STATE OF NEW YORK
COUNTY OF SUFFOLK
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Sworn to me this day
of , 20
Notary Public
FORM 87-03
Pursuant to Huntington Town Code Section 87-15(A)(7)
The undersigned, being duly sworn, desposes and says:
1. I am the owner of record, in whole or in part, of the property identified below.
2. The proposed work will be faithfully carried out as described in the application and as
shown on the accompanying plans and specifications and not otherwise.
3. I have been advised that Town Code Section 198-61 defines a "hillside area (steep
slope)" to include a lot with an average slope of 10% or greater.
4. I have been further advised that as per Town Code Section 198-64(J)(3) that the
subject pool shall be prohibited in an area with an average slope equal to or greater
than twenty (20) percent.
5. Upon information and knowledge of the subject property, I attest that either the parcel
has no hillside areas; or if there is a hillside area, that no part of the proposed pool
installation, clearing and/or grading will commence in a hillside area with an average
slope equal to or greater than twenty (20) percent.
6. These representations are made with full knowledge that the Town of Huntington is
relying on same in issuing a water pool permit.
Signature
Print Name
Property Address or Location
SCTM NO.:
Dist. Sect. Blk. Lot
DEPARTMENT OF ENGINEERING SERVICES
DIVISION OF BUILDING & HOUSING
