AFFIDAVIT OF PROPERTY OWNER
State of New York
County of Nassau
(PRINT NAME) ____________________________________________________________ being duly sworn, deposes and says: That
he/she resides at ________________________________ in the State of __________________________, that he/she is the owner in
fact of all that certain kit, piece of land shown on the diagram above, situate, lying and begin within the INCORPORATED VILLAGE OF
CEDARHURST, that the work proposed to be done upon the said premises will be done in accordance with the, approved application
and accompanying plans. (and he/she hereby authorizes APPLICANT to make application for a permit to perform said work in the
foregoing application and accompanying plans), and all the statements herein contained are true to deponents own knowledge.
Sworn to this day of
_______________________ 20____________
_________________________________________________
Notary Public, Nassau County, NY
APPLICATION FOR FENCE/HEDGE PERMIT
VILLAGE OF CEDARHURST
Permit No. __________________________
Date Received: _______________________
Fee:________________________________
www.cedarhurst.gov | building@cedarhurst.gov
Issued Pursuant to the Provisions of the Building Zoning
Ordinance and Building Code of the
VILLAGE OF CEDARHURST, NASSAU COUNTY, NY
Zone _____________ Section ____________________ Block __________________ Lots_______________
Owner Name _____________________________________________ Telephone #______________________
Address _________________________________________________________________________________
Proposed Work ___________________________________________________________________________
________________________________________________________________________________________
Contractor __________________________________________ Telephone #__________________________
Address ___________________________________________________________ Zip___________________
PLOT DIAGRAM
Attach Copy of Survey
SS:
This fence permit application is based solely on the survey and/or diagram as provided by the applicant. Approval of this application by
the Village of Cedarhurst Building Department does not certify as to the accuracy of the survey or the property dimensions as provided
by the applicant. Thus, the placement of any fence on said property cannot be certied by the Village of Cedarhurst.
____________________________________________
Signature of Owner
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