b. Intended use and occupancy ...e...x.g...~..a..n..~.e....~...o.~'...lg.e:!~/...i~.~.j,,1,er .................................................
c. Period of time trailer is to be located on premises .... l;).~'l~l~Ilei'Zt, ly. .........................................
3. Fee ..... ~'~.0tQ ............................. (To be paid on filing application)
4. Dimensions of trailer, length......~.~ ...................... width ..'10...~.i.t~...e, tt.t~.yl~eight.....'12 ......................
Registration Number ............................................ Serial Number ..:.~......~.Z...?...~..O.L...~....C../....~.. .............
Front ...... .~,.QQ .............................. Rear 100 De th .. 200
5. Size of lot:
6. Date of purchase or lease of land ~...~..~..1.....~.~.~..~....~...~..~..t.....~..~...1.~.~...a:~..a:~.~..~..s...t..a..~...e. ..............................
7. Zone or use district in which premises are situated ,..t.s.A~..~l,~,~.~.;~.~. ............................................
8. Does proposed use violate any zoning law, ordinance or regulation?.....~g....-....]:~r...~.{~.~.~.~.l;;....O~.....~.~..Wt3. ]~d.o
9. <3. Method of Sewerage disposal ..~3gi.~.~.iD,~...C:~.S,~0D.O~L ....................................................................
b. Source of Water Supply ..~_-%t;J.T~...~.8,.~.e~...~.U,~)~,~.~..-1~,~..~..~....!q.9..i.~) .........................
c. Source of Electricity ........ ]~.~.~a~.~,~.i..~g .....................................................................................
I~LOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimen-
sions from property lines. Give Street and block, numbers or description according to deed, and show street
names and ndicate whether nterior or corner lot. Indicate clearly location of proposed trailer on prem-
ises, showing distances from oil buildings and property Fines.
STATE OF NEW' YORK )
COUNTY OF SUFFOLK~'ss'
............ .~..o...s..e.~.]~....~...o..1.~.~.~.~{~ .......... : ........................................... being dub/sworn; deposes and says that
he is the opplican~ named above. He is the .......... 0%~e~...Q_f'...~.a,l'l ez.. ................................................
(owner or lessee or agent)
of said owner or owners, and is duly authorized to make and file this appl]ccrtion; and that all statements
contained in this application are true to the best of his knowledge and belief; and that the trailer will
be located irt the manner set forth in the applicotibn filed herewith.
Sworn to before me this ............~. ..................... day of D~cember~ ~961
'4/ (N ota~r~D iT~U~ ' ic~ )0,' ,;
F~otary Public, State et h,:, ~;
Iiu 52 f344963 Suffo k
~mrmsson Expires March 30,
TOWN OF SOUTHOLD
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ...., .............................. , 19 ........
Approved ..D~gl~0b~t'...J2 ............ , 19.~.l...Permit No. 53 .............
~pproved..Jor..one..¥ml,r..M~.l ¥ ..... t;~i.i.er...to
~. ~.. ~...~.~.~...k...f£.,.~.....t...~...d....~,~...f.~.~.[ ,....~.~ .~....~..t....I.~ ~.. ~ ~...f ~.e..t
from slde property lines.
Supervisor
,,
APPLICATION FOR LOCATION OF SINGLE AUTOMOBILE TRAILER OR HOUSE CAR,
OUTSIDE OF TOURIST CAMP.
Application No ...................................
Date ......... De~embe~.....6. ....... , 19_61.
Instructions
a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to
the Town Clerk.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or
public streets or areas, and giving a detailed description of layout of property and proposed location
of trailer must be drawn on the diagram which is part of this application.
c. Upon approval of this application, the Town Board will issue a trailer permit to the applicant. Such
permit shall be kept on the premises available for inspection:
d. No trailer shall be occupied or used in whole or in part for any purpose whatever other than specified
in permit.
Application is hereby mode to the Town Board for the issuance of a Trailer Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws.
Ordinances or.Regulations. The applicant agrees tc~/cgmply with all applicgble laws,/~rdinances and
regulations. ~~ .~~.~
C(S~naturd of*bpplicont) ................
(Address)
State whether applicant is owner, lessee or agent...O~:le;F. .........................................................................
Name of Owner of premises ...~.DZII3&....~.OJ, J,~.8,Cl& ................................................................................
If applicant is corporate, signature of duly authorized officer.
(Name and title of corporate officer)
1. Location of land on which proposed trailer will be located ....~./.~.....~.~,3r...Y,~,~31[..~.Ct~,l~l. ....................
Street and number ...,~a~...lat'.,'l,e~ .............. Southo~d ...........................................................................
2. State existing use and occupancy of premises and intended use and occupancy of proposed trailer:
a. Existing use and occupancy ...... t,:r&ller...or~....3,ot...pr~sea,t,],~ ............................................
b. Intended use and occupancy .~%C]31Ll0~e...t'ol~...13.ew...t,z'~].ez,. .................................................
c. Period of time trailer is to be located on premises ...~ez'mlnent3~. ..........................................
Fee .... .~e. OQ .............................. (To be paid on filing application)
Dimensions of trailer, length.....~[~ ....................... width .'i O..~l.~..,~Z~,~e~../~C~..~ ............
Registration Number ............................................ Serial Number ............................................................
5. Size of lot: Front ...... ,],DO .............................. Rear ..... ].00 .................... Depth ....... .200 ....... ~ ..........
