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NO.
TRUSTEES
Issued To~ DateJ~~~
Address~
THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION
TOWN TRUSTEES OFFICE,TOWN OF' SOUTHOLD
SOUTHOLD,. N.Y. 11971
TEL.: 765-1892
N
SURVEY OF P OPERTY
A T SOUTHOLD
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N. K
1000-90-04-17
SCM,E: '1 "=30'
MAY 20, 2002
JUNE 29, 2004
NOW 2, 2004 (REWSED)
OCTOBER 21, 2005 (TOPO. & WETLAND FLAGS)
FEB. 23, 2006 (EXISDNG SEP~TC SYSTEM)
JULY 13, 2006 (FLOOD ZONE)
SEPTEMBER 1, 2006 (PROPOSED ADDI170NS)
NOVEMBER 3, 2006 (WETLAND AREA)
NOV. 8, 2006 ILOT COVERAGE REVI~-D)
Dec 5~
FEB. 6, 2007 (revisions)
feb. ~ 2007 (rev/~/bn5)
OCT. 6, 2010 (GF. EL.)
TOTAL AREA =24,704 sq. fl.
WETLANDS - J~397' saT. fl.
UPLANDS 2/,50T sq. ft.
LOT COVERAGE UPLAND AREA = 21507 sq. ft.
EXISTING - HOUSE 1442 sq fl/21307 =
DECK IZBZ sq. ft./21507 =, 5 7%
SHED I01 a~.fL/ ~1307 =
LOT COVERAGE-
A T COMPLETION
HOUSE 2182 ,sq ff/21507 =
DECK 1056'sq.f// 21307 == 5.0~
SHED I01 sq. fl./'21507 0.5~
POOL 280 sq. fl./2l$07 =
LOT COVERAGE- 17%
A = WETLAND FLAG
Elevations referenced to N.G,V.D.
LOT NUMBERS REFER TO 'MAP OF CEDAR
AREA=£4,704 $,F, BEACH PARK' FILED IN THE SUFFOLK
COUNTY CLERK'S OFFICE ON DEC. CO, 1~Z7
TO TIE LINES - As MAP NO. 90,
GUTTERS, DOWNSPOUTS AND SUB-SURFACE DRYWELLS
TO CONTROL STORMWA TER
PROVIDE 4 DRYWELLS 8' DIA x 4' DEEP
uLOOO ZONE AE (el. 8)
FIRM J610JC0167 5/04/98
COASTAL BARRIER /DENT/FlED 1991 OR LATER
CER T/FlED TO:
LEE L BENINA TI
MARIE D. BENINA
CHICAGO TITLE
COUNTRY WIDE
F O. BOX 9~9
DEC 2 ? 2012
TROPICAL STORM SANDY EMERGENCY APPLICATION
Valid thru June 1,2013
Property Owner Name:
Permanent Mailing Address:
Phone Number(s): ~
Property Address:
Suffolk County Tax Map Number: 1OOO
Agent (if applicable)~-~,(~
Address: ~,
Phone Numbers):
Boa~ of Trustee Permit Numbers):
Will any part of this project require a Building Permit?
How much fill will be required?
County of Suffolk
State of New York
/~'~ ~-/Jl C/AT~ BEING DULY SWORN
DEPOSES AND AFFIRMS THAT HE/SHE IS THE 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), IF GRANTED. IN COMPLETING THIS
APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR
REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE
PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION.
Signature of Property Owner
SWORN TO BEFORE ME THIS ~7~ DAYOF'~I~
WlNOY L KUKLA
NOTARY PUBLIC-STATE OF NEW YORK
No, 01KU6176871
Qualified In Suffolk County
My Commission Expires November 05, 201,5
AUTHORIZATION
(where the applicant is not the owner)
(print owner of property)
residing at ~ ~ o,~c--~3oo~
(mailing address)
do hereby authorize
(Agent)
to apply for permit(s) from the
Southold Board of Town Trustees on my behalf.