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HomeMy WebLinkAboutTR-5990 F �,• 7 =,y � iiiiiijRRR�j i• Board Of Southold 'Town Trustees SOUTHOLD. NEW YORK q 'G Sept.22, 2004 DATE: ................................. ' PERMIT NO. .................. ........ :. Atta Imennava `x ISSUEDTO ...................................... J � Auto t tt#tort Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1893; and Chapter 404 of the Laws of the �. State of New York 1952; and the Southold Town Ordinance en- :: `title-d-1�'REGULATING-A.ND-THE-,PLACING-OF:O$STRUCTt-O _......_ IN AND ON TOWN WATERS AND PUBLIC LANDS and the I REMOVAL OF SAND GRAVEL-OR OTHER MATERIALSAtOOM �s LANDS UNDER TOWN'WATERS;•..'. and in accordance with'the Resolution of The Board adopted at a meeting held on ...Sept Y2 zoo.oo .. aid b 1 2004 : and in consideration of the sum of ... p y Atta Imennava .....................................................................................................:..........::......... i of .......SaS th-atd...............................................IK..... N. Y. and, subject to. the Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authcrizes and permits the following: We hand Penmc t to .instaU a W x 1 G' shed in the area ' zhown on the attached-,su&vey pnepaAed .by young and young, uce.ived .in thiz a 4 .ice on August 23, 2004. �5 � all in accordance with the detailed specifications as presented in the originating application. IN WITNESS WHEREOF, The said Board of Trustees Mere- : by causes its Corporate Seal to be affixed, and these presents to ? be subscribed by amajority of the said Board .as of this datre. -ti 4f.�-- . 7 fir' •► TERMS and COMMONS Tl�c Ptrmiictet residing at - N. Y., as pa-of the consideration for the issuance of the Permit does understand and prescribe to the fol- ltowiag: 1. That the said 'Board of Trustees and the Town of Southold are rdeased -from any and all damages, or claims for damages, of soots arising.ditady or ladirectly as a twit of any opera adon-perfctaoed-parsuaac o tthis_pertnit,_sasi_shesai _ _ ._ ._or._her own ems:: :..__ defend any and all such suits- aidattd'by third parties, and the said Veraiittee amaus full iiability - with respect thereto, to--the--vomplete'ezdusion of t%-,.Board of Trustees of the Town of Southold. 2. That this Viednit Is valid for a period of -nm which'is Wn� to be the estimated time-required to oocnplete the work involved, but•should nces vvatratt, request, for an extension ,may be made to the Board at a lager irate: - 3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to'maintain the structure or project involved, to provide evidence to anyone concerned that auth- orization was originally obtained. , { 4. That the work involved will be subject to the inspection and approval of the Board of its agents, and non-compliance with the provisions of the odgina*application, maybe cam far revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the wodc herein authorized. G. That there shall be no interference with the tight of :the public to pass and repass along the beach between high and low water matt 7. That if future operations of the Town of Southold require the,removal and/or alteradons in the location of the work herein'authorized, or U, in the opinion of.-the.Board of Ttasoees, the. work shall cause unreasonable obstruction to free navigation, the said Peamittee will be tequlr4 anon-due notice,to remove or alter this wotk or project herein stated without*peaces to the Town' ` • . . of $ottdeold. . 8. That the Bald Board will be notified by the Petmittee of the oompletion..of the wotk auth- odzed. 9. That the •Permittee will obtain in other permits and eooseaU•drat my be required sup plemental to this permit which may-be subject to revolve upon failure to obtain same. f . oSUFFot�-�, Albert J.Krupski, President ��► Q Town Hall James King,Vice-President =� G'f'� 53095 Route 25 Artie Foster y - P.O.Box 1179 Ken Poliwoda Southold,New York 11971-0959 Peggy A. Dickerson y�� a��� Telephone (631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD September 22, 2004 Alla Imennova 295 Mockingbird Lane Southold, NY 11971 RE: 295 MOCKINGBIRD LANE, SOUTHOLD SCTM# 55-6-15.59 Dear Alla Imennova: The Board of Town Trustees took the following action during its regular meeting held on Wednesday September 23, 2004, regarding the above matter: WHERE"AS, ALLA IMENNOVA applied to the Southold Town Trustees for a permit under he provisions of Chapter 97 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated August 23, 2004, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on September 22, 2004, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 97 of the Southold Town Code, 2 WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approve the application of ALLA IMENNOVA to install a 12' X 16' shed and all as depicted in the plan prepared by Young and Young received in this office August 23, 2004 (see attached plans). Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of$50.00 per inspection. (See attached schedule.) This is not a determination from any other agency. Fees: None Very truly yours, Albert J. Krupski, Jr. President, Board of Trustees AJK/hct n-V�g�EFO(,�co � Telephone p Town Hall (631)765-1892 H 'Z 53095 Route 25 O .1C P.O.Box 1179 y 0� Southold,New York 11971-0959 CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD At the meeting of the Southold Town Conservation Advisory Council held Tuesday, September 14, 2004, the following recommendation was made: Moved by Don Wilder, seconded by William Cook, it was RESOLVED to recommend to the Southold Town Board of Trustees DISAPPROVAL of the Wetland Permit application of ALLA IMENNOVA to install a 12'X 16' shed. Located: 295 Mockingbird Lane, Southold. SCTM#55-6-15.59 The CAC recommends Disapproval of the application and recommends a 100' setback from the wetlands and a 20' non-turf buffer. Vote of Council: Ayes: All Motion Carried _ --- --rT _— � ---- - UZI «-16-q6 I 6 s66 s6c xo.nt 16-�-W ♦ Y1iGl Id0. of-v-ol M-II.01 I500 IS61cl 0 •'t ]ay] 6a s6�c sc�c� t s //��,. LL cl 052-96-961 y3 Luw 6 p 6 § •S D 1] Y old u u 5 •✓ � , �V-,�+�p9 SW L69w F °NG ° H•. Y J 29.ollG) Y ulw ]0.LlU •3 ].l, 68 w16 i Yaw Lt 66(U ]Ll K m °' u9 y U � 12 6 —N— T�x � • S 0.9 O • c ^ 1- ,^•15 . .0 m ,a SWIN0.D M1 1t1xw MA •5� 23 •°R 4 9 roam � ' S m ' 36 $ 7y O 9 m � IlW • U_¢ � 10 \Q 2 ttqq ] \m II g1\ \\,• ,6 6 Sy 1L061<1 t a " t6 m l50'1 "uJ tD Ida , x62 � Ltxw v LWIU g-6 ti3 6� Ltxw • • 2�,516,a+�• 6 � yJ J ty �i tU � O ,533�� t5a C p�iy,f® 15.60 15.59 ,5.56 1 isa 5.6 0.6 SxS m m,4 �ti,ys°• a d 1x.66 J • ® m ® ®m W m � m m ® S(. B 4L Q TOaN SWi�D LOaN �w� �w�SM� 3-.�f..^ 'L tf • m m . O µ • m � o fir` d �g..• t, �A°a,gym t� ,s�' ���,e• q,� ,�' J Tlxw y-µJ 'h c ,lyio a �-d yl " w, c / S1a LtYa] y�04U Z. • o m �•a p� • S / IM. I169w 4 3 y ON • m Ul' O tT � d ]4irlU LS.fcl 5 ]166 16 99Nw �ad �d U • s� Y lfuc] ] lac wra—�iac c§ sEF zc wL oc] � rL°j 5� L •nw ? = Ix1TCE COUNTY OF SUFFOLK © E '� on SOUTHOLD SECTION NO eDNlwai�.>w Red Property Tax Service A r �y Mft TWm NY UNI vo t119S6 SFES N4OR ..5 �: .:ny;] ...TSvf� _.._." 'i-"..``�>ia•'<---T::t_ _ az scaxo.os now or former) Francis & Patricia O'Malley Y i y Young & Young, Land Surveyors � EDGE of 14ETLAN05 AS 1 400-, Ostrander Avenue, Riverhead, New York 11801 " LED M` �s PeR Fi ` 516-727-2303 .. - -._ .. . N 88'56'32" E 173.39 _ a _ /:- Wen W.Young, g, Land Surveyor 94) o H \ Thomas C. iPolpert, Professionat Engineer John Schnurr, Land•Surveyor I:aglrtrerirtg / � ; .,CONS V ER Ar/aN €4f . . n . _ N U� . NOTE MONUMENT SET a MONUMENT FOUND STAKE SET ♦ STAKE FOUND 14V i 1 V . AREA '= 30,640 SQ. FT. j NR 5H E� ;, \ �. SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF ¢FC 21 X 16 Lot 53 SUFFOLK COUNTY ON MAR. 19. 1990 AS FILE NO. 8912 WE HEREBY CERTIFY TO WILLIAM FEATHERSTONE, _ \ ,� �c ERICA FETI-IERSTONE, FIDELITY NATIONAL' Lot 54 i, TITLE INSURANCE COMPANY, NQRTH, FORK A$ - BANK, D.B.M. C O M PANY THAT THIS SURVEY WAS PREPARED IN ACCORDANCE WITH THE CODE OF PRACTICE FOR FeF: LAND SURVEYS ADOPTED BY THE NEW. YORK STATE ASSOCIATION g 5 \ , OF PROFESSIONAL LAND SURVEYORS. 1 ---rrTeee Q 1 1 7 -ie o•--' 48.2* SCHNIj f Lot 52. n 2 STORY FRAME W n g GARAGE HOUSE dt N J. i ��.; ,I _ �7.1•� 16.9' �_ F N y I r24.3-- i W;OO�D5 PORSCHNCH �m•` r JOHN URR NG, .Y.S. L.S. NO. 49517 CA r OW YOHARDW. UN , N.Y.S. L.S. NO. 45893N ' P. SURVEY. FOR I LOT 53 "HIGHPOINT MEADOWS, SECTION THREE" 2 R'Z30.00. R 2 0 0 , IMLUAM FEATHERSTONE & ERICA FEATHERSTONE �/ 0 ��o, At Southold, Town of Southold GRATA. �� ���� •tip `� Suffolk County, New York 6 2.83' � l MD v e Re County Tax Map District 1000 Section 55 Block 06 Lot 15.59 jFfi 00, FINAL SURVEYdill 3. t a AUG MAP PREPARED JUNE 18. 