6. Dote of purchase or lease of land ....1-.~,..£3,.Oa..~o~,~..~.O.]..~.w4~:]e,...,.~8.tDa~e ..............................
7. Zone or use district in which premises are situated ""~,~"d'~'$~5.~'t~, .............................................
8. Does proposed use violate any zoning law, ordinance or regulation?...,~. ....
9. a. Method of Sewerage disposal .e;ii.:fL.~-l.~..oee.]3oo~ .....................................................................
b. Source of Water Supply .-e-~t~,t,i.~lg...',/~t~ez'...e~.lUl>I.y{~i~h..~e,~..leo.$~.) .........................
c. Source of Electricity ....... Z,,t.]-..Z,,~.{h.t,.;{,~ .....................................................................................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimen-
sions from property lines. Give street and block numbers or description according to deed, and show street
names and indicate whether interior or corner lot. Indicate clearly location of proposed trailer on prem-
ises, showing distances from all buildings and property lines.
STATE OF NEW YORK
COUNTY OF SUFFOLK
......... ~O,-~el::~...,l~.o-]-;I,~&d~ ........................................................ being duly sworn, deposes and says that
he is the applicant .named above. He is the ....... O~'le~..~..~,~t~.].~.; ........................ : .......................
Co~ner or mssee or agenU
of said owner or owners, and is duly authorized to make and file this application; and that oil statements
contained in this application are true to the best of his knowledge and belief; and that the trailer will
be located in the monr~r set forth in the application filed herewith.
Sworn to before me this. ........~ ........................ day of De~embe~ "'"6]. - /' //
:(Notary Public)
JUDITH T. B K '
April 30, 19~8
Mr Joseph Pol~ada
Bay View Road
Southold, N.Y.
Dear Sir;
Your application for a single trailer permit was
reviewed by the Town Board yesterday and upon payment of the
required $5.00 fee was approved.
A permit is hereby issued for seasonal occupancy upon the
locatlo~ as shown on the application forms.
Yours truly
Town Clerk
Ap$1ication No../. .....
APPLICATIO~I FCR LOCATION OF SI~GLE A~720H~BILv~ TI~.ILEB OH HOUSE CAR, ~UTSIDE CF
TOURIST,
....
'~ Instructions
This appliqa%lan .muso 'be 'c6~[~{~ly filled in by typewriter or in ink and sub-
mitted in ~umlicate to the To~n
Plot plan sk~wlng, locatiOh' %¥ k~% and of buildings on premises, relaticnshlp to
.aSJoln[hk'~remises or public streets or areas, and giving a detailed descri~tion
of layout of property and proposed location of trailer must be drawn cn the
diagram which is part of this application.
c. Upon approval of this'application, the Town Board will issue a trailer permit
to the appltcanti Such permit shall be kept on the premises available for in-
' spectlon.
d. No trailer, s~l~ be occupied ~r u~ed in whole or in part for any purpose what-
ever cbher th~. ~tfi~ ~n.per~rlt. ?
issua of a Trailer rermlt
Application is hereb~ made to the Town ~eard for the
~rsuant to the Building Zone ~rdinance eT the Town oF Sou%hold, Suffolk County,
~.~ Ye~k,.~other applica~le Law~, ~rdln~tnce~ or Regulaticms. The applicaAt
agree~ to comp~ with all applical~"~Ws,' ordinances ,~ud regulations.
Address .
If applicant is~a~.c~ate, signature cf duly authorized officer.
(l~me and title of corporate officer)
Location of land on wh~h proposed tra~er w~ll be l~ated..,,. .. .... ..... , ....
Street and Ellmber ..~~.~w~.,~.~
State existing .use ~.~d oc~ancy of premises ~nd~tend~.~n~cy ~f
' ~ro~osed tr~iler~
- · ' ' ....
'%. Intenaed use and occu~mcy~---~,~~/~.'~~.; ....... , .
be
3. Fee ........... (to ~ · cn filing application)
Registration ~ber... ~.~.~ ......... S~rial
7. Zone or u~e distr~ct ~n which prom~e~ are ~tuated.
8, !oes proposed uoe viclat~ ~y Zoning law,¢ordin~nco or regulation?
'c. Source of Wager ~17 .............................................
' c. Source ~f 'elcctri~o&ty.
Locate clearly and distznctly all building , ~whethor existing or or0pcsod, and
indic~to al'l Sbt-back dimen.sions .from pro~oerty lines. Give ~reet ~d block num-
bers 0r ~ ' ' ·
daocr~pt~on accordi~g '~o dea~, ~nd shOw~ street names ~d in~icgte whether
~ntor~or or ccrnar lot', Indicate bloarly locat~om of proDosed trailar o~ rrcmisas,,
STATE.CF N'~,'~ YORK
) SS.
~ou~nty of Suffolk
"'' '''~ ~'~.~"~'~' ...... '- .~ .'~-~- ~-~,~'~w~rn' dopgse~ a~d Se~ that
h~is.the ~plicant abcve nemod. Ho is tho .,.~l...~.. .............. ' ..... ' ...... '**
' '< ' .... :, m' ...... (gwner%r lessee or ~ent)
,~f ~aid]owngr ~O~8'r~ ~i~ly ~n~or{~$e.l~9~i: file .this S.~plic~%ion;
k~[~ an~t~.n~,t~$~$o~$$$19~ ViII be located in the ~s.nn~r set ,forth
' ~ ~h~' a~licat~.~llod'~.th~nawith.~ ~' '" ~' n . ~ '// -~
....
(Not ~ryPublic)