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HomeMy WebLinkAbout3874 B~EIVEI /~,, · AUG 0¢ i~89 ~OU~ltlld TeWfl ael~ ~JlJJJl~ ~,4 ~ ' DATE ..~..:....~...'T..?..?. ......... TO THE ZONING BOARD OF APPEALS, TOWN OF ,,,,~.~"~l~l~.CYerk Name of Appellonl' Street and Number ......................... ..A..~.~e....C ............................................... /.~.:X.. ........... .ER[BY APPEL TO Municipality State THE ZONING BOARD OF APPEALS FROM THE DECISION OF THE BUILDING INSPECTOR ON APPLICATION FOR PERMIT NO ..................................... DATED ...................................................... WHEREBY THE BUILDING INSPECTOR DENIED TO Name of Applicant for permit of ..L~.:~........4..~..~: ........... ~,~u..~.~ ................... ~..,..~..... Street and Number Municipality State ( ) PERMIT TO USE (v0 / PERMIT FOR OCCUPANCY ( ) 1. LOCATION OF THE PROPERTY ../....O~...~....~....../~...~...~.....~.....~. ....... .~...~...~.~.~.. ........................................ Street /Hamlet / Use District on Zoning Mop ?.!s~.~..i..c.~..].°..°..°....s..e.c.~..!.°..n../..Z..~..B]~.°.~...k.~..S...L.9~..L~.~curre~ O~ner ~_.~/~/-~ ~--~uc~--~c Map No. Lot No. Prior 0wne~ 2. PROVISION (S) OF THE ZONING ORDINANCE APPEALED (Indicate the Article Section, Sub- section and Paragraph of the Zoning Ordinance by number. Do not quote the Ordinance.) Article kx~'/~/ Section /~c:) - ~ 3. TYPE OF APPEAL Appeal is made herewith for (please check appropriate box) A VARIANCE to the Zoning Ordinance or Zoning Mop A VARIANCE due to lack of access (State of New York Town Law Chap. 62 Cons. Laws Art. 16 Sec. 280A Subsection 3 ) 4. PREVIOUS APPEAL A previous appeal (ll~l~) (has not) been mode with respect to this decision of the Building Inspector or with respect to this property. Such appeal was ( ) request for a special permit ( ) request for o variance and was made in Appeal No ................................. Dated ...................................................................... ( ) ( ) REASON FOR APPEAL A Variance to Section 280A Subsection 3 A Variance to the Zoning Ordinance is requested for the reason that. ~orm ~,~! (Continue on other side) REASON FOR APPEAL Continued 1. STRICT APPLICATION OF THE ORDINANCE would produce ~racticol diff?culties or unneces- 2. The hardship created is UNIQUE and is not shared by all properties alike in the immediate vicinity of th is property and in this use district because 3. The Variance would observe the spirit of the Ordinance and WOULD NOT CHANGE THE CH^RACTER OF T.E D,S~R,CT because ~ 7~ .Z~~~~~ STATE OF NEW YORK ) ) ss COUNTY OF ) Sworn to this .................... / ....................... day of ..............~ ................... 19~7 Notary Public HELEN IL DE VOE NOTARY PU8LIC, State 0t New Yodl NO. 4707878, Suffolk Tram E, xpims M~rch 30, I~ FORM NO. 3 TOWN OF SOUTIIOLD .~~ a'Z~ aO-/-~ BUILDING DEPARTMENT /- '-~-'~"~'~-- TOWN CLERK'S OFFICE SOUTHOLD, N.Y. ~ NOTICE OF DISAPPROVAL ..... PLEASE TAKE NOTICE that your application dated . . .. ..... ~9"~/..~. ....... 19 ~ . ~o=,~o~,o~e,~ ~.~ ............. ~..~ ......... ~~. Street Hamlet County Tax Map No. 1000 Section .... .~'~6 ... Block ..... ~ ...... Lot ... ~.~ ...... Subdivision ................. Filed Map No ................. Lot No ........ ' .......... is returned herewith and disapproved on the following grounds .~...~.~ _ / ...... ;_ )...~./ .... ~p.,...~ ............ ~.~.