1999 3 2004 lair SCALE 1" = 40' �a1 JOB NO. 99-0413 O Southold Town DWG. NO. 990413 O O��- Albert J.Krupski,President ��; SAfF CD Town Hall James King,Vice-President ='Z` Gy� 53095 Route 25 Artie Foster h P.O.Box 1179 Ken Poliwoda 2 Southold,New York 11971-0959 Peggy A. Dickerson y�o Telephone (631) 765-1892 ,( Fax(631)765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only stal Erosion Permit Applicatio _ etland Permit Application Major Minor Waiver/Amen GUt/ gs /Received Application: I _%Received Fee:$ .eompleted Application EVWEfr _Incomplete D _SEQRA Classification: Type I Type II Unlisted 2 3 2004 —Coordination:(date sen AUG SAC Referral Sent: ,Date of Inspection: _Receipt of CAC Report: Southold Town _Lead Agency Determination: board of Trustees _Technical Review: public Hearing Held: o Resolution: Name of Applicant Z& �i'j'1 d/X/Ot/4i Address 2 07 Off'_kf n / Z o' . -lie sob 11/104W Phone Number:( ,92/2 Suffolk County Tax Map Number: 1000- 5-5-- 6 — /5:26 9 Property Location: .2—R�" Dc�(lam biaA 3mt1koO c� . C (provide LILCO Pole#, distance to cross streets, and location) AGENT: (If applicable) Address: /y f /// Phone: Board of Trustees Application GENERAL DATA Land Area (in square feet): 3(), 6//0 -tZ Area Zoning: 1Ges/ Well Zla Previous use of property: Intended use of property: 2-,e S'/We/j //a—e Prior permits/approvals for site improvements: Agency Date V No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? I/ No Yes If yes, provide explanation: AIZA Project Description (use attachments if necessary): !'Ie 7�-e R//.&P v-e Ito p2 Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: %p //7-fZ�q d�2 ZZAWI AdX7Q-e Waza P.e. V el Area of wetlands on lot: 991�00 square feet Percent coverage of lot: 6, 5 % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: 50 feet Does the project involve excavation or filling? ✓ No Yes If yes, how much material will be excavated? cubic yards How much material will be filled? _ cubic yards Depth of which material will be removed or deposited: ^' feet Proposed slope throughout the area of operations: —' Manner in which material will be removed or deposited: Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): 61 ,1 &11,/oCC ��� Board of Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity: /O /`l-�Y��e� � � YIeW (7i_ Are wetlands present within 100 feet of the proposed activity? No �/ Yes Does the project involve excavation or filling? No Yes If Yes, how much material will be excavated? (cubic yards) How much material will be filled? — (cubic yards) Manner in which material will be removed or deposited: ,(l� Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) �/19/7/ 2e17� 92 "l,'74 el�­1 e-li7//20!'!�'JJP�! PROJECT ID NUMBER 617.20 SEAR APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1.APPLICANT/SPON,9.QR 2.PROJECT NAME 117.r &e;n ioh 3.PROJECT LOCATION: Municipality ,o&/h 0/ � County J -ee 4.PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc -or provide map See p V6Z ~ze 5.IS PROPOSED ACTION: � New ❑Expansion ❑Modification/alteration 6.DESCRIBE PROJECT BRIEFLY: Ae phe ��. ;/I�e '�101'ee loee '/o 7.AMOUNT OF LAND AFFECTED: Initially ©, /,5- acres Ultimately ��/� acres 8.WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? NYes ❑ No If no,describe briefly: 9.WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) Residential ❑Industrial ❑Commercial ❑Agriculture ❑Park/Forest/Open Space ❑Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) � nYes [:]No If yes, list agency name and permit / approval: *41?W 01 1Vh1.4 1�a_r� , uw641�gy, D,::sri14-wGLef (So4?Vi�^-�/ 11.DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes RNo If yes, list agency name and permit / approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? ❑Yes ®No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor Name � `llnew-17OV4?.- Date: Signature_ If the action is a Costal Area,and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II - IMPACT ASSESSMENT(To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR,PART 617.4? If yes,coordinate the review process and use the FULL EAF. Yes No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative declaration may be superseded by another involved agency. Yes 0 No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten,if legible) C1. Existing air quality,surface or groundwater quality or quantity,noise levels,existing traffic pattern,solid waste production or disposal, 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 briefly: 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 briefly: C5. Growth,subsequent development,or related activities likely to be induced by the proposed action?Explain briefly. C6. Longterm,short term,cumulative,or other effects not identified in C1-05? Explain briefly: C7. Other impacts(including changes in use of either quanti or a of energy? Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA CEA? If es,ex lain briefl : Yes ❑No E. IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If es explain: Yes No 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 significant. Each effect should be assessed in connection with its(a)setting(i.e.urban or rural);(b)probability of occurring;(c)duration;(d)irreversibility;(e) geographic scope;and (f)magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked yes,the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY 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 supporting documentation,that the proposed actin WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi determination. Name of Lead Agency Date Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer F.v Signature of Responsible Officer in Lead Agency Signature of Prepater(If different from responsible officer) Albert J.Krupski,President O�OSufFo`�C� Town Hall James King,_Vice-President o`t` Gy�t 53095 Route 25 Artie Foster P.O.Box 1179 Ken Poliwoda o Southold,New York 11971-0959 Peggy A. Dickerson i Telephone(631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of ----_-(2 -- rnt N ------------------------- COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I, ��,�.2 �!??�/'1 n!0 Ye-residing at being duly sworn, depose and say: That on the // day of-�64 200�,I personally posted the property known �, if�l.� by placing the Board of Trustees official poster where it Fan easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing.Date of hearing noted thereon to be held a Dated: 1009 (signature) Sworn to before met s 1,?14 day of6pFmb&60 Notary Public BEST vxk NL 01 71 SBOT Board of Trustees Application County of Suffolk State of New York 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. '6�a' 'ge'e-/--, — Signature SWORN TO BEFORE ME THIS �� DAY OF 20 p Y AotaryPublic'/-�' PATRICIA CORMN Notary Public,State of New Yank No.0 05017852 Qualified in Suffolk County Commission Expires Sept 13,LaqQJ APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The nuraose of this form is to provide information which can alert the town of pgssible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: �1~19170 (Last name,first name,.piddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate.the.other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other',name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest"Business interest"means a business, 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 Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check 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 of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP -T Submitted this day of 200_ Signature Print Name Aeeh Form TS 1 A: t' PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS . rl « :M ru Ln u] U l �=co ED ro to Postage $ 0.37 UNIT IN 0971 r a O C3 Certified Fee 0 /0 0 0 2.30 M ! 0 ReRe'0 (Endors� (Endorseme n RegW ed) 1.75 Postmark ( (Endors; I Here .� ; O Restrir O Restricted Delivery Fee '•(End (EndorsRestric, (Endors (Endorsement Required) Clerk: KRUM 'n r'i m �Y 99 ft 1 Ta Total I Total Total Postage&Fees � 4.4, ' 0$1t3T ,a f� r h I � LSenSent To f1'1 O yA,.r3 Sen!O Sent To f� p lA 9,Wr Street,Apt.No.r%- Stre M1 Street, or PO Box No. orP orPOE - �- - Cltl Stets,Z%P+4 (70, e ----- L.1�� C(ty, City,Str _- w7-- STATE OF NEW YO -- - - - COUNTY OF SUFFOLK 7�i e,4wojla,- ,residing at ?--e�e QP.r7� / //Y, ,being duly sworn, deposes an says that on the day of , 20a, deponent mailed a true copy of the Notice set forth in the Board of rustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address 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 Office at �qx j4 o I d Ny ,that said Notices were mailed to each of said persons by (certified) (registered)mail. A�z Sworn to before me this A&d Day of S , 20 d Not Public f a b'