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HomeMy WebLinkAbout4584cl �J c�.L'c.f v�d Y/ea.r F+✓Y�. � la-Ti4T't9 �iC � rn9, TOWN 8) BUILOING TOWN C SOUTI ..Examined ...... ,!. F Y 11.0 ............ 19,6.:?., Approved ........ ..... ... ` .......... 19.....,. Permit No.4 SOUTHOLD • a $`0—" I , (EPARTMENT RK'S OFFICE .. j Nw14 ' ,k/, LO, N. Y. P � APPhcatwn Not ... .....: ....... ...... ........: .. ...... 3 < " 7i ! 70 3 !tsef'cq n (Budding Ins ctor) f � APPLICATION FOR BUILDING eE* e 5f i A4$ Date .........Wit' *7 19x... ,. C ©a G13INSTRUCTIONS Q e This applica#ion must be completely filled in by typewriter or in ink and submitted in duplicate to the `Building;, {nspeef�"r, c If,b, ,Blot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public strgets or; n {r s c# giving a detailed description of layout of property must be drawn ;on the diagram which i dart this ap�rc`at'on, G =,he work covered by this application may not ►ie commenced before issuance of Building Permit, �s. >: ,.'. �f4 ,4 d. pan approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shad b kept on the premises available for inspection throughout the progress of the, Work. t e. o building shall be occupied or used in whole or in part for any purpose w„hateyer until a -Certificate -of Occupancy i shdll hbve been granted by the Building Inspector. r, �PPJCATION IS HEREBY MADE to the Building Department, for the issuance of: o Building Permit pursuant to the Buildin Zone Ordinance of the Town of Southold, Suffolk County, New York, and ather applicable Laws, Qrdinances.or, Regula prls, for the construction of buildings, additions or alterations, or for removal or demolition, as herdm,descnbed: The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. J.............utism ,,�?..,.a�� �i(Signature of applicant or name, if a caOoratton) ` (Addre of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. c ...... ......... .................I.......1 ...,.. rt.�: .... ......... ......... .I.......� Name of owner of premises .......................... l!9?� v'. urca� If applicant is a car//orate sign ure of duly authorized officer. ..... lA .. .... (Name and title of orporate officer) 1. Location of land on �h proposed work will be done Map No �' Lot'No Street and Numbe� �avN ✓✓t`?.. ray l? ( Z85 Municipolity, 2. State existing use and occupancy of premises and intended use, and occupancy of proposed construction:` v a. Existing use and occupancy .:....... ........: ...... ..: b. Intended use and occupancy .......................,/ .... I cY...Dt?ve� Repair .................. Removal .................. Demolition..:.:. ........ Other Work (Describe).........................I........... 4. Estimated Cost ...... , . .ti?.. ....... Fee ...... '........................................................ .......... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........W. .......... Number of dwelling units on each floor ............................ I,I -: If garage, number of cars.................................................................. ......:,: 6. If business, commercial or mixed occupancy, specifynature and extent of each type of use . 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ..........................................' .... ......... ......... ......... Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ 8: Dimensions of entire new co strruction: Front .... �.� umber of ...................... StorRear t.... t% ............. Depth .....�b . Height ....... A± ..... Number of 'Stories ............:.....k4?.W....... Af�!41�_P...... .................... 9. Size of lot: Front .. 12 0 Rear . Depth ......I.. -3 s" I,fJ �j .. 5 10. Date of Purchase O �'�"................ %/ .....::.°�. Nome of Former Owner. .......>.bs...!�,.� 11. Zone or use district in which premises are situated ......... 12. Does proposed construction violate any zoning law, ordinance or regulation? .. /.o . ............................. ......... 1. - 4 13. Name of Owner of premises -A' {' #1.2rS}wr'` Address �� �H�L�°l "� No ... Phone �,l > Name of Architect lZimo.......:........ Address No `... j.. °.....`u f ' Name of Contractor ✓. �*y" °..... f .> e -Address ..... �o +� �+Zo ....... fte,? ,Phone No J ........ PLOT DIAGRAM Locate clearly and distinctly all buildings; whether existing or proposed, and indicate all set,beck-dimesians, from property lines.' Give street and block number or, degcription according to deed, and show street names_ond:; indicate whether interior or corner lot. f - 4 i i- 3st STATE OF NEW O ISS COUNTY ,y/�J, OO,,F- ... . t ....... ldzl�r....................................................................being duly -sworn; deposes and says that he is the applicant (Name o individual signing app icotlon) above named. He is the ... rBU. