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HomeMy WebLinkAboutTR-9451 uvw Michael J. Domino, President Town Hall AnnexJohn M. Bredemeyer, III, Vice-President 54375 Route 25 Glenn Goldsmith P.O. Box 1179 A Nicholas Krupski Southold, NY 11971 Greg Williams Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: Ct�R�sTvf'd�i�-� �hktssq (,�ZaS C10 PA�frleoR.b� Please be advised that your application dated qi opiq has been reviewed by this Board at the regular meeting .of 2#lqand your application has been approved pending the completion of the following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1st Day of Construction ($50.00) '/Constructed ($50.00) X PnM-tr TT'Fee ($50.00) 1�R-A'I�SF�Ie OF C•E tr Dock Fees ($3.00 per sq. ft.) 30-Year Maintenance Agreement (complete original form enclosed and submit to Board of Trustees Office) The Permittee is required to provide evidence that the non-turf buffer condition of the Trustee permit has been recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety (90) calendar days of issuance of this permit. Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will'be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: $ S_Uz BY: Michael J. Domino, President Board of Trustees Michael J.Domino,President �QF SO Town Town Hall Annex 0 John M.Bredemeyer III,Vice-President ,`O l 54375 Route 250 P.O.Box 1179 Glenn Goldsmith Southold, New York 11971 A.Nicholas Krupski y 4C G Q Telephone(631) 765-1892 Greg Williams a0 Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD October 16, 2019 Patricia C. Moore, Esq. aw 51020 Main Road Southold, NY 11971 I RE: CHRISTOPHER & MARISSA LAZOS �'� 1200 LEETON DRIVE, SOUTHOLD SCTM# 1000-59-1-1 -�— -� - Dear Mrs. Moore: The following action was taken at the Southold Town Board of Trustees regular meeting held on Wednesday, October 16, 2019: RESOLVED, that the Southold Town Board of Trustees APPROVE the request for a Transfer of Wetland Permit#9451 & Coastal Erosion Permit#9451 C from Antoine Van Horen to Christopher & Marissa Lazos, as issued on May 15, 2019. Any other activity within 100' of the wetland boundary requires a permit from this office. This is not a determination from any other agency. If you have any questions, please contact our office at (631) 765-1892. Sincerely, Michael J. Domino, President Board of Trustees MJD/dd DiSalvo, Diane From: DiSalvo, Diane Sent: Monday,August 26, 201910:36 AM To: 'pcmoore@mooreattys.com' Cc: 'Betsy at Moore Law Offices' Subject: Transfer to Lazos - 1200 Leeton Drive Please send us an additional check for$50.00 as there are two permits: 9451 &9451C to transfer. Thanks o Di a v,,e T %SCI LVo - - soL.thoLd Tom,. TrL.cstees 5437 5 rzou.te 25 �.o. -Fox I:L79 SoutkoW, NY 1:L971 (631) j 65-6641 i Michael J. Domino, Pt nt: OQSVI Ff7(�`' ;r z Town Hall Annex O . John M. Bredemeyer III, Vice..rresident v'A 54375 Route 25 Glenn Goldsmith coCz P.O.Box 1179 A.Nicholas Krupski _ Southold,NY 11971 Greg Williams A. p! Telephone(631)765-1892 kt �a Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: 1 Completed in field by: /I/I Patricia C. Moore, Esq., on behalf of CHRISTOPHER & MARISSA LAZOS requests a Transfer of Wetland Permit#9451 & Coastal Erosion Permit#9451 C from Antoine Van Horen, as issued on May 15, 2019. Located: 1200 Leeton Drive, Southold. SCTM#: 1000-59-1-1 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=q Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 4. Septic Tank: 75 feet �&2lrl q A 5. Swimming Pool and related structures: 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet j TOP OF BLUFF: f 1. Residence: 100 feet Z P 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Noti a of Hearing Card Posted: Y / N Ch. 275 Ch. 111' SEQRA Type: I I I Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland . Coastal Erosion Emergency Violation Non-Jurisdiction Survey :5 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski G. Williams Other Patricia C. Moore Attorney at Law 51020 Main Road Southold,New York 11971 Tel: (631)765-4330 Fax: (631)765-4643 August 7, 2019 Board of Trustees Town of Southold D E C E I V E PO Box 1179 L5 Southold,NY 11971 AUG - 9 2019 Hand Delivered Southold Town RE: PERMIT TRANSFER Dear President Domino and Board: Please let this serve as a permit transfer request of permit#9451 and#9451 C for property located at 1200 Leeton Drive, Southold,NY 11971 (SCTM: 1000-59-1-1) from Antoine Van Horen to Christopher&Marissa Lazos. I am enclosing the Affidavit signed by the new owners, their authorization, copy of deed evidencing their new ownership,together with my client's check in the amount of$100.00 for said fee. Thank you and please do not hesitate to call should you have any questions. Very truly yours, cia C. Moore PCM/j s Encls. ,h Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) I, CHRISTOPHER LAWS AND MARISSA LAZOS, as owner(s) of premises 1200 Leeton Drive, Southold,NY 11971,residing at 76 Beverly Drive, Albertson, NY 11507, do hereby authorize our attorney, Patricia C. Moore,to apply for permit(s) and appear before the Southold Board of Town Trustees on my behalf. (owner's signature) Christopher Lazos J- —Z�,-�Jowner's signature) Marissa Lazos Board of Trustees Application County of Suffolk State of New York CHRISTOPHER LAZOS AND. MARISSA LAZOS, BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS ARID FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO'MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. C herLazos AMarissazos Sworn t before me this day of , 2019 Notary Public AR HUA G. .=O?M I taryPebue,'scate of Na Yoh No. 31./60145 ouel4fled to New York Coomy Comftsftn Expires'Feb.26, 11l Michael J. Domino, President �o�p UfFOI Town Hall Annex John M. Bredemeyer, III, Vice-President ;�� cv�; 54375 Route 25 Glenn-Goldsmith N P.O. Box 1179 A Nicholas Krupskiy Southold, NY 11971 Greg Williams �d , ��� Telephone (631) 765-1892 Fax (631) 765-6641 SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITIES CHECKED OFF BELOW INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction % constructed When project complete, call for compliance inspection; ;`tiii+•i'i'i��� ,,, - ;'tii11'i''i�� a•�ii•'i'I'i��' '_ .�tii'i•'i'�o'i�:• -- _ :';viii''i'i'i'i�•• :•�iiii��'i'i'io�•• :'tit'H oiii°•. •C r '� i" or' ti\•s�' /,:•"+°'::�'.::::u�i,� .+" _ __ '✓-v�'_ � -�_' ,,,war, � �,..�"'%"'.._—, /-�^%• y //• I - y -`=o r• rl� � �� t�\. •) �k� .i�f ll'. � � h,T��C ' �- _� �i�.:ll` � .� .. /= � ,fes .�"�'. •nl nTn l)vrc+1'r(..q••r•,n,mri,nrtnrr• , nrnl q 1 umtnrrnrmry,,,arrc, ,npnrrrrr.rrrnAO n iir(.rrgPfina•,;r,nnn.Cv,.nivJrr/'n+'l.,rrfvr,:nJ,Srnm,� .r...:,.,,q•nJIXt•rf�i•n naa ry)),�(n<l i• ��( _ _ = �\�3,nn„grr'yr„(n;• ,ryar � Zr a, ,n ^� .). 