HomeMy WebLinkAbout3685
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°' `- ' �:+� MAIN ROAD - STATE ROAD 25 P.O. BOX 1179 SOUTHOLD, L.I., N.Y. 11971
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TELEPHONE (516)765-1809
FAX No. (516)765-1823
APPEALS BOARD
MEMBERS
GERARD P. GOEHRINGER, CHAIRMAN
CHARLES GRIGONIS, JR.
SERGE DOYEN, JR. May 18, 1989
JOSEPH H. SAWICKI
JAMES DINIZIO, JR.
Rudolph. H. Bruer, Esq.
Edson & Bruer
Main Road
Southold, NY 11971
Re: Appl. No. 3685 - Lester and Hope Albertson (Variance)
Dear Rudy:
In updating pending applications in our office, we find
that the above variance application is now obsolete based upon
the changes of the zoning regulations under Local Law #1-1989
(Master Plan Amendments) by the Town Board on January 10, 1989 .
The premises is now designated as a "Hamlet Business , (HB)" Zone
District.
This variance application will be deadfiled at this time;
however, if you find it necessary to reactivate the same at any
time in the future, please do so by requesting the same in
writing and the reasons therefor.
Yours very truly,
/GERkRD P. GOEHRINGER
CHAIRMAN
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cc: Southold Town Planning Board
Southold Town Building Department
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Southold, N.Y., 11971
(516) 765-1938
October 15, 19.87
Mr. .Rudy Bruer, Esq.
Edson and Bruer
Main Road
Southold, NY 11971
Re: Lester and Hope Albertson
SCTM# 1000-63-3-10
Dear Mr. Bruer:
The above application has been reviewed by the Planning
Board.
The Board requests that 'a copy of the deed or right-of-
way agreement be submitted for access from BOisseau Avenue.
This right-of-way is to be a minimum width of 50 ' for its
entire length.
It is also noted that the surveys were not signed by
the surveyor, therefore, when the surveys have been amended,
as per the above, would you please have them signed and
forward six to our office so that the Planning Board may
continue with its review.
Very truly yours,
BENNETT ORLOWSKI, JR. CHAIRMAN
SOUTHOLD TOWN PLANNING BOARD
cc: Zoning Board of Appeals
�thold Town Boa of Appeals -48- Novemb, 18 , 1987 Special Meeting
Appeal No . 3445 - JULIUS ZEBROSKI . Variance for
approval of insufficient area and width of two ' pro-
posed lots . E/s Waterview Drive and N/s Bayview Road ,
Southold . (**Await Art . VI action and copy of C . O . )
' Paul Caminiti , Esq .
Appeal No . 3449 - FRANK AND ETHEL BEGORA . Variances
for insufficient area , width and depth in this pending
division (three parcels ) . N/s Main Road , East Marion .
(Await P. B. appl.ication/referral comments after sub-
mission., of corrected maps . (for three rather than two
await C. O. of record , if any . ) Paul Caminiti , Esq .
Appeal No . 3403 - ANNA LORIA. Variances for approval
of two parcels having insufficient area , width and depth
in this pending division of land. W/s First Street and
N/s King Street , New Suffolk . (Await Co . Health Art . VI
action after application . )
Appeal No . 3426 - GERALD DOROSKI . Variance for approval
of access (280-a ) . N/s C . R . 48 , Peconic . (Await
additional information to clarify ROW and P . B. input
on pending division abutting premises to the east . )
Appeal No . 3411 - ANDREW FOHRKOLB . Variance to restore
existing building for habitable use (additional dwelling
unit) . S/s Lipco Road , Mattituck .
plans and C . O . ) Helen Rosenblum , EsgA�yait scaled floor
Appl . No . 3607 - JAMES P. O ' NEILL AND PETER J . McSHERRY .
Area , width , depth variances . Wiggins & 8th Streets ,
Greenport . [Await Co . . Health action and copy of
Pre-.C . O . ] .
Appl . No . 3685 - LESTER & HOPE ALBERTSON . Await Planner Board 1)-u-t and CrTMY ri e a I`c n A r G` action before
PuFlication . 36125 Main Road , Southold . Area &
Width variances . B- 1 Zone District.
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Southold, N.Y. 11971 �0 �1 3 d
(516) 765-1938
October 15, 1987
Mr. Rudy Bruer, Esq.
Edson and Bruer
Main Road
Southold, NY 11971
Re: Lester. and Hope Albertson
SCTM# 1000-63-3-10
Dear Mr. Bruer:
The above application has been reviewed by the Planning
Board.
