HomeMy WebLinkAboutMULHOLLAND, JOHN �; Fr'.V...c:.y...c.reli!Yh'.•r.XTv'.)...t•• :"1'.'..::......... .�.
FRANK A. T
KU AWSKI, .R., President
J ALBERT J. KRUPSKI, JR., Vice-President �' ' * TELEPHONE
JOHN M. BREDEMEYER, III ® �� (516) 765-1892
JOHN L. BEDNOSKI, JR. lye,
HENRY P. SMITH
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 728
Southold, New York 11971
June 24, 1988
05 rl 0�
Mr. Peter R. Stoutenburgh
a
President
Environment East, Inc.
RR No. 3 - 3075 Indian Neck Lane
Peconic, New York 11958
Re: John Mulholland
Dear Mr. Stoutenburgh:
The following action was taken by the Board of Town Trustees
during their regular meeting held on June 23 , 1988 regarding the
above matter:
RESOLVED that the Southold Town Trustees approve the request
made by Peter R. Stoutenburgh on behalf of John Mulholland
for a waiver of the wetland ordinance to construct a 3 ' x 36 ' x
12 ' addition to an existing residence and a front stoop on
property located at 725 Island ,View Lane, Greenport.
Please be advised that the grasses 30 ' landward of the stake
with the flag on your property, can only be mowed to a height of
one foot. No other mowing is permitted in this area. Should you
have any questions or concerns, please do not hesitate to contact
this office.
Please note also that the $25.00 fee for this waiver is now
due and payable.
- Vey truly yours
)
Frank A. ujawski, President
Board of To in Trustees
FAK:ip
cc: File
r !
Al
Town Hall 53095 Main Road
TELEPHONE P.O. Box 1179
�� �"a � �'
(516)765-1801 �� '* ` � Southold, New York 11971
p�
SOUTHOLD TOWN
CONSERVATION ADVISORY COUNCIL
To: Southold Town Trustees
From: SOUthold Town Conservation Advisory Council
Dated: June 22, 1988
Re: Wetland Application Recommendations
.a
The following recommendations were made by the CAC 'at its regular
meeting held Thursday, June 22 , 1988:
No. 625 - Clifford Eginton - Recommend disapproval. No major
need is shown, CAC suggests applicant revegetate the
slight problem area.
No. 628 - Anthony Panzarino - CAC divided the application into
parts A and B. It recommends approval of Part A which
is to repair existing deck; constuct. a timber dock
with a fixed elevated walk; hinged ramp; float ; and ,
construct an additon of w/s of beach house.
The CAC recommends disapproval of Part B which consists
of a retaining wall with returns ; backfilling; additions
to existing wood decks; construct concrete pads on
n/s of beach house. The CAC feels that the applicant
has shown no need for the retaining wall and additional
deck would be too close, and as a result wetlands would
filled. The land is stable, further work would destroy
wetlands .
No. 629 - Linda Wilton- Recommend::.disapproval. Property is wetlands .
Check for possible violation.
No. - Andrew and Bernice Lettieri - Recommend disapproval.
Not enough space for prosposed project , presents a
navigational hazard.
Recommend approval of Waiver Requests of Henry Smith, Joseph
Policano, George W. Bornschein, Venetia McKeighan and
Jon Mulholland.
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Environment East, Inc.
R.R.No. 3— 3075 Indian Neck Lane
Peconic,New York 11958
516-734-7474
June 14, 1988
Southold Town Trustees
Town Hall
Main Road
Southold, NY 11971
Dear Trustees;
As agent for John Mulholland we are requesting a
letter of waiver for the proposed addition to the
Mulholland home at 725 Island View Lane, Greenport.
The proposed construction encroaches on the wetlands
no further than the existing building with the excep-
tion of a stai
If any othe in ma on is needed, please let me know.
Sincerely 6 �/
yid
Pe ter . ou nburgh
Preside
Envir ent East, Inc.