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BOARD OF SOUTHOLD TOWN TRUSTEES -` SOUTHOLD, NEW YORK -$ PERMIT NO. 9451 &9451C DATE: MAY 15,2019 '='"; ISSUED TO: ANTOINE VAN HOREN PROPERTY ADDRESS: 1200 LEETON DRIVE,SOUTHOLD `= F, SCTM# 1000-59-1-1 F AUTHORIZATION ` Pursuant to the provisions of Chapter 275 and/or Chapter 111 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on May a 15,2019 and in consideration of application fee in the sum of$500.00 paid by Antoine Van Horen and subject to the Terms and Conditions as stated in the Resolution,the Southold Town Board of Trustees authorizes and permits the following: €' Wetland Permit to install 100 linear feet stone/toe armor(1-2 ton stone on infill rip-rap); 50 err= cubic yards clean sand; plant Cape American beach grass to disturbed areas; extend 5.66'x10'"' =} stair for beach access;with the condition that the dunal area is not disturbed; and as depicted = ' on the site plan prepared by DKR Shores,Inc.,dated March 20,2019, and stamped approved ;ra on May 15,2019. ' II . IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. f IN fywl MIL uw,. ',;u,�.,r8., :Rs, ,•,r,•,,,,,. n:.w•,i,;..:,.�u.,,,G„n„t„„iu••.,,•,.;,r•„r,,,,,.,i•rb,,,n..�.,•,oa�• •:•an,,,u.,,.,�\:.•�,,,.{.,v,a•;r.�11' � - //f�, .,,`.9ur^f;,`.,, _ ` „n,� Y _. ;. ,.,qn`:_ a- .�,.,�'; a;;'-,a,,.• .. ,; -va,�` s '` :i •'''�sl: 1ii1�`: ��i::i :iilsi.• iil� �!N '';��i%liiip.' - ��0! 11��..•• ,1/�• !�s•.•_ :ii �i%.•,' ' TERMS AND CONDITIONS The Permittee Antoine Van Horen residing at 1200 Leeton Drive Southold,New York, as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 1. That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will,at his or her own expense,defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto,to the complete exclusion of the Board of Trustees of the Town of Southold. 2. That this Permit is valid for a period of 24 months,which is considered to be the estimated time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved,to provide evidence to anyone concerned that authorization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized,or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation,the said Permittee will be required, upon due notice,to remove or alter this work project herein stated without expenses to the Town of Southold. 8. That the said Board will be notified by the Permittee of the completion of the work authorized. 9. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit,which may be subject to revoke upon failure to obtain same. 10. No right to trespass or interfere with riparian rights. This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. APPLICANT PROP08ES TO INSTALL.100'STONE ARMOR ALONG TOE OF BANK USING 1-2'TafV STONE O�1 INFILL RIR RAP BAS :'TO REST©RE AND PLANT UPLAND AREA WITH7-_'OAIE®-p= ®� Y 'y 50 CY CLEAN BEACH-COMPATIBLE SAND AND CAPS AMf klCAN ISEACH QRASS',PLUG$ 12"OC. TO EXTEND THE E XI,5TING BEACH ACCENS STAIRS 5.6'X 10'. AT�QNG ISLAND RD OF RU GES SOUNb, LE5tON fJRIVE,SQWTHOLp,SUFFOLK d UNTY,NEW YORKVGMAR 2 5 20 N,-,OF.-SOUTHOtD DATE G Boa!d ni Trtr'_re; I r (/JZ I N z WFf ' (' Z �- ❑ _ I W z l] W w W p�IV CoLo 55 . CO Z t U W lu > U) 2 STY a o pox o® �.. REPIpEN � o 5.6' W Q N U) (f) a wQ Y jt Q, I 10 O �+ � z `_Wl �- sn IIat U W F- Lu :.. z W W9 t°' N �_Jm U zz 4 dEL W ul �C Ch z Z U 4 pR I VE / v_Q a a �; r+q!� � W W I Q / -� a © z _r W W 0_'N m l — V W U fn t1 y pO vz !. d a I w "'a Applic _ -'Antoine Van Horen L catiotl: 1200 Leeton Drive, Town of SOLIthpld L4 _ Purpose: Stone ArMpr& beach access_gteps- © OlAtum: Apparent Lp�ry Water 0 S.,C.T.M,I? O. 1000= --1-1 Cr , / LOCUS:'41004'08" -72027_12$" �+ n ,W DKR SHARES INC, P-O. BOX 488 2Q M�r'19 SCALE 1,�„=►`• 20� ,0 �'`` HAMPT��V BAYS, N.Y. 11946 SHE'gT 1 OF 2 1 _ ------------- - X S BtRifSET Z w a , 510"EXPOSED ST6NE w zo cv z a � = 3 CDPe E o w ELE il) it 7 P OF BANK ELE VARIES 8-10 —� REP NT DISTURBE R -A H CAPE"e4ERICAN 8 C G S 12"O a ¢ ¢ �,P�?f�OX 50 CY CLEAN BEACH COMPATIBLE SAND � _ + x �<- -1- ELE 6 ELE 4 x _. ^may , < APPLICANT PRQPOSES TO IN,9TALL 100' EE 2 S`fONE ARM9R ALONG TOE QF BANK EXISTING BEACH GRADE VARIES USING 1-2 TCN$'PONE ON INFILL RIP RAP �— ¢ ¢ BASE TO RESTQRE AND PLANT UPLAND PROPOSED 100 LINEAR FT STONE ARMOR AREA WITH`50 Cy CLEAN BEAQH 1-2 TORI BOULDERS ON 5"-8"INFILL STONE c6MOATIB�E UND AND CAPE AMERICAN . AIRS BEACH ACCESS S STI EXIBtACH GRAS§PLUGS 12^OQ, TO EXTENb THE' PjF� T5E3' X 10' LONGI SAND SOUND,STAIRS CADATIOW2ITI— —� --r— Tr '�' DRIVE,SOUTHQLP,SUFFOLK OOUNTY, NEW YORK 'o^ PR PROP_ Ei3ALT R FABRIC PROPOSED 4'dW RIP RAP BASE �a7 E� ES I I'� 'f� PLACEDQNFILTF�RFABRICrQ A !� MAR 25 2019 Sr:a cId;-vin ciT_,�t �s Applicant: Antoine Van H�ren -- -- __ — Location: 1200 Leeton Qri�r4�, Town of Southold Purpose: Stone Armor& teach access steps` Datum: Apparent Low Water a; ,t.T.M.NO. 1000-5.0-1-1 OCu : 41"04'08" 1202712811 � I�;°�" -PKR SHORES INC, P.O. BO 488 20 Mar'19 .f; SCALE 1/4�`f=,, 1 ,R ',(" 1 . ���� � HAMPTON BAYS, N.Y. 19-46 SWEET 2 OF 2 Michael J.Domino,President �q so(/ry Town Hall Annex John M.Bredemeyer III,Vice-President ��� Old 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski G Telephone(631) 765-1892 Greg Williams Fax (631) 765-6641 COUNTY,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD COASTAL EROSION MANAGEMENT PERMIT COASTAL EROSION PERMIT #9451 C Applicant/Agent: DKR Shores, Inc. Permittee: Antoine Van Horen SCTM#: 1000-59=1-1 Project Location: 1200 Leeton Drive, Southold Date of Resolution/issuance: May 15, 2019 Date of Expiration: May 15, 2021 Reviewed by: Board of Trustees DESCRIPTION OF ACTIVITY: Install 100 linear feet stone/toe armor(1-2 ton stone on infill rip-rap); 50 cubic yards clean sand; plant Cape American beach grass to disturbed areas; extend 5.66'x10' stair for beach access; with the condition that the dunal area is not disturbed; and as depicted on the site plan prepared by DKR Shores, Inc., dated March 20, 2019, and stamped approved on May 15, 2019. INSPECTIONS: Final Inspection SPECIAL CONDITIONS: Dunal area not to be disturbed. In accordance with Chapter 111-15 Erosion Protection Structures: xx A maintenance agreement is attached hereto and is a necessary special condition of this permit. BY: Michael J. Domino, Pr sident Board of Trustees Michael J.Domino,President sv(/Ty Town Hall Annex John M.Bredemeyer III,Vice-President ,`O� ®�� 54375 Route 25 P.O. Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski G Telephone (631) 765-1892 Greg Williams Fax(631) 765-6641 �lycoUNTd,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD May 15, 2019 Agena Rigdon DKR Shores, Inc. P.O. Box 488 Hampton Bays, NY 11946 RE: ANTOINE VAN HOREN 1200 LEETON DRIVE, SOUTHOLD SCTM# 1000-59-1-1 Dear Ms. Rigdon: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, May 15, 2019 regarding the above matter: WHEREAS, DKR Shores, Inc., on behalf of ANTOINE VAN HOREN applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, and Chapter 111 of the Southold Town Code,_Coastal Erosion Hazard Areas, application dated March 25, 2019, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, the LWRP Coordinator issued a recommendation that the application be found Consistent with the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on May 15, 2019, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 275 and Chapter 111 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees have found the application to be Consistent with the Local Waterfront Revitalization Program, and, RESOLVED, that the Board of Trustees APPROVE the application of ANTOINE VAN HOREN to install 100 