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OFFICIAL USE ONLY TOWN OF ORCHARD PARK ox. 0 Permit Fee Paid: Issued By: FLOODPLAIN DEVELOPMENT APPLICATION 1, Project (Description, Location and Acreage) EO Vane Fe ba Bas vite px 2 DAG (iF ywatroyss Vorme? 2. Owner (Name and Address) Saesse Mer ayaye \ BH bAG Vytieans Poso’ tian “Moe lave 7 PhoneNo: [IG Gt 2-7 “AOeS 3. Contractor (Name and Address) LG hxc amr noe LAC Ove Vacca Rosa, ; CassApacia | Missote jet, : Phone Nor “byes acc SN ys 4. Permit Fees: NO |p $150 plus ($75 per acre or fractional part thereof) $50 plus (2% of the Construction Cost) Engineering Department will determine total fees upon submission of design package. 5. Site Improvement Bond: ; Surety Corporation Name: ro fd Bond Amount: nu [A ($2,000 per acre or fractional part thereof) In consideration of the grant of this permit, the undersigned agrees as follows: 1. Refer to and fill out the attached Floodplain Development Permit Application forms as a part of this permit. 2. Work under this permit shall be started within sixty (60) days from the date of approval thereof. Work under this permit shall be completed within one (1) year from the date of the approval thereof. Any request for extension shall be addressed in writing to the Town Board of Orchard Park. 3. The undersigned guarantees that all persons connected with the actual work under this permit are duly covered by Liability and Workman's Compensation Insurance and the State, County and Town shall be held harmless on account thereof of the undersigned. 4. The undersigned hereby agrees to hold harmless the Town of Orchard Park, its Districts, Subdivisions, or its agents or employees from all liability of any kind arising out of the performance of the proposed construction, activities of Town employees or the public in connection with the proposed construction or construction site. 5. Working hours: 7:00AM to 6:00PM NO SUNDAY OPERATION i have examined the foregoing application and agree to the terms set forth in this application and do hereby certify(that the required permit.fee as established by the Town Board of Orchard Park, New York has keeri paid. CoA ~ ( Na | Se Rp gf es Signature of Applicant: Oh Nl hv7 \ \ sh 7A Date: wp VV ra | FloodplainDevelopment Permit Application 1