~.m... ~ u~ing/~hspector ' RV 1/80 FORM NO, 3 TOWN OF SOUTIIOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. NOTICE OF DISAPPROVAL · ..~.~.,...~.~...~.~.c, ...... ~.. .... ~~~ ,. .~.. ~. . . // ~ PLEASE TAKE NOTICE t~at your appiication dated ..., ..... ~ ....... 19~. Location aftra e t /~ ~'~ ~ - - "~ ~ ~o~ ................. ~..:~... ~:~. Street Hamlet County Tax blap No. I000 Section .... ~'~... Block ..... ~ ...... Lot . .. ~.~ ...... Subdivision ................. Filed Map No ................. Lot No ........ ' .......... is returned herewith and disapproved on the following grounds .~...~~ · ~~ .... ~,. ~ ~ ~--~--,- ~ ~...~ ................. . ....... ..... ~'~ ~ r- · -A · ~ .... % ~.~ ~u~ing~hspcctor '' RV 1/80 / 'ALBO / / OWNER TOWN FORMER OWNER SEAS. ,-.- LAND IMP. STREET VILLAGE DISTRICT RES. 2..ZO OF SOUTHOLD PROPERTY RECORD CARD ~' //,~p t' .S,~SB. LOT VL. FA~RM COMM. I N D. ACREAGE,~%.~ ~ TYPE OF BUILDING [CB. J MISC. Est. Mkt. Value AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FRONTAGE ON WATER Farm Acre Value Per Acre Value Tillable 1 Tillable 2 3 Tillable Woodland Swampland Brushland House Plot Total FRONTAGE ON ROAD BULKHEAD Extensi°n ~ ~ ~ ~_ ~ ~ ~'Wells ~ .('~ Interior Finish Extension J; ¢' Fire Piece ~. ,.- HeQt ~ / ~C/~ ~ X ~A : ~ ~ ' ~" / ~ /' Porch Roo~ ]st FI~. Breezewey ~ X ~/ = ~ ~ / ~ ~ ~ Petio Rooms 2nd Floor Gerege ~/ ~ ~.- ~ /~ ~, Drivewey Dormer .1UDITH T. TERRY To: F rom: Dated: Transmitted herewith is Zoning Appeal NO. Robert $ Theresa Turner OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD $outhold Town Zonin§ Board of Appeals Judith T. Terry, $outhold Town Clerk August 4, 1989 3874 Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 TELEPHONE (516) 765-1801 · application of for a variance. Also included is: Notification to Adjacent Property Owners; Short Environmental Assessment Form; Iotter relative to NYS Tidal Wetlands Land Use; Noticeof Disapproval from the Building Department; survey of property; and any other attachments relative to this application. Judith T. Terry Southold Town Clerk JUDITH T. TERRY TOWN CLERK REGISTRAR OF VITAL STATIST[CS Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 FAX (516) 765-1823 TELEPHONE (516) 765-1801 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD August 4, 1989 No maps were included with this application (Zoning Appeal No. 3874) Joyce M. Wilkins Tc~wp~ oF E,O~T*.iOLD. N.Y. JUDITH T. TERRY TOWN CLERK REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 FAX (516) 765-1823 TELEPHONE (516) 765-1801 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON SEPTEMBER 12, 1989: RESOLVED that the Town Board of the Town of Southold hereby authorizes the refund of $150.00 to Robert and Theresa Turner, which sum represents an application (no. 3874) fee to the Board of Appeals; all in accordance with the recommendation of the Board of Appeals who advise that the application has been withdrawn and no legal advertisements have been published with respect to this application. Judith T. Terry Southold Town Clerk September 14, 1989 APPEALS BOARD MEMBERS GERARD P. GOEHRINGER, CHAIRMAN CHARLES GRIGON[S, JR. SERGE DOYEN, JR. JOSEPH H. SAWlCKI JAMES DINIZIO, JR. Southold Town Board of Appeals MAIN RnAD-STATE Rn-lAn 25 SnUTHnLn, /.I., N.Y. 119'71 TELEPHONE (516) 765 1809 INTERDEPARTMENTAL MEMO TO: FROM: DATE: SUBJECT: Judith T. Terry, Board of Appeals August 30, 1989 Request for Refund - Town Clerk Robert & Theresa Turner Appl. No. 3874 Attached is the original request by Mr. & Mrs. Turner. for a refund of the $150.00 filing fee under the above application recently filed with your office. It is recommended that the entire fee be refunded since no legal advertisements have been published. tr Encl. · ~PROJE~T'I.D. NUMBER 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) · PROJECT LGCATION:/..