linear feet stone/toe armor (1-2 ton stone on infill rip-rap); 50 cubic yards clean sand; plant Cape American beach grass to disturbed areas; extend 5.66'x10' stair for beach access; with the condition that the-dunal area is not disturbed; and as depicted on the site plan prepared by DKR Shores, Inc., dated March 20, 2019, and stamped approved on May 15, 2019. Permit to construct and complete-project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of$50.00 per inspection. (See attached schedule.) Fees: $50.00 Very truly`yours, Michael J. Domino President, Board of Trustees MJD/dd Town I-lull A.rinex Nlichnel J. Domino.President ' 54375 T3ooat.e 25 �,. John M, T3redet7uryer III.Viae-President ; .ti , P.O.Box 1179 Glenn Goldsmith i; µ I,` �r:.' j Suul.hold,New York 11971 A.Nichola:, Krupski 1`elc ph+ane t631.) e#�7 lti9'l Fay;(631) 7t7,>-#.641 Greg Williani�' BOARD OF TOWN TRUSTEES TOtN'rNT OF SOU'rHOLD 30-YEAR MAINTENANCE AGREEMENT EROSION PROTECTION STRUCTURES CHAPTER 111-16 OF THE SOUTHOLD TOWN CODE I (We) ANTOINE VAN HOREN The owners of record of property at. 1200 LEETON DRIVE SOUTHOLD SCTM#: 1000-59-1-1 in applying for a Coastal Erosion Permit for an erosion protection structure do hereby agree to a 30-Year Maintenance program for a structure as described: install 100 linear feet stone/toe armor (1-2 ton stone on infill ri -ra : 50 cubic yards clean sandplant Cape American beach grass to disturbed areas: extend 5.66'x10' stair for beach access with the condition that the dunal area is not disturbed-, as shown on the attached licensed survey and/or site plan for the approved structure. It Is my/our understanding that we are to maintain this structure with materials designed to endure 30 years and/or equivalent to the original approved structure. Any maintenance which involves more than 50%of the length of this structure requires approval of the Board of Trustees. We further understand that failure to maintain the structure could result in a requirement to post a bond and/or have the repairs ordered as a lien against the property upon a finding by the Board of Trustees that said lack of maintenance would risk life, property or important natural resourc atures. No rize nature of owner of record Sworn to before me this day of May, 2019 / -SABRINA M 13ORM -Notary Public,State of New York No.01806317038 Notary Public Qualified in Suffolk County Commission Expires Dec.22,2020„9 This maintenance agreement shall only be valid upon the attachment of a licensed land survey/and or site plan made within one year of the original construction and validated to show the final approval of the administrator. Michael J. Domino, President ;r�o Town Hall Annex John M. Bredemeyer, 111, Vice-President o d 54375 Route 25 Glenn Goldsmith o a .. g" P.O. Box 1179 A Nicholas Krupski y�j oola Southold, NY 11971 Greg Williams �'< Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES Sri rG� TOWN OF SOUTHOLD TO: ANTOINE VAN HOREN c/o DKR SHORES, INC. Please be advised that your application dated March 25, 2019 has been reviewed by this Board at the regular meeting of May 15, 2019 and your application has been approved pending the completion of the following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) — (Silt boom) 1St Day of Construction ($50.00) 'h Constructed ($50.00) xx Final Inspection Fee ($50.00) 6 Dock Fees ($3.00 per sq. ft) XX 30- Year Maintenance Agreement (complete original form enclosed and submit to Board of Trustees Office) The Permittee is required to provide evidence that the non-turf buffer condition of the Trustee permit has been recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety (90) calendar days of issuance of this permit. Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE. $.50.00 BY- Michael J. Domino, President �d Board of Trustees I} SURVEY OF << DESCRIBED PROPERTY SITUA TE A T } 1 MAR 2019 P�ERys°1310 SOUTHOLD TOWN OFSOUTHOLD O MEPN ON FEBRUPR SUFFOLK COUNTY, NEW YORK i'-R� �r���jrs;�,,;�,s -_`•__-.°s �Ov / S.C.T.M. DIST. 1000 SEC. 059 BLK. 01 LOT 1 QNO � ' 15 8 0 15 30 45 60 75 90 105 120 135 �f 00 56' SACLE: 1"=30' DATE:FEBRUARY 2, 2019 tAG 3303 / koo LOTAREA: 19,146 SQ.FT. =0.440 ACRES f ' '� �� CURRENT ZONING:R-40 ELEVATIONS HEREON REFER TO NAVD 1988 �' E L�6) / N FLOOD ZONE BOUNDARIES HEREON AS SCALED FROM THE / Lppp ZpN vE(E /// ——o_ F.E.M.A. FLOOD INSURANCE RATE MAP-MAP N0. 36103C0154 H ' F EFFECTIVE DATE:SEPTEMBER 25, 2009 N // FLOOD 9ONE \ N Ci 0 !Z f OF5 i O N-O f n o m \ rr0MOFeP%i / 000 � �rti CERTIFIED TO:ANTOINE VAN HOREN W C!1 \ 50 \0000 '� �•• RD LIN� O Q \ S Of��/ oD�EOK oEROSIOIH Y. OF 49P / i 0 C) 2Np STORY pEGK 3$.1 / PfS pEPAL 5,566 g3 SHEET 6 �� FONG¢pT10 ODER iN {�IR�S �P�010 OP ED 1a� 1 \ 34 JOB NO.:2019-116 �0 0/va > w&ANDINul MAP NO.:a FILED: 2FSTORY o REVISIONS: RAMg G4 0 -, �zh ..3it�.�itJj OS 0 o F.FE�67ELUN6Ilk zo cn /-w ELE�' 344' x .3 �— \ 95 _ m z03 10 (7) pOH m D363 O DON m W c •'" SIP- o a �0 F' 6m C-No o a { FN30w FN S o c v z mFc I 6.6 ENOE g o �� 1 VINYLF EASEMENTANDORSUBSURFACE J smuctvRESREcoROEooR ' UNREGOADEDARENOT GUARANTEED ywp(�IG / ryMtE55 PSlUlgV�YEV/OEVTA77NE w^TER ` 0 00� FLOOD f///1• ' NEAEOASET 111,E ENSIOgRE�":NE LICENSE NO. 050363 L7j /U. M('( 1,2) PAOPERTANDSAANOTF SPECIFIC VV �{ F PURPoSEAND USEANO THEREFORE c2 m Mc' `�� / ✓LSI A9ENOTINTENDED TO OWDETHE y - 1 T vv // ONE A EAEOnONOLS PATIOS. S�50 6-RH , ppVEME� '' FLppp Z WALLS.POOLS OE NGS HANDS ON SURVEYING AREAS,ADDITIONS TO TFILCOON avDa"YorHER coxsraucnav EDGE OF // UNAUTHSUA ISAVICnoN0AA06nON 26 SILVER BROOK DRIVE N C SECTION 709 W THE"NEW YOPXSTATE N> r / EDUD1nONLAW FLANDERS, NEW YORK COPIES OF THIS SURVEYMAPNOTSEAHING 11901 Y E THELANO SURVEYORS INKED SEAL OR oSEA wo�CONDTEECONSDERED TEL:(631)-369-8312-FAX'(631)-369-8313 // D CERnHGnONSINOCATEDHERONSHAIIRUN MARTIN D. HAND L.S ONLY TO THEPERSONX)FORWHOMTHESUAVEY 0/ IS PREPARED ANC OHMS SFXAIF DTHE TITLECOMPANY,GOVERNMENTAL AGENCYAND / LENDINGINSnnESOFTIIELDNEREON AND COPIES OF THIS SURVEY MAP,EITHER PAPER OR ELECTRONIC,NOT BEARING / W OAL ERTIFICATIDMELENONGINSn- / i CRduIINSTIUTIONSORSUBS�EQUUE� THE LAND SURVEYORS INKED SEAL OR EMBOSSED SEAL SHALL NOT BE i I Michael J. Domino, Presi o�Q1-C Town Hall Annex John M. Bredemeyer 111,Vice-President '�,,,�'i 54375 Route 25 Glenn Goldsmith y P.O.Box 1179 A.Nicholas Krupski Southold,NY 11971 Greg Williams Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: lb � � Completed in field by: DKR Shores, Inc. on behalf of ANTOINE VAN HOREN requests a Wetland Permit and a Coastal Erosion Permit to install 100 linear feet stone/toe armor (1=2 ton stone on infill rip-rap); 50 cubic yards clean sand; plant Cape American beach grass to disturbed areas; extend 5.66'x10' stair for beach access. Located: 1200 Leeton Drive, Southold. SCTM# 1000-59-1-1 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=� Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool). 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet, 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice Hearing Card Posted: Y / N Ch. 275 Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: Bredemeyer M. Domino; G. Goldsmith N. Krupski /G. Williams Other I Antoine Van Horen 1200 Leeton Drive, Southold SCTM#: 1000-59-1-1 5/8/19 t Hill Ifili-11 - ���! ,. ,un,q v�. • ,� ��"{; r runt r ' ����,�,� - 7- On - - y 0111 Ow 11P Jw ► ' 46. �) � � � ' .F.._� -- ._ . � ••L -Cf ••.j, • as y Tom.