The Board requests that a copy of the deed or right-of-
way agreement be submitted for access from BOisseau Avenue.
This right-of-way is to be a minimum width of 50 ' for its
entire length.
It is also noted that the surveys were not signed by
the surveyor, therefore, when the surveys have been amended,
as p-er the above, would you please have them signed and
forward six to our office so that the Planning Board may
continue with its review.
Very truly yours,
BENNETT ORLOWSKI, JR. CHAIRMAN
SOUTHOLD-'TOWN PLANNING BOARD
cc: Zoning Board " of Appeals
z�,
XV
aonfhold Town Board of Appeals
MAIN ROAD;-. STATE ROAD 25 SOUTHOLD, L.I., N.Y. 11971
TELEPHONE (516) 765-1809
APPEALS BOARD
MEMBERS
GERARD P. GOEHRINGER, CHAIRMAN
CHARLES GRIGONIS, JR.
SERGE DOYEN, JR.
ROBERT J. DOUGLASS November 16 , 1987
JOSEPH H. SAWICKI
Rudolph H. Bruer , Esq .
Edson and Bruer ,
Main Road
Southold , NY 11971
Re : Appl . No . 3685 - Lester and Hope Albertson (Variances )
Dear Rudy :
This letter will acknowledge receipt of your recent
application _before the Board of Appeals . . The., Board members
will be conducting field inspections and environmental reviews
as . may be required by State and local laws prior to scheduling
your .application for_, a public hearing .
It is requested in the interim that you proceed with
the [X1 Planning Board [X1 County Health for. Art . VI action
concerning their jurisdiction in this matter in order that
they m'ay submit their written comments , formal action , or
other input as early as possible . Upon receipt of their input ,
your application w.i.11 be schedule.d for the earliest available
hearing date .
If the above document (s ) are submi-"� ted within 20 days ,
it is expected that a public hearing would be held about the
early part of January . A copy of the notice of hear-
ings as published in .the Long Island Traveler-Watchman and
the Suffolk- Times will be sent to you as confirmation .
Please feel free to call at any time if you have questions .
Yours very truly ,
GERARD P . GOEHR:INGER
,CHAIRMAN
cc : Planning Board By Linda Kowalski
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O�oc��FFO(k��li -
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Southold Town Board ®f Appeals
MAIN ROAD STATE ROAD 25 SOUTHOLD, L.I., N.Y. 11971
TELEPHONE (516) 765-1809
APPEALS BOARD
MEMBERS
GERARD P. GOEHRINGER, CHAIRMAN
CHARLES GRIGONIS,JR.
SERGE DOYEN, JR. November 16 , 1 987
ROBERT J. DOUGLASS
JOSEPH H. SAWICKI
Rudolph H. Bruer , Esq .
Edson and Bruer
Main Road
Southold , NY 11971
Re : Appl . No . 3686 - Lester and Hope Albertson (Variances )
Dear Rudy :
This letter wi..11 acknowledge receipt of your recent
application _before the Board of, Appeals . ,The.. Board members
will. be conducting field inspections and environmental reviews
as may be required by State and local laws prior to scheduling
; your - application for a public hearing .
It is requested in the , interim that' you proceed with
the [X] Planning Board [X] County Health for Art . VI action
concerning their jurisdiction in this matter in order that
they m'ay submit their written comments , formal action , or
other input as early as possible . Upon receipt of their input ,
your application will be scheduled for the earliest available
hearing_ date .
If the above document (s ) are submi`�ted within 20 days ,
it is expected that a public hearing would be held about the
early part of January. A copy of the notice of .hear
-
ings as published in the Long Island Traveler-Watchman and
the Suffolk. Times will be, se.nt to you . as confirmation .
Please feel free to call at any time if .you have questions .
Yours very truly ,
GERARD P . GOEHRINGER
CHAIRMAN
By Linda Kowalski
cc : Planning Board
�0C�FOL�%�G�
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er ""y ,7a-^•;y'' ��p' Town Hall, 53095 Main Road
P.O. Box 1 179
Southold New York 11971
JUDITH T. TERRY
TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
October 23, 1987
TO: Southold Town Zoning Board of Appeals
FROM: Judith T. Terry, Southold Town Clerk
Transmitted herewith is Zoning Appeal No. 3685 application of Lester 8 Hope
Albertson for a variance. Also included in notification to adjacent property
owners; Short Environmental Assessment Form; Letter relative to N.Y.S.
Tidal Wetlands Land-Use; Notice of Disapproval from the Building Department;
survey of property; and any other attachments relative to this application.
