By checking the "I agree" box below, I certify that all information is true an accurate and subject to a penalty for making a false statement subject to Penal Law 210.45. I attest that I will comply with all rules and approvals for the application herein.
Please only fill out this section if the owner is different than the applicant. Be advised that the owner of record for the property referenced herein has reviewed the proposal herein, hereby consents to this and approves this application. By this application, the owner hereby authorizes employees or agents of the Town of Brookhaven, in conjunction with this application, to enter and inspect the project site as necessary.
By checking the "I agree" box below, I certify that the owner of record for the property referenced herein has reviewed the proposal herein, hereby consented to this and approves this application. By this application, the owner does hereby authorize employees or agents of the Town of Brookhaven, in conjunction with this application, to enter and inspect the project site as necessary.
Any temporary accommodations granted herein will expire on November 1, 2020 and shall be removed by November 10, 2020. For permanent improvements or uses, please use standard Town permit applications.
Submission Requirements:
Certification:
Compliance Inspection:
Once the tent or membrane structure is erected, an inspection, prior to the event or use by the public, will be required.
A Transactional Disclosure form is required when someone submits certain applications to Brookhaven Town. The purpose of the disclosure is to alert the Town if a party of influence has an interest in this application or if someone within the Town who will participate in the decision has an interest. *Note: It is required that a copy of this form be sent to the Director of the Board of Ethics.
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
This field is not part of the form submission.
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