`a !.1 ��T�a :N- "1�: �_3r. �j' �Ul� � no 40 'c•f -.�- "-SAL '.:ni y S`.� .. i + r. CCC t,` r.�. ..• >.�,�rF• _ .r .� ,� sib . '� � � '► sem.. a "`i'+� - .t.v; .:�.� ,�. -;� - • .� ,� � __ '�" _ • r •.11 t• - .r_�J1Alf.t C. Ji/ �` f a ii ^+Y i !� i � 1 Jill M.Doherty,President ��1�f SO�Tyo Town Hall Annex Bob Ghosio,Jr.,Vice-President �� lQ 54375 Main Road l [ �[ P.O.Box 1179 James F.King Southold, New York 11971-0959 Dave Bergen G i0 Telephone(631)765-1892 John Bredemeyer Ol�COU� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0704C Date November 22, 2011 THIS CERTIFIES that the repair of the existing deck framing, decking and handrails and for the new stairs At 1200 Leeton Dr., Southold Suffolk County Tax Map#59-1-1 Conforms to the application for Trustees Permits heretofore filed in this office Dated 5/17/11 pursuant to which Trustees Wetland Permit#7577 and Coastal Erosion Permit#7577C dated 6/22/11 were issued and conforms to all of the requirements and Conditions of the applicable provisions of law. The project for which this certificate is being issued is for The repair of the existing deck framing,decking and handrails and for the new stairs. The certificate is issued to MARGARET MOLLOY owner of the Aforesaid property. ?thorized Signature BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD,NEW YORK PERMIT NO.7577 & 7577C BATE:JUNE 22,2011 ISSUED TO: MARGARET MOLLOY PROPERTY ADDRESS: 1200 LEETON DRIVE,SOUTHOLD SCTM#59-1-1 AUTHORIZATION Pursuant to the provisions of Chapter 275 and/or Chapter 1 I I of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on June 22,2011,and in consideration of application fee in the sum of$500.00 paid by Margaret Molloy and s subject to the Terms and Conditions as stated in the Resolution,the Southold TowwBbard of Trustees authorizes and permits the following: Wetland Permit to repair the existing deck framing,decking, and handrails, and install new stairs; and as depicted on the site plan prepared by Nancy Dwyer Design Consulting, Inc., last dated February 3,2011, and stamped approved on June 22,2011. IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. 0 0 C* : fi 0 .`�O �phr �Ye4c cr- i i I Jill M.Doherty,President riF SO(/ly Town Hall Annex Bob Ghosio,Jr.,Vice-President ��� Old 54375 Main Road P_O. Box 1179 James F.King Southold,New York 11971-0959 Dave Bergen 012 John Bredemeyer sii �O Telephone(631) 765-1892 "DUNT'I,�c� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD COASTAL EROSION MANAGEMENT PERMIT COASTAL EROSION PERMIT#7577C Applicant/Agent: Tom Quarty Permittee: Margaret Molloy SCTM#: 59-1-1 Project Location: 1200 Leeton Drive, Southold Date of Resolutionlissuance: June 22, 2011 Date of Expiration: June 22, 2013 Reviewed by: Board of Trustees DESCRIPTION OF ACTIVITY: To repair the existing deck framing, decking, and handrails, and install new stairs. The Coastal Erosion Management Permit allows for the operations as depicted on the site plan prepared by Nancy Dwyer Design Consulting, Inc., last dated February 3, 2011, and stamped approved on June 22, 2011. INSPECTIONS: Final SPECIAL CONDITIONS: (apply if marked) In accordance with Chapter 111-15 Erosion Protection Structures: A maintenance agreement is attached hereto and is a necessary special condition of this permit. BY: Jill M. CVherty, President Board of Trustees SURVEY OF PROPS r 5111)ATE: 5OUTHOLD TOM, 5OUTHOLD �PPROV SUFFOLK COUNTY, NY 'rD G. 5WVEYED- 03-25-2011 WN OF E : 51JFFOLK GOIJNTY TAX 1000-5q-I-I CEltluqm TO. JAMES T.M0=Y 1,14 BOTTOM OF aAW OF a"- 01 OKX j 00 o 00' S45 5'30 Lew" OF NEII, NOTES: MONUMENT FOUND'�Tom LIKES REFEREW-E N&VD'2q DATUM i'GA FEMA FLOOD ZONE ANNOTATED FROM FIRM OF 6 MAP*36103r,0154(5 PTO MAY 4,iqqb tiSFo WASTAL EROSION HAZARD LIKE ANNOTATED FROM DEC PHOTO 0 56-566-83 SHEET b OF 49 DTD 8/29/88 AREA= 16,595 S.F.OR 0-38I0 ACRE JOHN C.EHLERS LAND SURVEYOR 6 EAST MAIN STREET NYS'UC NO 50202 6RAPHIC SCALE I.= 30 RPRJUMAD NY 11901 369-1Z8 F.369-4287 REF C-%D�wand Sm � ags�OeMyD�WyDopbo.XIIXII-114.p. 5 i5�r404A - 6 1 �14 a -ell ?� b - oq I Y �jJ d . LP.a UV V ZZ� i Ake, �_ 4 i; _ = i t 4 j Y IJ 7, Z.L ` 3 rWT a - 't �-�- K�"'�:�'_�s _ - < •-may- y •'As-�':- ,.—"�•,�5 -.� .: - - : c-as.- --.-�� syr^_`' _ - 6 _ wow �. '� a. ♦ 'b81i.�,s Legend Untitled Map tr 1200 Leeton Dr Write a description for your map. Dadaab Refugee Camp T Feature 1 i Feature 2 s Feature 3 IN NATIONAL WILDLIFE REFUGE M On + <; v 0 x b � �... a � •'`.��� f�+ *�• � r{ ;ip• 'tit„ ! ` 4 WAGE 2U'IS dirop-3 V 2018 Googly � � r �" .' V �: � h SEE 9EC.NQ 651 N ��� ♦ � a+ $ b �d �`�^' a A bpd na ��N.�..a 4�, �•' Cs 267 . ms 14 h f N T° ,�w �° ♦ 27.4 e w h-0 ,TN.) c- '-' s 25 a. Mv�ry I '•'a1 o a z> w � ! I FOR PCL NO 2 , a TORN OF sourNaf) SEE sec No.r`.) ti4 s 6 a GREAT roNo 1e.TA h I .2A � C' �Na d wl � 2T N CauR BIS Am tb ,2aNq a 1 o 11A 2M M1' n Z A S� w °j 2eNc) ]0.5 ry .2 2wns' i II°N iRvsi.eC. 3 m MI SA( r SEE SEC.NO .d A CT A \ \ \ MaTCN ----_—z------ �l1NE —NO Nm. gNgqs.t N Sff slec.MQOA ^ SEE SEC.NO.eee " — SECTION NO NOTICErn COUNTY OF SUFFOLK C E °f Real Property Tax Service Agency 059 «n.,K Nv a. PtnN, en A ra 1000 ceun,Cwty RFnrMa,n q P PftOPERTV AMP •aNf i s� .^ —r. OFFICE LOCATION: �'�®�So(/�y® MAILING ADDRESS: Town Hall Annex h0 l® P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) Southold,NY 11971 • Telephone: 631765-1938 ®lycoUNT`I,��' LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President Town of Southold Board of Trustees From: Mark Terry, AICP LWRP Coordinator Date: May 9, 2019 Re: LWRP Coastal Consistency Review for ANTOINE VAN HOREN SCTM# 1000-59-1-1 DKR Shores, Inc. on behalf of ANTOINE VAN HOREN requests a Wetland Permit and a Coastal Erosion Permit to install 100 linear feet stone/toe armor(1-2 ton stone on infill rip-rap); 50 cubic yards clean sand; plant Cape American beach grass to disturbed areas; extend 5.66'x10' stair for beach access. Located: 1200 Leeton Drive, Southold. SCTM# 1000-59-1-1 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, the proposed action is recommended as CONSISTENT with the LWRP. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Damon Hagan, Assistant Town Attorney Qg�DFFO�,� Peter Young,Chairman y Town Hall,53095 Main Rd. Lauren Standish,Secretary P.O.Box 1179 Southold,NY 11971 Telephone(631)765-1889 Fax(631)765-1823 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., May 8, 2019 the following recommendation was made: Moved by Carol Brown, seconded by Peter Young, it was RESOLVED to SUPPORT the application of ANTOINE VANHOREN to install 100 If. stone toe armor, 50 cy. clean sand, plant Cape American beachgrass to be disturbed areas and extend 5.6'X 10' stairs for beach access. Located: 1200 Leeton Drive, Southold. SCTM#59-1-1 Inspected by: Carol Brown, Peter Young Vote of Council: Ayes: All Motion Carried irk 4 � Town Hall Annex Michael J.Domino,President 54375 Route 25 John M.Bredemeyer III,Vice-President P.O.Box 1179 Glenn Goldsmith Southold, New York 11971 A.Nicholas Kruskiom„ Telephone(631) 765-1892 Greg Williams Fax(631) 765-6641 Q07y Y BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application;etland Permit Application Administrative Permit Amendment/Transfer/Extension Received Application: 1,25,,Iq Received Fee: $ 6000 ]� Completed Application: — Incomplete: SEQRA Classification: Type I Type 11 Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: 6Coordination:(date sent): LWRP Consistency Assessment Form Sent: CAC Referral Sent: 24, AR 2019 Date of Inspection: .5.F, Receipt of CAC Report: Technical Review: vl' Public Hearing Held: _.