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make ander file ' this application; that all statements contained in this application are true to the best of his knowledge and belief; and - that the work will be performed in the manner set forth'in the application filed therewif Sworn toj before me this .. *nty . ...r .. .. ........................` ...................... Notary Publiice/GNG/Ks � .... ................. .....pDiT L. OKEN �Srgn re of applicant) _ ^wary Public State of New Yor 52.0344963, Suffolk county _—' �— wmmimcn Expires March 30 14 TOWTV ter SOUtHOi.r, ExzInined .1V.! 6/iy Approved . 19 9 to nvnhU ur ntAt,acr .. 0. 3 PL.S SETS OF N K FORM N 1 `- 1,� SURVEY . . , TOWN OF SOUTHOLD cnEcK ....417�y. . , , BUILDING DEPARTMENT SEPTIC FORM .. .... TOWN HALL $oUTELL..�5 802t�1z1 NOTIFY: TEL.; MAIL TO: � ., 19 9 Permit No. i Disapproved a/c ............ ....................r ........ r 't r (Building- Inspector) APPLICATION FOR BUILDING PERMIT i Date .. Jl.%....`.. ....... 41 INSTRUCTIONS a. This applicationmust be completely filled in by typewriter or in ink and submitted to the Building Inspector, wia, sets of plans, accurate plot plan to scale. Fee according to schedule. b Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public strce or areas, and oivin a detailed description of layout of property must be drawn on the diagram which is part of this app cation. c. The work covered by this application may not be commenced before issuance of Building- Permit. -d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such perm shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupant shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to.the Building'Department for the issuance of a Building Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describec The applicant a_rees to comply with all applicable laws, ordinances, building code] housing code, and regulations, and t: admit,authoriied inspectors on premises and in building for necessary inspections.� ign/aturefo"applicant, or name, if as corpor tioonn)) (Mailing- address of applicant) State whether applicant is ovine ,`lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................ �-....... M.F3 U S F V j ..................................... Name of owner of premises i fs /✓�/,r G� ...� ................... ................ . (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer. . (Name and title of corporate officer) y Builder's License Na: _.. ............. . Plumber's License No . ........................ Electrician's License No. ............ I ........ Other Trade's License No. . ......... . I. Location of land on which proposed work will be done; llousc Numbcr, Street Hamlet County Tax Map No. 1000 Section `. i ............. Block .... ............. Lot . J......... S• Subdivision ...... .... .:..................... Filed Map No. ......... .(Name) Lot State existing use and occupancy of premises and intended use and occupancy or proposed construction: A. Lxiseing-use and occupancy.. ., .. t Ve aB. Intended usn occupancy.... TOWN OF SOUTHOLD, NEW YORK ACCESSORY APARTMENT APPLICATION FOR SPECIA6 ,EXCfPTTON Application No. Y j�9 Date Filed: ./ TO THE ZONING BOARD OF APPEALS, SOUTHOLD, NEW YORK: p� nn Town Clerk Sown,� I (We), Ane Rc-Lku:seuec�� of c,?? 310UAQv+et_.i �IiP_ Ouse o, and Street= Hamlet, Statedi, Zip Code hereby apply; to THE ZO,NING,BOARD OF APPEALS for a SPECIAL EXCEPTION in accordance with the ZONING ORDINANCE, ARTICLEV1 SECTION =31 SUBSECTIONZ ]tb for the below -described property for the following uses and ;purposes:' 1�c"GSDrtj { ar�meA� �0u3lp_leve_ <o s In ccr � �b,3 L9 e -r t eS c4enee �jui �I [ iC�S lyn��r Z as shown on the attached plan drawn to scale. A. Statement of Ownership and Interest. Anne- MarUSeyiJA is (ate the owner(s) of property known and referred to as A-Je; House No., Street, Hamlet identified on the Suffolk County Tax Maps as District 1000, Section Block Lot I which is H-s�on a subdivision map (Filed "Map of Filed Map No. T. The above-described property was acquired; by the owner o j 6 91 B The applicant alleges that the approval of this exception would be in harmony with the intent and purpose of said zoning ordinance and that the proposed use conforms to the standards prescribed therefor in said ordinance and would not be detrimental to property or persons in the neighborhood for the following reasons: ar 0 I h,2,Y'`S iLsc , r C. In addition to meeting the standards prescribed by the zoning ordinance, the following requirements will be met: 1. The'accessory apartment will be located only in the principal building. 