[Suffolk County, NY] APPLICATION FOR STREAMLINED REVIEW

APPLICATION FOR STREAMLINED REVIEW
OF WORKFORCE HOUSING DEVELOPMENTS BY SUFFOLK COUNTY

This is an application to fast-track review and waive all Health Department, Office of Wastewater Management, fees in connection with projects related to economic development and workforce housing.

Applications will be Submitted to:

Director of Real Estate
100 Veterans Memorial Highway, 2nd Floor, Hauppauge, NY 11788
Phone: (631) 853-4800 | Fax: (631) 853-5906 | Email: ecodev@suffolkcountyny.gov

Project Information:

Property Name:

Tax Map #:

Address:

Does property front on County Road?:

Yes

Health Department Reference #:

Number of Affordable Units*:

Total Number of Total Units:

*Waive Suffolk County Health Department Fees

Income Limits (i.e. % of median income):

Purchase Price(s)(If applicable):

Rent Levels (If applicable):

Entity Certifying Occupants:

Applicant Information:

Applicant Name:

Applicant E-mail:

Town Contact (If not Applicant):

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First Name

Last Name

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I hereby certify that I, the Applicant, have completed this form with all information being accurate to the best of my knowledge.

The following will be completed by the Department of Economic Development and Planning.

Application has been reviewed and approved for submission to Suffolk County Department of Health Services.

By: ________________________________________________________ Date: ______________________________

Economic Development and Planning - H. Lee Dennison Building - 100 Veterans Memorial Highway, 2^nd Floor - Hauppauge, NY 11788