~"~";*,.~ ~ ,z~O Munlcl~sallt¥ COunty .~.( ~--~ ~' SEQR 4. PRECISE LOCATION (Street addresa and road inl 5. ~ New ~oanslon ~ Modification/alteration IS PROPOSED ACTION- 6. DESCRIBE PROJECT BRIEFLY: Z. AMOUNT OF LAND AFFECTED: 8. WILL p OPOSED ACTION COMPLy WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ~ [] No II No, describe briefly g. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? [~Resic~en rial r-] Jnaustrial Oescnae: f0. DOES ACTION INVOLVE a PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)~ []Yes L..~'No If yes, list agency(si and perrnitlabprovals t !. DOES ANY ASPECT CF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? p~-,~'/~, ; z- f2. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form be/ore proceeding with this assessment OVER 1 (Continued on reverse side) The N y S Envlr°nmental Quality Revlew Act requires ~HORT ENVIROM__ME~TAq ASSESSME~;T ~0~! (a) in order to answer the questions in this short EAF it is assumed that the preparer will use CUrrently available information Concarnin~ 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 sig- (c) If all questions have been answered NO it is likely that the project is not significant. (d) En~ironmentai Assessment 1. Will project result in a large Physical change to the project site or physically alter more than 10 acres of land2 2. Will there be a major change to any unique or ~usual land form on the site? 3. Will project alter or have a large effect on an existing body of water? 4. Will project have a potentially groundwater quality? large impact on 5. Will project significantly effect drainage flow on adjacent sites? 6. Will project affect any threatened or endancered plant or animal species? - Yes ~/No 7. Will project result in a major adverse effect on~ air quality? 8. Will proj$ct have a major effect on Visual char- acter of the community or scenic views or vistas known to be important to the community? · _Yes 9. Will project adversely impact any site or Struct- ure of historic, pre-historic, or paleontologzcul, 10. Will project have a m~jor effect on existing or future recreational opportunities? ll. Will project result in major traffic problems or systems? Will project regularly cause objectionable odors, noise, glare, vibration, or electrical disturb- 13. Will project have any impact on public health or Safety? 14. Will project affect the existing community by directly causing a growth in permanent popula- period or have a major negatLve effect on the charact~ Of tho community or neighborhood? 15. Is there public contrOVersy Concerning the pro]eot? Z~A ~/75 Date: QU .... O.,,,~AIRE TO ~E CO.'4PL.T. TED .A,~D SUB,'I~TTTD Please complete, sign and return to the Office of the Board of AppealS with your completed application forms. If "Yes" is answered to any questions below, please be sure to depic~ these areas on ,four survey (or certified sketch), to scale, and sub,it other supporting documenta- tion. l. Are there any proposals to chang~ or alter land contours? Yes 2.a)Are there any areas which Con~in wetland grasses? (Attached is a list of the wetland grasses defined