2. The owner of the existing dwelling will occupy one of the dwelling units as the owner's principal residence. The other dwelling unit which is part of this application shall be leased for year-round occupancy, evidenced by a written lease for a term of one or more years, which will be filed annually. 3. The existing one -family dwellingshall contain not less than sixteen -hundred (1,600) sq. ft. of livable floor area. (continued on page two) Application for Special Exception < Page Two (continued) C. 4. The accessory apartment shall contain not less than four -hundred fifty (450) square feet of livable floor area. 5.- The accessory apartment shall not exceed forty (40%) percent of livable floor area of the existing dwelling unit. 6. A minimum of three off-street (on-site) parking spaces shall be provided. as shown on the attached plan. 7. Not more than one.(1) accessory apartment will be on this parcel. 8. The accessory apartment will meet the requirements of a dwelling unit as defined in Section 100-13 of the Zoning Code. 9. The exterior entry to the accessory apartment has not changed the existing exterior appearance of a one -family dwelling. 10. All exterior alterations to the existing building, except for access to the apartment, is made on the existing foundation as shown on the attached plans. - 11. I understand that the Certificate of Occupancy will terminate upon the transfer of title or upon the owner ceasing to occupy one of the dwelling units as the owner's principal residence; and that in the event of the owner's demise, the occupant of the accessory apartment may continue in occupancy until a new owner shall occupy the balance of the dwelling or one (1) year from date of said demise, whichever shall first occur. 12. This conversion shall be subject to inspection of the Building Inspector and Renewal of Certificate of Occupancy annually. 13. The existing building which is converted to permit this accessory apartment has been in existence and has a valid Certificate of Occupancy issued prior to January 1, 1984, and attached hereto. 14.. The existing building, together with this accessory apartment, shall comply with all other requirements of Chapter 100 of the Town Code of the Town of Southold. 15. This conversion for the accessory apartment shall comply with all other rules and regulations of the New York State Construction Code and other applicable codes. D. The property which is the subject of this application is zoned and [ ] has not changed since the issuance of the Certificate of Occupancy attached. f ] has changed or received additional building permits, and Certificates of Occupancy for these changes are attached or will be fu s e_ . L � L?: 9? o7�c25%sseee cl !/-/D-6_ COUNTY Of SUFFOLK) STATE OF NEW YORK) ss" S'" natur)2 Sworn to before me this o?� day of �° � 19 �2 . �Nftary Public)' ZB5 .2/6186 LMDA F. KOWALSKi ftyPu. Stateofiftwyotk Qaallfied n. 1kCf4tlC (j iftssion 1 xp ras Nov. 30, isl fi k G o o �.. c.' , j 1" vow ftovw W i r rv,rr.rs Yl 'iA°i`YiiM\ Y Y fti1r%o*eV llw#-.*AdMKLO OWNER STREET r 2 ' VILLAGE DISTRICT 'SUB. LOT iii _Y -fid I G a Cl� tJ r f' w ha 7% le, I rr FORMER OWNER N p E _ AZREAGE R/VO e, W -S fila S <-�i�t� c.cs{� i%LCt.f.✓� J� L' C WTYPE ' J{� lr' OF BUILDING !^ dX RES. % p SEAS. VL FARM COMM. IND. CB.Sc. LAND _ IMP. TOTAL DATE REMARKS elh5,r _ M N Lt I��- bYFC2N � ad. ori .iAy DRQ_ o 0-9 ,- z. LG g44 3Y /� s GE ° I G N[iI [ C NEW NORMAL BE W ABOVE L}?�i;� -., /t7Ci .�._—. - GJ—g?�O � 2..2Lc%% / 9.'6P 7s cri/�S-7. L r a a Shed LTillable 2 Tillable 3- -- — -- ---- ------ Woodland — Swampland -- -- --- Brushland — House Plot — Total , M. Bldg. �✓ �. o Foundation Bath Extension Basement ��, Floors C Extension Ext. Walls 2w.la Interior Finish y p : °f o Heart 1- Extension Fire Place tr,�t � Porch Attic % , i Porch Rooms 1st Floor — Breezeway Patio Rooms 2nd Floor Garage ;, q Driveway ._. s Ot� o - ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER 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) 765-1800 THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD TOWN BOARD AT THEIR REGULAR MEETING HELD ON JUNE 23, 1998: RESOLVED that the Town Board of the Town of Southold authorizes the refund of $400.00 to Anne Marusevich, which sum represents a filing fee to the Board of Zoning Appeals, which application was found to be, unnecessary. Elizabeth A. Neville Southold Town Clerk June 24, 1998 OFFICE OI'' BOARD OF ZONING APPEALS Gerard P. Goehringer ' Linda Kowalski, Full -Time Assistant ZBA Chairman Clerk -Typists (Part -Time) : MaryAnn Cybulski Lucia Farrell 765-1809 (Intercom 225, 223, 224) MEMORANDUM TO: TOWN CLERK ELIZABETH NEVILLE FROM: BOARD OF APPEALS DATE: JUNE 12, 1998 SUBJECT: REQUEST FOR REFUND Please find attached letter from Anne Marusevich confirming her request to withdraw Application No. 4584, and requesting. a refund of the $400.00 application fee. By Resolution of the Board of Appeals adopted at our Regular Meeting of June 11, 1998, it was recommended that a full refund be authorized for this recent submission. 