Judith T. Terry
Southold Town Clerk
�,ClGan .2�1.CL �iJ�l��
ATTORNEYS AT LAW
MAIN ROAD-P.O.BOX 1 466
SOUTHOLD,NEWYORK11971
LEFFERTS P.EDSON (51 6)765-1 222
RUDOLPH H.BRUER (51 6)765-2500
PATRICIA C.MOORE September 24 , 1987
Southold Town Planning Board
Town Hall
Main Road
Southold, New York 11971
Re: Set-Off for Lester & Hope Albertson
Southold, N.Y .
SCTM# 1000-063-3-10
Dear Sirs:
On behalf of our clients , Lester Albertson and Hope Albertson, his
wife, we submit herewith for your consideration an application for the
division of their Southold, N.Y. property. We respectfully request
that the Board consider this a set-off.
Enclosed please find the following:
M 1. Application for Approval of Plat in duplicate
2. Twelve (12 ) copies of the subdivision survey map.
3 . Form letter re drainage, etc.
4 . Part I of Short Environmental Assessment Form
5 . List of adjoining property owners
6. Completed application questionnaire
6. Our check, in the sum of $250. 00, in payment of your application
fee.
Be advised that, to applicants ' knowledge, there are no existing
restrictions of record which apply to the subject property.
We await the Board's comments or recommendations .
Sincerely,
Rudolph H . Bruer
RHB/df
Encs .
cc: Mr. Robert T. Albertson
Southold Town Zoning Board of Appeals
319
TOWN OF SOUTHOLD, NEW YORK
AA OM DECISION OF BUILDING INSPECTOR APPEAL NO.
DATE .. . ..V. ........
TO THE ZONING•BOARD OF APPEALS, TOWN OF SOUTHOLD, N. Y.
1 (We) LESTER & HOPE ALBERTSON .................of (No#) Main Road .
..... .... .... . ...
Name of Appellant Street and Number
Southold N•Y..................HEREBY APPEAL TO
..................................................................................... ..:..
Municipality State
THE ZONING BOARD OF APPEALS FROM THE DECISION OF THE BUILDING INSPECTOR ON
APPLICATIONFOR PERMIT NO. ............•........................ DATED ......................................................
WHEREBY THE BUILDING INSPECTOR DENIED TO
Rudolph H. Bruer... ....... .... ....
Name of Applicant for permit
of
(No#) .Main Road, Southold, NY
............................................r..............................................................................
Street and Number Municipality State
( ) PERMIT TO USE
( ) PERMIT FOR OCCUPANCY
( X) PERMIT TO SUBDIVIDE
1. LOCATION OF THE PROPERTY ....Main Road B-1
...............................................
Street Use District on Zoning Map
SCE'!## 1000-063-3-10 .:.Current QwnerLester & Hope Albertson
..............................................
Map No. Lot No.
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.)
3. TYPE OF APPEAL Appeal is made herewith for
(X ) A VARIANCE to the Zoning Ordinance or Zoning Map
(X ) A VARIANCE due to lack of access (State of New York Town Law Chap. 62 Cons. Lows
Art. 16 Sec. 280A Subsection 3
4. PREVIOUS APPEAL A previous appeal (has) ( as not) een made 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 a variance
andwas made in Appeal No. ................................Dated ......................................................................
REASON FOR APPEAL
( X) A Variance to Section 280A Subsection 3
( X) A Variance to the Zoning Ordinance
is requested for the reason that
Appellant desires to set—off a 39,326 sq. ft. lot from this 85,451 sq. ft. parcel
Form ZB1 (Continue on other•side)
'A VIA"
REASON FOR APPEAL Continued
1. STRICT APPLICATION OF THE ORDINANCE would produce practical difficulties or unn`eces-
sary HARDSHIP because 91*3 r 646t"
Appellant would be unable to set-off the proposed lot, which contains
more than sufficient lot area .
2. The hardship created is UNIQUE and is not shared by all properties alike in the immediate
vicinity of this property and in this use district because
Although this property has sufficient acreage for the proposed
division in a B-1 Zone, its physical characteristics prevent
compliance with lot width requirements .
3. The Variance would observe the spirit of the Ordinance and WOULD NOT CHANGE THE
CHARACTER OF THE DISTRICT because
The lot proposed to be created would be substantially larger than .the
majority of the lots within this zoning district.
STATE OF NEW YORK )
ss ......... . ... .. ............. ........ ..... ..
COUNTY OF sUFmLK ) ignature
Sworn to this ............ ................ day of.. .. .-�. 1987
,i -� '
.............
...