by Town Code, Ch. 97 for your reference.) Yes b)Are there any areas open to a wate~ay without bulkhead? Yes 3. Are there existing structures at or below ground level, such as patios, foundations, etc? Yes No 4. Are there any existing or proposed fences, concrete barriers, decks, etc? 5. If project is proposed for an accessory building or structure, is total height at more than 18 feet above average ground level? State total: ~ ft. Yes No Yes No If project is proposed for principal building or structure, is total height at more than 35 feet above average ground level? State total: .... ~ ft. Yes NO Are there other premises under your ownership abutting this parcel? If yes, please submit copy of deed. Yes No Are there any building permits pending on this parcel (or abutting land under your ownership, if any)? State Permit ~ and Nature: ~0 ~3~ ~ ~/~.m~.~ Yes No Do state whether or not applications are. pending concerning these premises before any other department or agency (State, Town, County, Village, etc.): Planning Board Town Board Town Trustees County Health Department Village of Greenport N.Y.S.D.E.C. Other Yes Yes No Yes N~o Yes No Yes Yes Yes 10. Is premises pending a sale or conveyance? If yes, please submit copy of names or purchasers and conditions of sale. (from cqnt~act) 11. Is new construction proposed in the area of contours at 5 feet or less as exists? 12. If new construction is proposed in an area within 75 feet of wetland grasses, or land area at an eleva- tion of five feet or less above mean sea level, have · you made application to the Town Trustees for an 'inspection for possible waiver or permit under the requirements of Ch. 97 of the Town Code? Yes No Yes No Yes No 13. Please list present use or operations conducted upon the subject property at this time and proposed ~;'~ Please submit photographs £or the record. I certify that the above statements are true and are being submitted for relia~B~ls in considering my application. S~na~ure ~Proper~y Owner; {Aunnorlzeu 1/88 WETLANDs [Amended H-'26-71; hy L.L. No. '~-I.l-U: 85 hy L.~ No. A. TIDAL W~TLANDS: (1) All [andf generflll~, cnvvred or intermittently ered with. or w ch bord.r on. tidal ~vater:;. or lamb; lying beneath tidal waters, which at mean Iow tide . are covered hy tidol ~vatera to a maxim,m depth five (5) feet. inch,ling but not limited to bank~;. ho~s. salt marsh. Swamps. meadows, flat:; or other Iow lying lands subject to tidal action: (2) All banks, bogs. meadows, flats and tidal mar..;h subjec~ ~ ~uch tides and upon which grows or grow some or any of the fi~llowing: salt bay. black grass, saltwort, sea lavender, tall cordk, tass. high hush. cagtails. ~roundacl. marshmallow and low march cordgrass; and/or (3) All land immediately odjacent to a tidal wetland as defined in Subsection Al2) and lyin~ within seven. fy-five (75) feet landward of the most landward edge of such a tidal wetland. FRESHWATER WETLANI)S: {1) "~reahwa~r wetlands" as defined tn Article 2.I. Ti- tle 1. ~ 24-0107. Suhdivision~ l(a) ~ l(d) inclusive. of the Environmen~l Cooservation Law of the Sta~ of New York: and (2) All land immed/atels, adjacent ~ a "treshw:tter wet- land." as defined in in ~Uhsection ~{I) and lyin~ with. seventy-five (75) feet landward of the most. land. ward edge of a "fi'cshxvater wetland." 9705 FOP, M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT 'I'OWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. Z. 2~1+.~ .... Date ............. 