PR : gym
TELEPHONE
(516) 765-1892
\� BOARD OF TOWN TRUSTEES
TOivN OF SOUTHOLD
Town Hall, 53095�Main Road
P.O._BOX 728
Southold, New York 11971 '
`V� APPLICATION IS HEREBY MADE TO THE TOWN TRUSTEES OF THE TOWN OF
SOUTHOLD, SUFFOLK COUNTY, NEW PORK '-FOR THE ISSUANCE Or A .PERMIT
PURSUANT TO -'THE LAWS , ORDINANCES AND REGULATIONS GOVERNING THE
COASTAL AND INTERIOR- WETLANDS , FLOOD PLAINS AND DRAINAGE AREAS
OF THE TOWN OF SOUTHOLD, AND THE ISSUANCE OF PERMITS PURSUANT
TO CHAPTER 32 OF THE CODES OF THE TOWN OF SOUTHOLD.
APPL1-CATION NO. DATE OF APPLICATION Ma 2 1p88 ,.
„I DEN T1,TY ;OF !;APPLIGANTBnVir.Onment East nc For. John Mulholland} _
*-------------�—I-------------- E N O
..ADDRESS OF APPLICANT 3075 Indian Neck Larva
Peconic NY 11958
---------------------------s------ ----------------- -- ----------
-TAX TAX MAP NO. . innn
------- - -------------------
---------------
-
L1Y3Y'9t1@1LFAAt, I' I, 1'---
AGENT �t3C�-----------------�34-q4��# -----
PHONE NO .
PERMIT REQUESTED TOti nn
------------------- � —-��LqO-�-------------------------------- '.
LOCATION OF PROPERTY, FOR WHICH PERMIT WANTED
11}] r-r_ _------ ---------. ------- ---------------- --
HOME ADDRESS OF PERMIT APPLICANT IF DIFFERENT FROM AFORESAID L;OCAT,IOFI
�341�_Zn�r_BQ�i}_M�nr�e7-� �- -----------------
77 -----
.CREEK, BAY OR HARBOR FRONTING PROPERTYSauthold-Bay' ----_---
SIZE OF PROPOSED- ,WORK314b1x12t-------
-------------------------
LENGTH
-----3�'------------------------------------- ---- ---
W I D T H------ —f+�_1i1---------�
---------------------- ----.----
;, HEIGHT ABOVE _ HIGH WATER 1
DEPTH BELOW LOW WATER �T�/ .
- ------ Y/ ------------------------- ----- --
YARDS TO BE EXCAVATED
------- --------------------- ------ -
YARDS TO BE FILLED
------------ ------------—--------------
WIDTH OF CANAL , CREEK OR BAY FRONTING PROPERTY IA
DEPTH AT LOW TIDE --
--- A- -------------------------
AVERAGE RISE IN TIDE ,
�1----------------------------------------
DISTANCE TO THE NEAREST. CHANNEL
------ iI-A--FT.
DISTANCE PROJECT EXTENDS BEYOND SIMILAR PROJECTS IN THE AREA N/A
IS THIS FOR PRIVATE OR BUSINESS USE?----Private
AREA ZON.I NG -
z� rs-vy -.-^------- ------------- .----. -- --
MANNER IN WHICH MATERIAL WILL 13E REMOVED OR DEPOSITED--_---_N/A - ---
--------------------------------------------------- -------------- -
1 NTENDED USE OF PROPERTY farm_ dwelling 'with _addition
_
Res1
nn ,inl
It _' DESCRIBE ANY KNOWN PRIOR OPERATIONS CONDUCTED ON THE PREMISE `
'NZA-------- ----------
---------------
AND WHETHER ANY PRIOR LICENSE OR PERMITS HAVE BEEN ISSUED TO ERRECT
STRUCTURES OR TO DREDGE OR-DEPOSIT )FILL ON SAID PREMISES AND WHETHER
ANY PERMITS OR LICENSES WERE EVER SUSPENDED OR REVOKED BY A GOVERNMENT
AGENCY 1��-
i' "�^ . ------------------------------------------------------
----------------------------
------------------------------
DESCR.IBE . FULLY THE REHABILITATION AND PROPOSED CONDITION OF THE
;,.:.