__Bnr(j of -Resolution: Owner(s)Legal Name of Property(as shown on Deed): Ar)4-1);r1e_ Van J 0'e-e_A Mailing Address: Iq Old �Qan,oCj 8aok J Phone Number: . '3 n S 0 qq� Suffolk County Tax Map Number: 1000- 5 oi- 1�o C) �'f e"400 /j Property Location .. L , Soo (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): Mailing Address: Phone Number: Board bf Tirurtees--Applt� as �n I // GENERAL DATA Land Area(in square feet): 7! a .J� . 7�T �" Vc/0 �C°��6 Area Zoning: /c- L/0 r L Previous use of property: �G�i�� ``t' QS �- Intended use of property: L - Covenants and Restrictions on property? Yes No If"Yes", please provide a copy. -W-11 I-this prcject=require a=Building hermit asp-ex Town-Code? YesNo If"Yes", be advised this application will be reviewed by the Building Dept. rior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes If"Yes",please provide copy of decision. <<<«< ,Will this project require any demolition as per Town Code or as-determined-by the Building,,Dept.? Yes I No Does the structure(s) on property have a valid Certificate of Occupancy? Yes No Prior;permitsfapprovals for,site imnprovernents: Agency Date No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? o Yes If yes, provide explanation: Project Description use attachments if necessary): alo(, � dJi)2)rh—<'-`d � Boamd of Trustees -Applic& Pn WETLAND/TRUSTEE LANDS APPLICATION DATA { Purpose of the proposed operations: /'Qy-*rol � /)// ) Gh' &TY14 Area,of wetlands,on lot: 'square feet Percent coverage of lot: % Closest 4istance_between-nearest existing struoture-,and-upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: feet _ (�( -7b Does the project involve excavation or filling? leo Yes If yes, how much material will be excavated? cubic yards How much material will be filled? 50 cubic yards 'Depth of whichmateria]. will"be-removed�or deposited: � feet Proposed.slope-throughout the area_of operations: Manner in-which.material will be removed;orYdeposited: atz, Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason.of such:proposed operations (use attachments if appropriate): k o lar-e4 v h (3Iz�n6 6 Ad-Ll fader �� 's��e o Board, o€- t3mst;ees Appli.ca! " ` an COASTAL EROSION APPLICATION DATA ..Purposes iof:proposed,;actiuity: E_V'l)5 J 1 r -a 4-JAW/L '42 06�-L:C-�-f Are wetlands present within 100'feet of the-proposed-activity?' No Does the-project•"involve excavation or filling? No --- Yes- If Yes, how retch material will be excavated? .(eubac yards) How much material will be�filled? �� (cubic yards) Manner in whic'h,material will be removed or deposited: Describe the nature and extent of the environmental impacts to the subject property or neighboring properties reasonably anticipated resulting from implementation of the project as- proposed, sproposed, including erosion increase or adverse effects on natural protective features, (Use attachments it necessary) �k ak- 5 Y W�OlaA41'Q- 1-J �Y- w Sot O' au r-OA al r r Board of Trustees Application AFFIDAVIT BEING DULY SWORN DEPOSES AND FIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT,AGREES.TO HOLD THE TOWN OV SOUTHOLD-AND-THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES, INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO,ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL ' EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. ,Aff ature of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF �'� ,20 '_Notary PA' ANNETTE JACK, ON ivat�rj Public,state of New York Registration#O1JA6018470. Qualified in Kings Countl ? Certiticate Fled in w Count My Commission Expires Jan.11 ` I Board of Trustees Application AUTHORIZATION (Where the applicant is not the owner) II W e, C�l�l/(i�� 4-)t P 4, 164""'d VZ? fi( Gt owners of the property identified as SCTM# 1000- ! /3-/C Q/Z-07-01 in the town of New York,hereby /� authorizes Z)k-k C S-,Ll'1 c v d�2_ to act as my agent and handle all necessary work involved with the application process for permit(s) from the Southold Town Board of Trustees for this property. 4-reopertyOwner:"s Signature Property Owner's Signature SWORN TO BEFORE ME THIS '[ DAY OF ✓ v t`�` ' ' , 20 "'Notary Public -ANNEiTE JACKSON Notary Public,State of New York Registration#01JA6018470, Qualified in Kings County ! Certificate Fled in NY Counlpa ''� My Commission Expires Jan.11 ' 1 617.20 Appendix R Short Eitt)irotmteaztal Assesffi4t�nl:Form- for, Part 1 -Project Information, The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of'the application•f6rapproval or funding,are subject4o,public Teview,and+may,be subjecvw further verification, CompletePaff I',based on informatian currently available. 4f'additional reseafch-or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful -to the lead agency;attach additional pages asmecessary-to supplement any item. Part 1 -Project and Sponsor Information A1C CE S n _anY� Name of Action or Project: Pro S ea 4`11 Project Location(describe,and att ch a location map): 190D Br I' Lo v��UICC r Brief Description of Proposed Action; Pro 05f- /0C �,-�- 6'0 , Gly 50-1- cd /0/ax-J77 Name of Applicant or Sponsor: Telephone: l Gt /�-lr L�� AKIZ �holzi E-lbtaik: krs UY2SC �� Address 0b , &� W 9 City/P ': State: Zip Code: �� BQ 1.Does the prup sed action only involvdfthe legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? ?f Yes,aftach-a nartgfive description oftheantent of4he;proposed action and-the envircrr mer fial resources'that f may'.be,a'ffected rn:the inatnicip-ility.and,pToceed to-Part 2.'1'.f no,continue to question 2. 2., Does-the,proposed:action require a.permit,approval,or funding from any other governmental Agency? NO 'YES If Yes,fist agency(s)name and permit or approval: ❑ n uts cter. 3:a.Total acreage of the site of the proposed action? . acres b.Total acreage to be physically disturbed? acres c.Total acreage(project site and"any contiguous-properties)-owned- or controlled by the appkicant or project sponsor? acres 4. Check all land uses that occur on,adjoining and near the proposed action. E]Urban ❑Rural(non-agriculture) ❑Industrial ❑Commercial residential(suburban) ❑Pores(- CAgriculture ❑Aquatic ❑0ther_(spe6fy ❑Parkland Page 1 of 4 5. is the proposed action, NO- YES N6A a.A permitted use under the zoning regulations? F, b.Consistent with the adopted comprehensive plan? a �' 6. Is'the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? 