7f1rt adoaounuviewAve. —j;�'�' Mattituck, NY 119523049 I cut;�Izl ✓ � G tL C, C, i ELIZABETH A. i Di LLE, TOWN CLERK RECEIPT" 69472 Town of Southold � Southold, New York 11971 DATE 7y 19 Phone: 516-765-1800 RECEIVED OF: FOR: 1), �;� ❑ CASH BY: CHECK/ -n-11_ Ln •' • r POSSIBLE RESOLUTION FOR MEETING OF: ------- • Re: � �f4r not I ° "�-� OF: . ( )checked to show more than one item is attached, received fro ( ) applicant/agent m. ( ) other: Comments: 7 11 �Ia/ Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: for new building or new use: 1. Final survey of -property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from: Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. . 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non -conforming uses, or buildings and "pre-existing" land uses: . 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and a consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees Certificate of Occupancy - New dwelli.n $25.00 Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Buildine - $100.00 3. Copy of Certificate of Occupancy - _ .25v,-. 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date......................................... New Construction........... Old Or Pre-existing Building ............... Locationof Property....................................................................... House No. Street Hamlet Onweror Owners of Property ........................................... ..................... County Tax Map No 1000, Section ......... ..... Block ................ Lot ...................... Subdivision....................................Filed Map ............ Lot ...................... PermitNo................Date Of Permit ................ Applicant............................. HealthDept. Approval..........................Underwriters Approval......................... Planning Board Approval ........................ Request for: Temporary Certificate........... Final Certicate........... Fee Submitted: $............................. ................................................ APPLICANT liv 3'/a9 9� I FE_. T I . v, AT I / MATTITUGK, A I % (,ante hoarc AT I / MATTITUGK, A I % Scale 2`a'�'Lrz��Cce �• , .sUt,9�01% 60Ua1� 7 -ax Ana i ��, >�OC•� �i /OOC. Sr C fr 9Ll-/ -1 (,ante hoarc QIP oy 1,14 Scale 2`a'�'Lrz��Cce �• , .sUt,9�01% 60Ua1� 7 -ax Ana i ��, >�OC•� �i /OOC. Sr C fr 9Ll-/ -1 ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO:' Southold Town Zoning Board of Appeals FROM: Elizabeth A. Neville DATED: June 1, 1998 RE: Zoning Appeal No. 4584 - Anne Marusevich Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 Transmitted herewith is Zoning Appeal No. nn Marusevich - application for a special exception. Also included is: Transactional disclosure form; Z.B.A. Questionnaire; and copies of plans. FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT_ TOWN CLERK'S OFFICE SOUTHOL,D,. N.=Y:' r ` � 4€�:-'t•;��'. -• Sn, ^ l3UILDING'RERMIT 'fir _ _�.-��•�- - , f . .. ', .. � .. (THIS'PERMIT'WUST BE KEPT- ON',THE'-_RREMjSES,UNTIL FULL, - COMPLETION OF THE WORK AUTHORIZED) N° '2925'. Z' . Date a..:... .. ►, off, - � - r .• � 1' „c -'J ,:ice.{ u.�}4i `��Y �l� .', - Permission is hereby granted to: 4. •A/C•OtieiFe;t�:.i�F�lpwi�h�;�. •..•. ................................. ................................. to M..1d..new=tate•..famf•17••1dv'07:-i:...... .........................: . ...... ................................................................y:;.l..; .;.�; .:.::. . y_.....:,...:.... . at remises located at �►,;. ....0 ...a.•..•....`• ..:•:•..:•' ......................•!_.!• • •.• ••.•.•...•.....•...•••.....•.•....•••.•••.•...... ................... •.. •.. ..•. ... ..Y. .•• ............... pursuant to'•application'dated::;.:.... ....... ..... aDiv"bev..14) , .1 q0 ..:,.'and approved 'by 'the Building Inspector Fee $...10.00....,.... Bui�ding'' ectprl.,,. 1 � - ! • _ .S. '_ ..