0cf/,obe,V · · ~,8 ...., 1966. THIS CERTIFIES that the building located at . ~.~....A],~0. ~[~ .............. Street Map No. ~ ........ Block No..Y-J~ ....... Lot No. ~...~.~t.~*[~ ........... conforms substantially to the Application for Building Permit heretofore filed In this office. dated ........... t~y. ..... 2~t.., 19.~6. pursuant to which Building Permit No. ,~0~)~..Z. · dated .......... Halr.... 20 .... , 196R .. was issued, and conforms to all o/ the require- ments of the applicable provisions of the la w. The occupancy for which this certificate is issued is..FrJ,va.~e, one. t'~mtly..dwall/.~ ......................................... The certificate is issued to .. ~Ob~tr~;..Ig,..TiLl:ne2: ........... .~l~ler ...... ' ............ (owner, levee ot tenant) ' nf the a~oresatd buLldIng. Suffolk County Department of Health Approval . .Allg,. ~9~-.1~6...by. .R,..V:ELla ..... A-C R-80 MATTITUCK LIO R-80 GREAT BAY PEGONIC R-~.O - SOUTHOLD - 473~,~0 Art L E SECTION TAX MAP NU.~ER SEC t~,x ,,~Ap P~RCEL NUMBER PROPERTY LOCATION & CLASS ASSESSMENT EXE NAME SCHOOL DISTRICT ---LAND--- ~ ~ (U~RE'dT ONNE~'S ADDRESS ..... _PA~CEL.S_IZEIGRID C__OORD____~--_TOTA~L-,- AL~O DRIVE ~ ~'126.-z-16 - ~Q~ ~0 SINGLE FAMILY'RESI~EN ..... VETER ~ i:NOL9- HARLEY ~ WF ~ LAIJREL SCHOOL 473811 1,700 ~: ACRES ~ANK ~¢ DEED gOOK 4 PG-00124 7.500 - ....... ALBO DR RQ 210 SINGLE FAMILY RES[DEN ~O~ERT ~S~ .... LAIJREL~SC'H-O0~ .... ~'7~811 600 ST AC~ES 0.2~ DANK 40006 = ~IY ~1800 ~EED BOOK 4 PG-O0151 4,400 ALBO DRIVE ~SJ ~10 SINGLE FAMILY RESIDEN KEITH ~ WF--- L~iIREL ~HO0[ ...... ~-73811 600 OR ACRES 0.32 ~ANKARTSIO5 Y 11945 D~-~ -- 4 ~00i47 6,100 ALRO DRIVE ~TC ~10 SINGLE FAMILY RES[DEN j~, LcSTER E & WF SSB LAUREL SCHOOL 47_811 800 ACRES 0.41 BANK 40006 1i94~ ................................... 4 PG-O01~ 4,700 DEED ALBO DRIVE NF 210 SINGLE FAMILY RESIDEN DANIEL ~ ~F ........... [-AtJ~E[ SCHOOL 473811 700 19C ACRES 0.45 ~ANK017001~ t19~8 .................. D E E ~"-~qO0 K 4 PG-00136 6,500 .,,,' 1 ~ R ~80 M,~T'I'[TtJCK LIO ,~-80 GREAT BAY PE¢ONIC CORRENT OWNERS NAME SCHOOL DISTRICT ---LAND-~- ' - -TAX DESCRIPTION TAXABLE VALUE CURRENT OWNERS ADDRESS PARCEL SIZEFGRID COORD --TOTAL--- SPECIAL DISTRICTS ACCOUNT NO. ******************************************************************************************************* 126o-3-16 ****************** 21 ALBO DRIVE . ~6.-3-16 QX/2~O S~NGLE FAMILY RESIDEN VETERANS 41101 0 600 600 0 ARNOLD, HARLEY & WF ~/ LAUREL SCHOOL 473811 1,700 COUNTY TAXABLE VALUE 6.900 MATTITUCK NY 11952 ~:'~' ACRES 0~75 BANK 40004 ' TOWN ' T~×A~LE VALUE 6,g00 ~/ 4 PG-00124 7,500 SCHOOL TA×ARLE VALUE 7,500 DEED BOOK " FD030 MATTITUCK FIRE DIST 7,500 TO PK071 MATTITUCK PARK DIST 7,500 TO · W~O WASTE WATER DISTRICT 7,500 TO '' ALBO DR 126.-3-17 RQ 210 SINGLE FAMILY RES[DEN COUNTY TAXABLE VALUE 4,400 TURNER, ROBERT & WF SSB LAUREL SCHOOL 473811 600 TO~N TAXABLE VALUE 4,~00 9 ADAMS ST ACRES 0.25 BANK 40006 SCHOOL TAXABLE VALUE 4,400 HICKSVILLE NY 11800 - DE~D ~OOK 4 PG'00151 ~,~0 FDO.50 MATTiTUCK FIRE DIST 4,400 TO PK071 MATTITUCK PARK DIST 4,400 TO ~20 WASTE WATER DISTRICT 4,400 TO · ALBO DRIVE 21 126.-3-18 SJ 210 SINGLE FAMILY RESIDEN COUNTY TAXABLE VALUE 6,100 'R~ERTS KEITH & WF .. LAUREL SCHOOL ~73811 600 ' TOWN -TAXABLE VALUE 6,100 16~5 ALRO DR I / ACRES 0.~2 BANKARTSI05 SCHOOL TAXABLE VALUE 6,100 LAUREL,N Y 11948 ~/ DEED BOOK 4 PG-00147 6~100 FD030 MATTITUCK FIRE DIST 6,100 TO PK071 MATT[TUCK PARK DIST 6,100 TO WHO20 WASTE W~TER DISTRICT 6,100 TO ALRO DRIVE 126.