7. is the site of the propo`sed`act:ion located in,or does it adjoin,a state listed Critical Environmental Area? NO YES 1f Yes,,identify: 8. a.Will the proposed action result in a substantial increase in'traffic above present levels? NO YES b.Are;public transportation service(s)available at or near the site-of the proposed action? c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? 9.Does the proposed action meet-or exceed the state energy code re4utirem.ents? 10 YES ]f the proposed action will exceed requirements,describe design features and technologies, 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: 1].Will tbe praposed action connect.cto existing wastewater utiJiries? NiO YES if No,describe method for providing wastewater treatment= p 12. a.Does the site contain,a structure that is listed on.either the State or.National Register of Historic N YES 'Places? b. Is the proposed action located in an archeological sensitive area? ET I 13.•a. Does any portion of the site of the proposed action,or lands adjoining-the proposed action,contain NO YE wetlands or other waterbodies regulated-by a federal,state or local agency? b.Would the proposed'action physically alter,or encroach'into,any existing wetland or waterbodyT if Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. I_d�ntify the typical habitat types that occur on,oi-are-likely to be found on the project site. Check all that apply: 0 Shoreline 0-Forest 0 Agricultural/grasslands '0 Early mid-successional ZI Wetland uurban Suburban 1`5.floes thesite ofthe proposed action coaitain any species of animal,or associated habitats,'listed NO ' YES by the State or Federal government as threatened or endangered?mot`l i G ow El na 16. Is the project site located in the 100 year flood plain? NO YE AS IVII czJ Y7. Witt the proposed action create storm water discharge,either from point or non-point sources? 1!V.el IVES If Yes, a.Will storm water discharges flow to adjacent properties? NO []YES b,Will storm,water discharges be directed to established conveyance systems(rui off and storm drains)? If Yes,briefly describe; NQ DYES Page 2 of 4 18.Doe's the proposed action include construction or other activities that,result in'the impoundment of NO YES water or other liquids(e.g.retention pond;waste lagoon,dam,)? If Yes,explain purpose and size:-_-,._,-,,,. 19. Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? 4f Yes,describe: 1 AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE REST OF MY KNOWLEDGE r Applicant/spon rame: 40vt4bOA—n1/ Date: `'� �_.. ...._..,_._.. ,�... Signature; Tart 2,-Impact Assessment. -The[Aad oaMpletiou OfTm t 2. Apswer alt of She; 1low•ing questions in?art 2 using the information contained inTart-1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering-the scale and context of,the,-proposed•action?" 'No,or Moderate small to large impact impact may may, occuV occur I. Will the proposed action create a material conflict with an adopted land use plan or zoning regulations? El 2. Will the proposed action result in a change in the use or intensity of use of land? 3. Will the proposed action impair the character or quality of the existing community? 1 D 4. 'Wild"the proposed aetion',have an`impact on the environmentdl dharacierisrics that causes!t1le J, establishment of a Critical Eaviroanmeaatal Area(C-EA)? S. , Will:the proposed,action,restilt-in,an,adverse.change.in the existing level-oftraffac.or,- D affect existing infrastructure for mass transit,biking or walkway? 6. Will-tbe.proposed action cause an pancrease in the use of energy and it fails to incorporate D' reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: a.public/private water supplies? b.public 1 private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of-important historic,archaeological, architectural or aesthetic resources? i---J 9. Will-the proposed-action res«lt in as adverse change to natUfal resources(e.g.,wetdands, waterbodies,groundwater,air quality,flora and fauna)? D Page 3 of 4 ...m..�.... ._...�_�.--.w..-.�.�,...,�.,..-. No,or Moderate smalf- to large impact impact `may rrray occur occur M. Witt the proposed action result in an increase in the potential for erosion,flooding or drainage 1'--t' problems? L-1 19, tJ iflithepraposed action createahazar&to envaroamentAsesourcesonhumanbealtb? L—j C3 Part 3-Determination of significance. The!Lead Agency is responsible for the completion of Part 3. For every •question=in-:Part 1.1hat-wasanswered`,,moderate;to targedropact.may occar',,or,if,there-is-a need to explain-why.aparticular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain-how.ihe'lead agency determined that the impact may or will not be significant. Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. Cbedk this box if you have determined,based on the information and analysis above,and any supporting documentation, Mat the proposed action may ;result in one or more;palentiaily Farge or significz`tnt adverse impacts and an environmental impact statement is required. Check this box ifyou have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental i pact . _ - l Town of Southold-Board of Trustees Name of Lead Agency Date _Michael J. Domin® President Print or Type!\lame of Responsible Officer in Lead:Agency T-R-re of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) 1 e 1 ff� t1 ` '�rtif`.r •�fY 1.' DKR Shores, Inc. Permit Expediting- P.O. Box 488 Environmental and Construction Hampton Bays,N.Y. 11946 Drafting/Design . 631-566-6o16 fax 574-8999 Native Landscape/Restoration dkrshorescor @aoLcom Rutgers Certified Wetlands Consulting& Delineation MWBE Certified Remediation Specialist .. File,ld,No.5'9366 Vendor Id No. 20345704 OOSR approved vendor under the Governors Office o%Storm Recovery Southampton Town License Ncx Lo04926&Insured April la,2G19- Ms. Diane DiSalvo /Board4Towa1 Truistees Town of Souflicild 54375 Route 25 P.O.Box 1179 Southold,N.Y. 11971 Re: Application for Coastal/Wetland Permit for Antoine VanHoren 122o Leeton Drive,Southold Dear Ms. DiSalfvo: As per the email(copy enclosed) on 4/3/19; attached please find Transactional Disclosure Form(s)si edb4y myself and-the applicant/owner. Please feel-€ree in contacting me should you require any additional material's. Rae RigdoiP aresidentt JD EC' E IC APR 12, 2019 Southold Town Board of Trustees APPLICANT/AGENT/REPRESENTATWE TRANSACTIONAL JDISCLOSURE FORM e o o S tho d's Code. I. tfr 'hits contlic#s o `nt o the&rt of kers and employees,11M of this farm t' videjnforrna ion which.can a ert the MM of ib aflirts ofinrest and allow it to take wh 2� ae''n is. ; e d's~atee. YOUR NAME: L (Last nam t name,iZriddte Itriti unless you are applying%n.the name of sottmeone else or.other emit)+such as.a company:If so,indican th6other parsoezor compar y±� name;). NAME OF APPLICATION- (Check all that apply.) 'fax grievance Building \� Variance Tiustee � °M �VygAk Change of Zone Coastal Erosion „ Approval oi',plat Mooring ytiYfrtn+.platu�roffrciatnap _ Planning ,Other *'"Other",`name the acvlty) I)o you pa otiany.,(or.thmagh your company,spouse,sibling,,parent,-or.child)have a r�jatianship with.gnny',officet'or employee 4fi Ute Tovurr of 5outhald'� "rtela#iansltip"includes by.blood,nlan i or usiness iutetest.�`Iiusiness rnttxest"means a business, ir�ct�irtg aatersl�ap.aaa wlti�eli Lta to orcmis)ray . 