PREMISES AFTER THE .WORK IS COMPL TED INCLUDE AN ADD1 �'. IONAL SURVEY OF
THE PROJECT $ l;T-E� 1 F NECESSARY N/A
----- --- ------------ -------------------------
- ----- —,------- .--- ----
,{: - -^--•------------------------•-----------------•--- ----
WRITTEN CONS'�NT .OF THE OWNER OF THE PROPERTY, 1F NOT THE SAMEAS THE -
APPLICANT.
---------
------------------------------------ -------. - ------ _-
AREPTHERE ANY COVENANTS OR RESTRICTION$,. IN YOUR DEED THAT WOULD
P.ROIIIBIT THIS PROJECT? N/A
t.
COUNTY OF SUFFOLK )
STATE OF NEW YORK ).S$;
F_nvirnnmAn , Fast, InC„for J Mulholland as1nG DULY SWORN D9
POSE!
? .:,.
AND SAYS THAT HE 15 THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS,
` AND THAT-ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST
OF HIS KNOWLEDGE AND 9EL1EF, THAT THE WORK WILL BE DONE 1N THE
MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED aY
?•' THE TOWN BOARD OF THE TOWN OF SOUTHOLD. 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 aY .
f VIRTUE OF SAID PERMIT, IF GRANTED.
: In completing this application I hereby authorize the Trustees ,
`} agent or representative to enter o m
y property to inspect the
P;x'GmiSes in. conjunction with r V1, cation.
Pre side nt
SIGNATURE OF APPLICANT
`s'
'.'.
w : SWORN TO BEFORE ME THIS
c.; DAY OF
EL!lA13ETH ANN NEbf{.0
NNOT-8 2 Public
o New Yo*'
Ter—
olk Cou
NOTARY PUBL I C 31,1
EXAMINED ;
APPROVED PERMIT (CHAPTER. 97)
APPROVED °BONc3�:;DOGKS,, WHARVES" PERMIT (CHAPTER 3 2) ,
DISA,PPROVED " WETLANDS PERMIT" (CHAPTER 97)
AISAPPROVED BOATS , DOCKS., WHARVCS18 PERMIT (CHAPTER 3-2)
CONDITIONS , 1F ANY
EXAMINING BODY
i'. : SIGNATURE OF CHAIRMAN
1Y,,. COMPUTATION OF FEES
7. 1::::Ts AND VIEW LANE
t PRIVATE RO AD
PUALIC WATER 1N STREET )
RIGHT 0 F WAY
S. 85°40'30 E . 75.00 pope
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-- CERTIFIED TO
A.
JOHN H . MULHOLLAND
2.6
��•' a s Prepared in accordance ::w
standards for title strrveya,c
� the L.I.A.C.S. and approv
for such use by -The Now,
Title Association. . .'
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Environment East, Inc.
R.R.No. 3— 3075 Indian Neck Lane
Peconic,New York 11958
516-734-7474
• - ��ooaoo�d�
Southold Town Trustees
Town mall
P. 0. Box 728
Southold, NY 11971
Dear Trustees,
Enclosed is our check in the amount of $25.00 to
cover the fees involved in the request for waiver
for Mr. John Mulholl and' s roperty on Island View
Lane, Greenport.
Your assistanc n his tter is greatly appre-
ciated.
Sincerely,
f/�j
Peter R. Sto tenbux
President
Environme t East, Inc.
i
En .
PR `t 3
• } R �{�UPO.Qi �PMaMM®K�®Ws•RST.tRb �• ���
• dYA R.`qCl1
BOARD OF TOWN TRUSTEES
TOWN OF SOU'THOLD ?To 3 2 5 8
53095 plain Road Phone 765-1892
Southold, N. Y. 11971 ` off' _--_19,2_
Date.