7
Notary Public
OF E
I ESA
P 1GUST 31,1989
BOARD OF APPEALS, TOWN OF SOUTHOLD
In the Matter of the Petition of
LESTER & HOPE ALBERTSON NOTICE
TO
to the Board of Appeals of the Town of Southold ADJACENT
TO: PROPERTY OWNER
YOU ARE HEREBY GIVEN NOTICE:
1. That i intention of the undersigned to petition the Board of Appeals of the Town of Southold
to request a Varianc (Special Exception) (Special Permit) (Other) [circle choice]
).'
r
2. That the property which is the subject of the Petition is located adjacent to your property and is des-
cribed as follows: 56125 Main Road, Southold, New York
Suffolk County Tax Map designation: 1000-063-3-10
3. That the property which is the subject of such Petition is located in the following zoning district: i
B-1 , GeneraI Rlisi nays
e
4. That by such Petition, the undersigned will request the following relief: permission to
set—off a 39,326 sq.—ft. lot from this 85, 451 sq. - ft. parcel with
insufficient lot width.
5. That the provisions of the Southold Town Zoning Code applicable to the relief sought by the under-
signed are Article III Section 1 00-31 & Article I, Sec. 106-20
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. (516) 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:
Rudolph H. Bruer, atty. for Petitioners
Petitioner .
Post Office Address
Main Road, P.O. Box 1466
Southold, N.Y. 11971
f X ftlptl j utoik cal II"4ki'irwm:
PROOF OF MAILING OF NOTICE
ATTACH CERTIFIED MAIL RECEIPTS
NAME ADDRESS
Edmund Pressler & wf. Grove Drive
Southold, N.Y. 11971
Charles W. Witzke 56215 Main Road
Southold, N.Y. 11971
MTA LIRR 1700 Broadway
New York, New York 10019
a
r
STATE OF NEW YORK ) ss.:
COUNTY OFSUFFOLK )
Mari Diana FnstPr residingat (No#) McCann Lane,
Greenport, N.Y. , being duly sworn, deposes and says that on the cq Ad—day
of .ecIc�.� � , 19 87 , 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-
fice at Southold, N.Y. ; that said Notices were mailed to each of said persons by
(certified) (Mkwj" mail.
Mar Diana Foster
Sworn to before me this
day o4x— o
�1 1 8 7
ry Public
IN IM"K 1111111M
"AwwP AMR•MMef Newya t
US U4146iila,i1AlIoR C&ARV
CNMMNIon IwWm llllfnoh 34100
FORM NO.3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD,N.Y.
NOTICE OF DISAPPROVAL
File No. Date 73
� . . . . . . . . .
'
�,.°..- . ... . . . . . . . . . . . . . . . . . . .
�.�. . . . . . . . . . . . cc
PLEASE TAKE NOTICE that your application dated . . �?r-rV . . .�. . . . . .. 19 �.1. .
for permit to eexeet . '. ,�t-� ju� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at
a 4
Location of Property $�1�. �. . .�44•^:• . . . . .. . . . . . . . . . . . . . .
House No. Street p� Hamlet
County Tax Map No. 1000 Section . . . We . . . . . Block . . . .Ca A. . . . . . Lot /o. . . . . . . . .
Subdivision . . . . . . . . . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . . .. nLot No. . . . . . . . . . . . . . . . . .
is returned herewith and disapproved on the following grounds .
Xr�j AA�� -k'3UJ
�. . . . .M^- � . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
'- .. . . . . . . . . . . . . . . . . .
Building Inspector
RV 1/80
14-16-4(9184)
PROJECT I.D.NUMBER
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
DIVISION OF REGULATORY AFFAIRS
T 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 Set-off f o r
Lester & Hope Albertson Lester & Hope Albertson
3. Project location: Main Road, Southold
Municipality Town of Southold County Suffolk
4. Is proposed action:
® New ❑ Expansion ❑ Modification/alteration
S. Describe project briefly:
Set-off of 39,326 -sq. ft. lot from this 85,451 sq. ft. parcel*
6. Precise location(road intersections,prominent landmarks,etc.or provide map)
N/s Main Road (NYS Rt. #25) ,- 425. 14 feet easterly of Boisseau Avenue;
Southold, N.Y.
7. Amount of land affected:
Initially 1 . 962 acres Ultimately 1 . 9 6 2 acres
8. Will proposed action comply with existing zoning or other existing land use restrictions?
❑ Yes 13 No If No,describe briefly
Proposed lot is of insufficient width under existing zoning.