4en 3 otcrstup•af dor=e€r ? mnt'�,n aQrpdts'n in which the town officer or employee owlts•morethan °foo to shares. YES NO' If yow answered"'YE'S7,complew-ft balance of this and.date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person_ Describe the relationship-between yoursetf(the applicant%ent/representative)and the town officer or employee.Either check the appropriafc line A)througkD)•andlor describe in the space provided. ThetownotRcar,onerrooyeeorhis,or-tier�spouse,'-sibling,•parz4t *T:child'is(4h0ekallt a`t-"Wf A)the•owner of greater than 5`yo of the shares of the corporate stock ofthe applicorit (when-tbe applicard is a corporation); B)the legal or beneficial owner of any,interest in anon-corporate entity(when the .�,pfrtt•s��tot.�cor�oratl�rn?:. _C)-an o f deer,director,prtn aer,or.erripipp*of the applicant;'cant;or D)the actual applicant. r DESCRIPTION Or-RELATIONS141PJ Submitted this `1 day ofk\� 20 `\\ ,\��q lrNq Print Name Fnan% k MoAN 0\. -` .-No.O1NA6374429'•. Forth TS l ,QUALIFIED IN SUFFOLK COUNTY : COMM.EXP- 04-30-2022 0A-30.2022 r O pI IN APPLICANT/AGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE,FORM a The Town of SorithoWs Code of Ethics,prohibits conflicts of interest on the part of town officers and employees.The parnase of this form is to provide inforination which can alert the town of possible conflicts of interest and allow•it to takewhatever action is nece&sM to avoid same. �p E. lI-ID' t e l �d L��� . ��� 16 2 YOUR NAM . (Last name,first name,.rpiddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee- Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other I (If"Other',name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with-any,officer or employee of the Town of Southold? "Relationship"inciudes.by blood,rgan•iagc,or business interest."Business interest"'means a business, including a partnership,in which,the town officer or employee has even a partial ownership of(yr employment by)a corporation in which the town offish or employce'owns more•than 5%of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold, Title or position of that person Describe the relationship between yourself(the applicanttagentfrepresentative)and the town officer or employee.Either check, the appropriate line A)through D)and/or describe•imthe space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); __B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); CI an officer,director,partner,or employee of the applicant of j D)the actual applicant. DESCRIPTION OF RELATIONSHIP i ' Submitted this - ' 1 20 j Signature- 4- Print Form TS ] ',;r r. SARRARA A. cum YL/<J`- . r`�V �/l� yl{/�/i 4 ` Jtuf l:El�l0 L11-5, 5 Newt:'rfa ,. C.f.� EI" /� r3o: O Vcsl:U?5253 / g , O�Q/r�j '+�5 Q 3lii:ry? Ira �i'r'1 5e ii33?fir �.m lrOty / (r '1> �.).r,Ir�S / 1'• APPLICANUAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM awn ri S uth'o1d' Code,otic, rr�h`blts conflicts otam ereston the of-town'rifficers And em to .The a age o his fo i to rovi"a'n or' tion which can ate the town of ibt igLs of ftercct and ►ow it ke wh vertion is t2 r neosaai travail sante: �/ l r YOUR NAME: 12,4 4 d2/` Ac (Last nam ,first name,.Qtiiile Initful,unless you are applying iii the name of some=else or other,entity,such as a company.if so,in tate the other person's or company's name.)- NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone _ Coastal Erosion Approval of Plat- —_ Mooring ,,re stion. rhplat€T,6f#"aciai.map_, — "PlannIng — Other (if"Other,name the activity.) Do you personally,(or through your company,spouse,,sibting,parent,or child)have a relationship with#ny officer or-employee *f the Town of$outhold? "Relationship°#includes by blood,marriage,or business interest.==`Business interest"means a business, inctudizig vpartimprAip,in which ih�ir+avxr�a or.erl�ploy leas oven�partiul,osvite hid a�(gar einf+Irit�t lay)�i corprst* p In which the town of icer or employee owamore than 5%of the shares. YES NO If you answered"YES"r complete the balance-of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicantiagent/representative)and the town officer or employee.Either check the appropriate line A)through D)ondtor describe in the space provided. The town officer or_employee,or his or-her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than Ste of the shares of rite corporate stock of the appticl;int (when the appficant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the appi icanv is-not o.•corporation'f C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP tjD Dn nV V ------------- ,,n�pp,��,, 'n �alllllllllllll!! Submitted this day of 1�`�J1 � 20 A J`�\\\��`0 qNq�;��,,� Sig art D OA /71PApS Punt Name _ ;d0.01 NA6374429', '; i~oTTn 1S 1 = QUALIFIED IN SUFFOLK COUNTY COMM.EXP. �'•, 04-30=2022 VBL..... /����� 0F IN S44 ���� C3 m i2- C3 �HUC3 .1 WIN! JA- Cr fj t 14, 4 1T11P1LP"9TL111T!114 OE T"', �U 0) ru Certified PAaji Fee 1rU Certified Mail Fee $ • ,0931 $3.30 L-,n $ 05 $ 7' Extra i�Nices&Fees(Checkbox,add ft of ❑Return Recelpt(hardcopy) $(hirdw Ices Feeelcheckboxaddibe. Flat Receipt(hardcopy) te) 'to-1I ec $ O ❑Return Receipt(electronic) $ oq ark C3 EOI FIG Receipt 1:3 ❑Certified Mail Restricted Delivery $ 'Oq ark C3 (electronic) $ C3 []Adult Signature Required $ &if e%n C3 El Certified Mall Restncted Delivery $ P%Mark C3 OAdult Signature Required $ LIP ❑Adult Signature Restricted Delivery$ 0 0 Postage 0 ElAdult Signature Restricted Delivery$ , a C) C3 PostageO C= $1.A5 G) $ El—POSt1911,d F /07/2 FG, p2s .2) C3 C3 C3 Totat Postage and F's 0C./- $ 75 ?7-7-3 99119 $ ,a5T.�015 1 "3 Sen rEMS 4 -- --Street -- ---- --- -- ----- --- ------- r- --- - r rC3 ---------------- L ff'N- Lr) r3 7 A"N L2 ru Certified Mail[Fee 1-0 $ Lr) Extra Services&Fees(check box,add Iee ❑Return Receipt(hardcopy) $ IMP 10, Return Receipt(electronic) �-Oftstrnark C3 ❑Certified Mail Restricted Delivery Here r-3 []Adult Signature Required 0 cl%j E]Adult Signature Restricted Delivery$ C3Postage 51.4 N3 C3 Tota)Postage andSAO/2 Ws.7. ------ ---- CCO3 :!eis tan --- -- - -- ------ 511-- ----- ------ -------- ---------- 7W PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: ' C STATE OF NEW YORK COUNTY OF SUFFOLK residing at being duly sworn, deposes and says that on the day of , 2C , deponent mailed a-true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were.mailed at the United States Post Office at that said Notices were mailed to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. Sworn to before me this Day of , 20 ' r Notary Public r PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: STATE OF NEW YORK COUNTY OF SUFFOLK 1' residing at �J,���•�?c ,� bein duly sworn, deposes and says that on the Vfoin ay o s , 20 , deponent mailed a true copy of the Notice he Board of T tees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment o11 of the Town of Southold; that said Notices were mailed at the United States Post Office atthat said Notices were mailed to each of said persons by CERTIFIE MAIL, TURN RECEIPT. Sworn to before me this Day of 20-L c Wwry public,State of NewYWlt 01KE6316526 Notary Public oualified in Suffolk cwrV my