E REC IVED OFi C Dollars
For
• BOARD OF TOWN TRUSTEES �
i
Cash ❑ Check By
14.16.4(2187)—Text 12
,,�• PROJECT I.D.NUM
BER 617.21 .SE
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) +
1. APPLICANT/SPONSOR 2. PROJECT NAME
EaviroMant East, Inc for Owner Mulholland
3. PROJECT LOCATION:
Municipality Green port County guff 011[.
4. PRECISE LOCATION (Street address and road intersections, prominent landmarks,etc.,or provide map)
725 Island View Lane, areenport, NY
located on Conklyn Point
5. IS PROPOSED'ACTION:
❑New Expansion ❑Modification/alteration
6. DESCRIBE PROJECT BRIEFLY:
Addition to existing first floor, new secondfloor
and porch. Existing sq. footage= 6841
proposed total square footage= 16691
7. AMOUNT OF LAND AFFECTED:Initially -391 acres Ultimately • 7n
1
acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING-OR OTHER EXISTING LAND USE RESTRICTIONS?
i
Yes ❑No If No,describe brielly
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
IZResidential ❑!ndustrial ❑Commercial ❑Agriculture ❑Describe: ParklForesl/Open space ❑Other
one family dwelling _
10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERA
STATE OR LOCAL)?
®Yes ❑No If yes, list a ency(s)and per i proval
DEC and Southold ' own Buil � rig Dept.,
11. DOES ANY ASPECT OF THE ACTIO14 HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
❑Yes No If yhs, list agency name and permit/approval
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REpUIRE MODIFICATION? ,
❑Yes No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant/sponsor na e• VlA-rA rime nt E s t Inc .
Date: May ;�4,1988
Signature: q de nt
1 i
If the action is in the Coastal Area, and you are a state agency, complete the
Coastal Assessment Form before proceeding with this assessment
OVER
• 1
PART II—ENVIRONMEN, ASSESSMENT (To be completed by AgEr—Y)
A. DOES ACTION EXCEEANYE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes,coordinate the review process and use the FULL eAF,
❑Yes ❑NB. WILL ACTION RECEIATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative declar:
may be superseded bvolved agency.
❑Ye s ❑N
C. COULI]ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten, if legible)
Ct. Existing air quality, surface or'groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or dlspi
potential for erosion,drainage or flooding problems?Explain briefly:
C2. Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources;or community or neighborhood character?Explain b
C3. Vegetation or fauna,fish,shellfish or wildlife species,significant habitats,or threatened or endangered species? Explain briefly:
C4. A community's existing plans or goals as officially adopted,or a change in use or Intensity of use of land or other natural resources?Explain t
C5. Growth, subsequent development,or related activities likely to be induced by the proposed action? Explaln briefly.
C6. Long term, short term,cumulative,or other effects not identified In CI-05? Explain briefly.
C7. Other impacts(including changes in use of either quantity or type of energy)? Explain briefly. `
D. IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS?
❑Yes 1 No If Yes,explain briefly
PART III—DETERMINATION OF SIGNIFICANCE (To-be completed by Agency)
INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large,important or otherwise signific
Each effect should be assessed in connection with its (a) setting (i.e. urban,or rural); (b) probability of occurring;.(c) duration '
irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure
explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately,addressed.
❑ Check this box"if YUAJ-have identified.one or more potentially large or significant adverse impacts which hill A)
occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration.
❑ Check this box if you have determined, based on the information and analysis above and any supportinc
documentation, that the proposed action WILL NOT result in any significant adverse environmental impact: .
ANQ provi& .on.attachments as necessary, the reasons supporting this determination:
e". tialln•ur I pad AgV11t:V
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14 Peconic,New York 1195$
516-73+7474
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To Whom It MaLy Oogoern:
Srnwironment last, Inc. to act as my agentin appling
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on my property at . 4 P-r.J
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Nature.of work.(check which applicable): New Building . . . . .•. . . . . Addition n . . . . . . Alteration . . . . . . .
