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HomeMy WebLinkAboutTR-9584E GRAND AVENUE N 1 1'17'20"W 245.98' N58'00'20"W _ _ _ _ _ _ _ _ _ _ 13.74' — — — — — — , 2 740±' 125.00 a \ �� N20'45'2� � � � � — a ROOF OFR t^ CD N � a 4j,J sos � a 8° 23 0 / 1 X8'2 „w` g ELECT. 61.93, s 4 SEPTIC 0 S3 TANK 00 o' 44 w o S6. I/A TREATMENT 0 ol GEOMAT 42 ABANDON EXIST:---' / s SANITARY SYSTEM �".79 DISTRIBUTION ° POOL � NOV 1 8 L-19w ON G �% QC 87 03 k PROPERTY: DANIEL R . FALAS C 0 , P .E . , P . C . 1150 GRAND AVENUE, MATTITUCK SCTM NO.: 1000-107-8-44.1 CONSULTING ENGINEER 94 STEUBEN BLVD., NESCONSET, NY 11767 (516) 317-7209 DATE SCALE DRAWING N0. 11-10-19 1"=30' Michael J. Domino, President SU&jTown Hall Annex 54375 Route 25 John M. Bredemeyer III,Vice-President �� Ol0 P.O. Box 1179 Glenn Goldsmith lxt Southold, New York 11971 A. Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams '0 �� Fax(631) 765-6641 �yI1 hqUtM,Nc� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD EMERGENCY WETLANDS PERMIT Permit No.: 9584E Date of Receipt of Application: November 6, 2019 Applicant: David & Helen Leis SCTM#: 1000-107-8-44.1 Project Location: 1150 Grand Avenue, Mattituck Date of Issuance: November 18 2019 Date of Expiration: 90 Days from Date of Issuance Reviewed by: Board of Trustees Project Description: Removal and replacement of existing sanitary system with IAS system to be located landward of existing. Findings: The project meets the requirements for issuance of an Emergency Wetlands Permit as determined by the Board of Trustees. The issuance of an Emergency Wetlands Permit allows for the operations as indicated on the site plan prepared by Daniel R. Falasco, P.E., P.C. Special Conditions: A full Wetland Permit must be obtained within 90 days in order to conduct any further activity on the property. This is not a determination from any other agency. Michael J. Domino Board of Trustees s SOUTHOL ql� I r ti No. Issued To �� Woo Date Address JI� �•, 14AIRMICA THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION TOWN TRUSTEES OFFICE TOWN OF SOUTHOLD SOUTHOLD, N.Y. 11971 TEL.: 765-1892 svFFoc,� Michael J. Domino, President �Q ea _; Town Hall Annex John M. Bredemeyer III, Vice-President by y_1� 54375 Route 25 Glenn Goldsmith � x P O. Box 1179 A.Nicholas Krupski ^h Southold,NY 11971 Greg Williams y pl, Telephone(631)765-1892 ,t=�0� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time. Completed in field by: Jeffrey Patanjo on behalf of DAVID & HELEN LEIS requests an Emergency Permit to remove and replace existing sanitary system with a new system that is to be an I/A type and be placed landward of existing failing system. Located: 1150 Grand Avenue, Mattituck. SCTM# 1000-107-8-44.1 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 of 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: J. Bredemeyer M. Domino G. Goldsmith N. Krupski G. Williams Other Ixw riw 1' 6EE 6EC.NQ 100 SEE SEL.NO.tw Aw nx�p 15 IMTLn osn-w 1a A z� i H ---�—__ ___- __ — S — � wi - w n•I�w ` R 9 o-nm 3 x. 11 t0.t• � raRra xa g Ixo�m t.a � q ° ���mwr,a t00A40ee3 rN$ 61b0M1L onTawe'MrwGm9 2e tr nn[aa,vwrmrary IW Izawi 15y SOA ;i Y Io wa•w �. ax-zoos . xs osasal nu ���A1O1O� O ep, os osoe 16uu a q 1 1] ♦ x]A owsw xaa 7 iiwv 1 SA y\1 01 1610 ozatx r i JA ix t� p�' e.sn x.tA � ae,Fions:r �pl� •i i SI y� ) •\0 � SA I 6 \ >A • e.at.woe SM 8 f✓ 112K� I I � � rnntrx ♦ " I '.