canis rm E*M Dcmnbw 16.2 MAy 15 2019 A of 013 CU -DKR Shores, Inc. Permit Expediting- P.O. Box 488 Environmental and Construction Hampton Bays,N.Y. 11946 Drafting/Design 631 566-6016 fax 574-8999 Native Landscape/Restoration dkrshorescolp(@aol.com 'Rutgers'CertifiedWetlands Consulting& Delineation MWBE Certified-Remedidtibn Specialist File Id No. 59366 Vendor Id No. 20345704 GOSR approved vendor under the 'Gbvernors.Office of Sto_nnkeeovery Southampton Town License No. Lo04926&Insured May io,,2019, Mrs. Diane DiSalvo -Board.,of,.T�own.,Tzustees Town ofsaffthold PO Box 1179 Southold,NY 11971 -Re: Permit Application for'VanHoren 120o Leeton Drive,Town of Southold Dear Mrs. DiSalvo: Attached please find the Certified Mailing receipts fof the above referenced Project. Please note the project location has,been posted as well. Please feel free in contacting me with any additional questions. NUTILt: Ulm HI: AKING NOTICE IS HEREBY GIVEN that a Public Hearing will be held by the Southold Town Board of Trustees at the Town Hall, 53095 Main Road, Southold, New York, concerning this property. OWNER(S) OF RECORD: ANTOINE VAN HOREN SUBJECT OF PUBLIC HEARING : For a Wetland Permit and a Coastal Erosion Permit to install 100 linear feet stone/toe armor (1 -2 ton stone on infill rip-rap); 50 cubic yards clean sand; plant Cape American beach grass to disturbed areas; extend 5.66'x10' stair for beach access. Located: 1200 Leeton Drive, Southold. SCTM# 1000-59- 1 -1 TIME & DATE OF PUBLIC HEARING : Wednesday, May 15, 2019 — at or about 5 :30P. M . If you have an interest in this project, you are invited to view the Town file(s) which are available for inspection prior to the day of the hearing during normal business days between the hours of B a.m. and 4 p.m. BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (631) 765-1892 Town of Southold L,WRF CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS I., All applicants-fbr,Hermits* including Town-ofSouthold agencies,-shall complete•this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency-Review Law. This assessment is intended to supplement other information-used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits.not;docated within-the Coastal Erosion Lazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations-of each policy contained:`in the Town of Southold Local Waterfront Revitalization Program. A r_roposed action will be evaluated as, to its siva ficanr beneficial and adverse effects upon the coastal area L`whicSi includes all of Suutliald Town1: 3. If any quesffori in Section C on thin forrii=is,answered "yes" or"na", then=the-proposed action-will affect the achievement of the LWRP policy standards and conditions contained in the consistency .-r-eview law. -Thns-,eaeh.2avw Miustbot,- daM in d Ilstln su both ortingr.and uotr- - Rotiricts. if an action cannot,be-certified as consistent with the;LWRP policy standards and conditions, it shall not be.unAe-da en. A copy of the LWRP is available in the following places: online at the Town of Southold's website(southoldtown.northfork.net), the Board of Tiustees-Office, the-Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND-PROPOSEDACTION SCTM#, ori L ,� ��rr,�� PkO�CT iV � C ----T--�--- The-A.pplicatiowhas,�i�een,-sri iittedle;{check appropriate-response): 5- D1� TownBoard F-1 Planning Board F] Building Dept. 1-1 Board of Trustees 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital construction,planning activity, agency regulation,hand transaction) Q� (b) Financial assistance(e.g. grant, loan,subsidy) (c) Permit,approval,.`license,certification: Nature and xtent of actioV: r 10 0 Lr t0 C_ 1' �2 , S Location of action: °ZDo /-f Site acreage: Present land use: I Y r 'Present zoning-classification: 2. If an application for the proposed action has been filed with the Town of Southold agency, the following ,Jnformation.!shall,be provided: (a) Name of applicant: �!�-�DmP, &,dzo 4� L&� (b) Mailing address: � 12o awir, Aro DL) f j`l �U (c) Telephone number: Area Code( ) .-(d) Application number,if any- Will the'actionbe-directly undertaken,-require finding, state federal agency? r yes P No 'If yes, which°state sir fedcr tagency? C. Evaluate the project to the foll'awing°poYiei"es by analyzing laow the pf6jeet will`furth6r,91upport or not support-the policies. Provide all-proposed Best Management Practices that will furthek each policy. Incomplete answers-will require that the-form-lbe returned for completion. DEQ` tIPY,D..;CQA- T' PQI1 ." Policy 1. Poster a pattern of development in the Town of Southold that enhances community character, ;preserves open apace,makes effidient we of infrastructure,makes-beneficial use of a coastal location,,and minimizes adverse effects of development. See LW1tP Section III—Policies; Page 2 for evaluation criteria. a'l'es "[ Nom- D Nvt'Applicable Attach additional sheets if aecessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See Section U1—P6licles'Pages 3 through 6 for evaluation=m iteria 0 Yes 0 leo tAot Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Towyn of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria Yes Fj No Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIE& Policy 4. Minimize loss of life, structures, and natural resources from flooding,and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria f0 Yes a3 No LI Not Applicable s - -1-A -P cs ��± GZ r as 5 cv- Attach additional sheets if necessary Policy 5. Protect and improve water quality and-supply--in the Town oUSouthold. See LWU Section III —Policies.Pages 16 through 21 for evaluation criteria Yes of Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and: function of the Town of-Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands: See LWRP Section:HI-Policies;,-Pages 22-- through 32 for evaluation-criteria. E Yes leo pplicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Tages 32 through`344or evaluation criteria. 0 Yes Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substancesand wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. 0,Yaes '[],No,' -NApplicable PUBLIC COAST POLICIES Pon* 4. ]Provide for public access to, and recreationaf use of, coastafl waters, public land's, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation terla. 0 'Ye1:1 .No+,UNot Applicable Attach additional sheets if necessary Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locaific-ffis: See LWRP Section III--Policies;Pages-47 thrai�ghr 56-for evaluali6n criteria. Yes.,E] No; Not p icable Att&addifioiW sheets if necessary Policy 11. Promote sustainable use of living_ marine resources in Long Island S'ound, the Peconic Estuary and Town waters. See LWRP Section III-Policies; Pages 57 through 62 for evaluation criteria. El Yes No Not Applicable Attach additional sheets if necessary Policy 12. Protect agriculturat lands in,the Tow*of'Southold. See LWRR geeti'oi III —Policies; Pages 62 through 65 for evaluation criteria. O Yes 0 No of Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LVVRP Section III--Policies; Pages 65 through 68 for evaluation criteria. Yes No Not Applicable r PREPARED BY040. TITLE,PM5 MkIZ DATE j D.