-Repair . . . . . . . . . . . . . . Removal . . . . :. . . . . . . . . Demolition . . . . . . . . . . . . . . Other Work . . . . . . . . . • . .
— (Descripxion).
Estimated_Cost . ,,.�` . .. . . . . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . .
` (to be paid on filing this application) ,..
If dwelling,,number of dwelling units . . . . .I . . . . . . . . . Number of dwelling units on each floor . . , . .
Tf garage;number of cars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. .
If business,'commercial or mixed occupancy, specify nature and extent of each type of use . . . . . . . . . . . . . . . . . ... .
;;Dimensions of existing structures, if any: Front . . .I.8,2 t. . . . . . Rear . 38.2t. . . . . . . Depth . . ...18 21. . .
Height . .. . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . : .
Dimensions'of same structure with alterations or additions: Front . . . . 54� . . . . . Rear . . . 4�. . .
:.Depth . . . . . . .1!�. . . . . . . . . . . . . Height . . . . . . . . . . . . . . . . . . . . . . Number of Stories . . ?. . . . . . . . . . . . . . . . . ...
Dimensions of entire new construction: Front . . . . . . . . . . . . . . . Rear . . . . . . . . . . . . . . . Depth , . .. . . . .. . . .
Height . . . . .. . . . . . Number of Stories . * . . . . . . . . . . . . . . . . . . . .
Size of lot: Front . . .7 .. . . . . . . . . . . . . . . . Rear . . 9.7,t%... . . . . . . . . . . . . Depth ? 9 . . . . . . . . . . . . .
Date of Purchase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of Former Owner '
Zone,or use district in which premises are situated Ro alde mttii$1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
'.Does proposed construction violate any zoning law, ordinance or regulation: . . . .No. . . . . . . . . . . . . . . . . . . . .. . . . . .
:Will lot be regraded Will exc ss �l�e !eg�om premises: Yes No
,.Name of.Owner of premises.t�a. Mullholla.. Address NLonroe. h tone No2032$5-9 7.. . .
Name of Architect . . . . . . . . : . . . . . . . . . . . . . . . . . . Address 3 a'T • I rid i ari 'N6 c °he No, . , . . . . . . . . . : .
:.,Name of:ContractorF a3Ti.3;o=0.nt.E as t. lAq Address pgco tic iv*Y }3.9 one No. 73 - . ?
. . . . .
Is this property located within 300 feet of a tidal wetlan$? Yes . . No .
*If„ yes, Southold Town Trustees Permit ma be required.
PLO DIAGRAM
Locate clearly and, distinctly all buildings,whether existing or ,proposed, and,indicate all set-back dimensions from
Pperty lines. Give street and block number or description according to deed, and show street names and indicate whether
nor or corner lot.
,TE OF NEVJII OR S.S
j-NT Y.
� •. G�� ' r� . . being duly sworn, deposes and says that he is the applicant
(Name of individual signing contract) / \\
ve named.
. . . . . . . . . . . . . .
ontrac , agent, corporate officer, etc.) .
aid :owner or owners, and'is duly"authorized to perform or have performed the said work and to make and file this
:ication;._that all statements contained in this application are true to the best of his knowledge and belief;and that the
K"will be performed in the manner set forth in the application filed therewith.
Irn to:before me this
• 7 `I . . . . . .day of*. �1. . . . . . . . . .. 19 �
ary:Public, . . . . . . . . . kcouELI nt
NN NEVI E (Signature of applicant)
Notaryary Public, fate of New York
No.62-8125850,,SuffolkCo . /
Term Exoiros Octobnr 31•, 1 q, •_ /
B'_ ID OF HEALTH . . . , - .
3 SETS OF PLANS . . . . . . .
FORM NO. 1 SURVEY . . . . . . . . . ..
TOWN OFSOUTHOLD CHECK • • - - • • - - - •
BUILDING DEPARTMENT SEPTIC FORM • - . -
TOWN HALL NOTIFY
SOUTHOLD;N.Y. 11971 .