9. What is present land use in vicinity of project?
❑ Residential ❑ Industrial Commercial ❑ Agriculture ❑ Parkland/open space ❑ Other
Describe:
10. Does action involve a permitlapproval,or funding, now or ultimately,from any other governmental agency(Federal,state or local)?
® Yes ❑ No If yes, list agency(s)and permit/approvals
Suffolk Co. Dept. of Health - Approval under Article 6
Southold Town Planning Board - Subdivision approval
11. Does any aspect of the action have a currently valid permit or approval?
❑ Yes rL7Y No If yes, list agency name and permitlapproval type
12. As result of prop sed action will existing permit/approval require modification?
❑ Yes No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE 15 TRUE TO THE BEST OF MY KNOWLEDGE
ApplicanUsponsor' name: Rudolph H. Bruer, Atty. for Applicant Date:
JO L
i
i
Signature: 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
PART 11 Environmental Assessment(To,be.completed by,Agency)
A. Does action exceed any Type 1 threshold in 6 NYCRR, Part 617.12? If yes,coordinate the review process and use the FULLILONG_FORM EAF.
❑ Yes ❑ No
B. Will action receive coordinated review as provided for Unlisted Actions iri 6 NYCRR,Part 617.7? If No,a negative declaration may be superceded by anoth:
Involved action. _......,.
❑ Yes ❑ No
C. Could action result in ANY adverse effects on,to,or"arising from the following:(Answers may be handwritten,if legible)
C1. Existing air quality,surface or groundwater quality or quantity,noise levels,existing traffic patterns,solid waste production or disposal,potential for erosio,
drainage or flooding problems? Explain briefly:
C2. Historic,archeological,visual or aesthetic,or other natural or cultural resources;agricultural districts;or community or neighborhood character?Explain brie
C3. Vegetation or fauna,movement of fish 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. Secondary,cumulative,or other effects not identified in C1-C6?Explain briefly.
C7. A change in use of either quantity or type of energy 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
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.
❑ 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/LONG FORM 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,action WILL NOT result in any significant adverse environmental impacts AND provide here, and on
attachments as necessary, the reasons supportng this determination:
Agency Name Agency Preparer's Name
Preparer's Signaturefritle Date
QUEST - _ INAIR-E TO -BE COMPLETED AN,.:-. UBMITTED
WITH YOUR APPLICATION 'FORMS TO THE -BOARD OF APPEALS
Please complete , sign and return to the Office of the Board of Appeals
with your completed application forms . If "Yes " is. answered to any
�uestions below , please be sure to depict these areas on your survey
or certified sketch ) , to scale , ' and submit other supporting documenta-
tion .
1 . Are there any proposals to change or alter land contours Yes oNo
seaward of area under construction?
2 . Are there any areas which contain wetland grasses ?
(Attached is a list of the wetland grasses defined by Yes N
Town Code , Ch . 97 for your reference . )
3 . Are there existing structures at or below ground level , �
such as patios , foundations , etc?
4. Are there any existing or proposed fences , concrete
barriers , decks , etc?
es)
5 . If project is proposed for an accessory building or
structure , is total height at more than 18 feet above Yes No
average ground level ? State total : ft .
6. If project is proposed for principal building or
structure , is total height at more than 35 feet above Yes No
average ground level ? State total : ft .
7 . Are there other premises under your ownership abutting Yes No
this parcel ? If yes , please submit copy of deed.
8 Are. 'there any . bui ]ding. ,pe,rmi ts.::. pen.d, .ng,...on„ th,"�;;s ,parcel
or abutting land under ,your owners.hip:, if any).? Yes
State Permit # and Nature :
9. Do state whether or not applications are pending
concerning these premises before any other department
or agency (State , Town , County , Village , etc . ) :
Planning Cy Board - '' � ✓ Y es No
Town Board - Yes No
Town Trustees Y No
County Health Department �� Q � �� es No
Village of Greenport es No
N . Y-. S . D . E . C. Yes No,
Other Yes No
Is .premises , pending a sale or. conveyance?.
If yes , please submit -copy- of names or purchasers
and conditions of ' sale . (from contract ) . Yes No
11 . Is new construction proposed in the area of contours
at 5 feet or. less as exists? Yes N
12 : If new construction is proposed in an area withi .q,�''
75 feet of wetland grasses , or land area at ad 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 YesN No
the requirements of Ch . . 97 of the Town Code ?
13 . . Please list present use or operations conducted upon the
subject property at is time
�G�.c/T
and proposed A 14.
I cert ' f haj th bove statements are true and are being submitted for
reli Bo rd of Appeals n considering my. application .
Sig ature PropertyOwner ) (Authorized Agent
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