-3-19 TC 21~ SINGLE FAMILY RES[DEN COUNTY TAXABLE VALUE 4,700 HUBBARD JR, LESTER E & wF SSB LAUREL SCH°O[ 473811 800 ' Town TAXABLE VALUE 4,700 ALSO ~R ACRES 0.41 BANK 40006 SCHOOL TAXABLE VALUE 4,700 LAUREL NY 1194~ ~ DEED 900K 4 PG-001~4 4,700 F0030 MATT[TUCK FIRE DIST 4,700 TO PK071MATTITUCK PARK DIST 4,700 TO WWO20 WASTE WATER DISTRICT 4,700 TO ALRO DR~VE 126.-3-~0 NF 210 SINGLE FAMILY RESIDEN COUNTY TAXABLE VALUE 6,500 KOWALSKI DANIEL ~ WF LAURE~ SCHOOL 473811 700 TOWN TAXABLE vALuE 6,500 PO BOX 194 ACRES 0.4~ BANK0170015 SCHOOL TAXABLE VALUE 6,500 lAUREL NY 11948 ' ' DEED ~oOK 4 PG~00136 6,500 ~D030 MATT[TUCK FiRE D[ST 6'500 TO PK071 MATT~TUCK PARK DIST 6,500 TO WHO20 WASTE WATER DISTRICT 6,500 TO BOARD OF APPEALS, TOWN OF SOUTHOLD In the Matter or the Petition of to the Board of Appeals of the Town of Southold TO: NOTICE TO ADJACENT PROPERTY OWNER YOU ARE HEREBY GIVEN NOTICE: 1. Th,~ i! !_~ t.~e intention of the undersigned to petition the Board of Appeals of the Town of Southold to requesta~(Special Exception) (Special Permit) (Other) [circle choice] ). 2. That the property Thichjs Ihe subiect of the Petition is located adiacent to your property and 3. That the property which~i% the s~bject of such Petition is located in the following zoning district: . 4 l~lat h~ SUCll Petition, the undersigned will request the following relief: ~.~f.,.~..~_/~.,~.~._~e~/~. 5. That the provisions of the Southold Town Zoning Code applicable to the relief sought by the under- signed are Article ~'~'---~ Section /~0 -- ~ [ ] Section 280-A, New York Town Law for approval of access over right(s)-of-way. 6. That within five days from the date hereof, a written Petition requesting the relief specified above will be filed in the Southold Town Clerk's Office at Main Road Southold, New York and you may then and there examine the same during regular office hours. (5'16) 7~5-1809. 7. That before the relief sought may be granted, a public hearing must be held on the matter by the Board of Appeals; that a notice of such hearing must be published at least five days prior to the date of such hearing in the Suffolk Times and in the Long Island Traveler-Mattituck Watchman, newspapers published in the Town of Southold and designated for the publication of such notices; that you or your representative have the right to appear and be heard at such hearing. Dated: [Copy of sketch or plan purposes,] Petitioner -~_~/~L.~-l~.7''/A) ,,' 7"'f-/~,,~. /~. Owners ' Names :~_~~ Post Office Address Tel. No. (~/&) ~ ~ showing proposal to be at~ached for convenience P 077 471 t86 P 077 471 187 PROOF OF MAILING OF NOTICF ~H CERTIFIED MAIL RECEIPTS ADDRESS STATE OF NEW YORK ) COUNTY OF SUFFOLK ) SS.: , being duly sworn, deposes and says that on the __ of , 19 , deponent mailed a true copy of the Notice set forth on the re- verse side hereof, directed to each of the above-named persons at the addresses set opposite their respective names; that the addresses set opposite the names of said persons are the addresses 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 Of- f~ce at (certified) (registered) mail. Sworn to before me this "~ day of ~:~~, 19 ~"~ Notary Public that said Notices were mailed to each of said persons by HE1.EN IL DE ~E gO1'~y PUBLIG, S~e of Neff YoI~ No. 4707~7~, Suffol~ Ten~ Expires Ma~ch (This side does not have to be completed on form transmitted to adjoining property owners.)