TEL.: 765-1802 CALL • • • - - • • . - - -
MAIL. TO :
xamined . . . . . . • . ., 19 . . .
.pproved . . . . . . . . . . . . .. 19 . . .Permit No. . . . . . . . . . . . 1
tisapproved a/c : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
z
. . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . •
( . . . . . . . .
Building Inspector)
APPLICATION FOR BUILDING PERMIT
Date . . . . . . . . . . . . . . . .09 . .
INSTRUCTIONS i
a. 'This`application must be completely filled in by typewriter or in ink and submitted to the Building Inspector,..v 3 {
,ts,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 streets
r:areas;;and giving a detailed description of layout of property.must be drawn on the diagram which is part of this appli-
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 permit
tali 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 Occupancy
tall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
wilding Zone Ordinance of the Town of Southold;Suffolk County, New York, and other applicable Laws, Ordinances or
egulations,,.for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
he, applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
lmit authorized inspectors on premises and in building for necessary inspections.
Aoy�xa ampnt .> aat, . I.nc. . ... . . . . . . . . . . . . . . .
(Signature of applicant, or name, if a corporation)
3075 Indian Neck Lane
.P.e c o.ni c, . .NY.11958. . . . . . . . . . . . . . . . . . . . . . .
(Mailing address of applicant)
tate-mhether applicant is owner; lessee, agent, architect, engineer, general contractor, electrician; plumber or builder.
G�ntractAx. . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.,`ame of owner of premises .-Io.ha .R.. Mu111o11 and. . . . . . . . . . ... ,
(as on the tax roll or latest deed)
applicant is a corporation, signature of duly authorized officer.
: . : . . . . . . . . . . . . . . . . . . . . . . . . . ... . Praside.nt
(Name,and title of corporate officer) -
ALL CONTRACTOR' S' MUST BE SUFFOLK COUNTY LICENSED
Builder''s License No. . . .5556 -HI• • • • • • • • • • • •
Plumber's License No.
e.- aectrician'.s License No. .
;'. Other Trade's License No. . . . . . . . . . . . . . . . . . . . . .
.t Location of land on which proposed work will be done'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
VAgw. xano. . . . . . . . . . . . . . . . . . . . . . . . . . .4j:,�r.npQrt. . . . • •
e`House,Number Street Hamlet
',County Tax.Map No. 1000 Section . . . .057. . . . . . . . . . . Block . . . . . . 02 . . . . . . . . . Lot . . . . . . . ..?.!µ . . . . .
'Subdivision . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot'. . . . . . '•. . . . . . . .. . .
(Name)
.State.'existing use and occupancy of premises and intended use and occupancy of proposed construction,:
',a: Existing use and occupancy . .0 ao. .Fami ly.Dwol I iag.. . ... . . . . . . . . . . . . . . . . . . . . . . ... . •
''tb `Intended use and occupancy .On�. .Fami,l.y.Dws.11ixl .�rith .$dd.i,t on • • • • • • • • • • • • . . • • . . . . . . . .
FORM NO.3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD,N.Y.
NOTICE OF DISAPPROVAL
Date . '�'yZ. . . . . . . . . . . . . . . . . . . ..
To
0� r
. . .. . . . . . . 9. .
PLEASE TAKE NOTICE that your application dated . . . . . . . . .-�' . . . . . . . . .. 19000,
for permit to � . . P? . . �. vti: . . . . . at
er 7S ��Gl �T . . . .
Location of Property a . . . . . . . . . . . . . .
House No. Street let
County Tax Map No. 1000 Section . . . . 7. . . . Block . . . .0.'2. . . . . . Lot . . . . . . .a?
Subdivision . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . . . Lot No. . . . . . . . . . . . . . . . . .
is returned herewith and disapproved on the following grounds .
. . . . . . . . . . . � . . . .%�-
. . . . . .. . . . . ....;.,. .-4�4
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
i Bu� ding spector
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