�. ori. _ �:')• � _ J...................... ........... : .......................... .... ... PRODUCT 205.1�Inc., Groton, Mau. 01471. 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' _.t: t[�.i a�-L:v/ _ _ - _ - •_-: ., .__z�_. .01 �T�.�'W�_r,l i. "fr_. - n - ,_iLTt7l-t-i,l{,i`-•V i-. _ ...� _ - - _ , %« a „y, y 1` 1 i ,'i. it' . I ;�5' • . - i! tr ., ,i_ - "G G. - 0 ti• I.• >° t f" ,.. -. - — .. 1. ' . . I — , ,.:'— �s �r- �t i' T- rr "ice: .-.-- ;t'Ag f: , J.. { - . _ - P 1 :: =4 S 1 i ( ,`r, - r " ,7 t. . :i - or" f r. ;r �. '% - 4' .� rA r s Q.;... >;'. ... ti N. �. - - �1.,i+-Y _% - - -�. i.. ti�� i '` '•� ♦, j fe^,: N' .': r: !-, %,' :..b • k - :L. T E -U RA WING: Nl? ffl- W1.:NiODEt. -NAC �' `lam Q'�'L' .TYPE a... . i' . • .- ry>- 6't' �;�`a et.'A N-` , : ' • `HAND iSCAI ._.., : ,,. .... ....... 4. Tfl� yy 4 1. xsC 14 "fi -AW7 U, WIN Ari -X, PPL a ice, .3 _.k� kT ► - I. All. it" J. -C t. k' fiR DE 711 VAT -- -------------------- APPLICANT TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts interest on the part of town officers and employees. The purpose of this form is to provide information which can alert the town ofop ssible conflicts of interest and allow it to take whatever action is.necessary to avoid same. YOUR NAME: . C C--ldd-&��4F/C 17Z _ (14asu name, £lr.s - iia ►ne, micldle initial, you are applying in Hie name of someone other entity, such as a company. I£ eo, 'the other person's or company's name.) NATURE OF APPLICATION! (Cl►eck all that apply.) Tax grievance Variance Change of zone Approval of plat Exemption from plat. or official map Other. (If "Other.," name the activity.) unless else or indicate Do you personally (or through your company, spouse, sibling. parent, or child) have a relationship with any officer or employee of the Town or Southold? "Relationship" AncludeF; by blood, marriage, or business interest. "Ilusiness interest" means aibusinens, including a partnership, in which the town officer or employee has even a partial ownership of (or employment. by) a corporation in which the town officer or employee owns more than 5% of the shares.. YES NO If you answered "YES,". complete the balance of this form and date and sign where indicated. Name of person employed by the 'Down of Southold Title or position of that person Describe the relationship between yourself (the applicant) and the town officer or employee. Either clie.ck the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or his or her spouse, sibling', parent, or child is (check all that apply): A) the owner of greater than 5% of the shares of: the corporate stock or the applicant- (when the app.l.icanl; is a corporation); B) the legal or beneficial owner of any interest in a noncorporate entity (when the applicant is not a corporation); C) an officer, director, partner, or.empl.oyee of the applicant; or. D) the actual applicant. DESCRIPTION Or i2ELATIONSIIIP Submitted t-l►is day of 199_ Signature � % T Pr.Int name /y d5c-, l� QUESTIONNAIRE FOR FILING WITH -YOUR Z.B.A. APPLICATION A. Please disclose the names of the owner(s) and any other individuals (and entities) having a financial interest in the subject premises and a description of their interests: (Separate sheet may be attached.) B. Is.the subject premises listed on the real estate market for - sale or being shown to prospective buyers? { ) Yes (g,j No. (If Yes, please attach copy of "conditions" of sale.) C. Are there any proposals to change or alter land contours? { ) Yes (k) No D. 1. Are there any areas which contain wetland grasses? 2.. Are the wetland areas shown on the map submitted with this application? �r 3., Is the property bulkh aded'between the wetlands area and the _upland building area? 4. If your property contains wetlands or pond areas, have You contacted the Office of the Town stees for its determination of jurisdiction? E. Is there a depression or sloping elevation near the area of proposed c nstruction at or below five feet above mean sea level?,<< (If not applicable, state F. Are there any patios, concrete barriers, bulkheads or fences which exist and are not shown on the survey map that you are submitting? If none exist, please state "none." G. Do you have any construction taking place at this time concerning your premises? If yes, please submit a copy of your building permit and map as approved by the Building Department. If none, please state. H. Do you or any co-owner also own other land close to this parcel? 00 If yes,. please explain where or submit copies of deeds. I. Please list present use or operations conducted at this parcel proposed use and A ized i nature and Date 3/87, 10/901k