� xwa ,� �, ;Na � .fid '♦ ��' su. is S r>a1 tAi'T •1 �' •aµel ,(4 j I 1.3 IS SEE SEC q 1 c O � tuw saA / eu I � !\ • 1J y � Pq \01 � 151 tr �//y� ' 1A • L YAC[) 1M \ ei \a4 �p pL ,p e'er e O ��� O eerumrwv rrm. Y \ \7 <f(f.`- Sa (p 9 y E j iY/ecl � / � •gi I 1 �t�'S 9 ,'1 ° 4 y © • , ' ~�•o • Fon u W. I F00.PLl rq. - ♦ A6 SEE SEc.Iq. ," ♦ ' r 9 ..aw ° ± �'e`.\±' c' °'T f9: SS ,,xY ,:.awcl L( trr C i fe � C i` r WTpI -----LINE \, \e y ; 1^. IEOaI • A wT—C*i— NOTICE COUNTYSUFFOLK — 1111E _ ty a e�� ;^m� �� i+�' � �e+� �.sw«. _ we w. •e �t `" sEE SEc.wo.to 1211 S © E BOV11gLo UFFOLK 6ELTtcN MO r n4Y`r x November 13, 2019 NOV 1 8 2019 Town of Southold Trustees Town Hall Annex Building 54375 Rte. 25 _ P.O. Box 1179 Southold, New York 11971 RE: 1150 GRAND AVE. -MATTITUCK SUM No. 1000-107-8-44.1 EMERGENCY PERMIT APPLICATION-REVISIONS Dear Trustees: Attached please find 4 copies of revised plans per comments at the recent work session. Plans have been revised to relocate the geomat system in a more landward location as previously submitted. If you should have any questions or require anything further, please do not hesitate to call me at 631-484-9332. Very truly yours, )e;rey Patanjo P.O. Box 582 Bohemia, NY 11716 �F S�Ur Michael J.Domino,President Town Hall Annex f��� �J� l 54375 Route 25 John M.Bredemeyer III,Vice-President h O 1179 Glenn Goldsmith { l�t P.O.Box t� Southold,New York 11971 A.Nicholas Krupski O�Y Telephone(631) 765-1892 GregWilliams L��-�COJ , � 4y5 Fax(631) 765-6641 Z77 I BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD r / This Section For Office Use OnlyJ� ( ; �_-=��� f� Coastal erosion Permit Application i Wetland Permit Application NOV _ 6 2018 E Administrative Permit Amendment/Transfer/Extension Received Applications. [1168/! e.ar S Received Fee: $ _Completed Application: ol 6 [ Incomplete: SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent): LWRP Consistency Assessment Form Sent: CAC Referral Sent: Date of Inspection: Receipt of CAC Report: Technical Review: Public Hearing Held: Resolution: Owner(s)Legal Name of Property (as shown on Deed): y av►dl. > d at^ Lett's Mailing Address: -1 &0 W . E ^& A v c '- 15-A AJ e w Phone Number: Suffolk County Tax Map Number: 1000 - I °? ' X_ yy. Property Location: !! o C�f ,q••c,•,,tom _ n/L a�.� tv�tL SCG �G4'�[•/� /✓ik� (If necessary, provide LILCO Pole#, distance/too cross streets, and location) AGENT(If applicable): --5e (f(� ! 4L 4 -4 , Mailing Address: P. ( '� S�1 13, 11 -71 G Phone Number: y Py• 9�3�— --ard of Trustees Applicatio- GENERAL DATA Land Area(in square feet): `��►. 7 Z_ Area Zoning: Previous use of property: mss' Intended use of property: IZfi15 Covenants and Restrictions on property? Yes No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? Yes ✓ No If"Yes", be advised this application will be reviewed by the Building Dept. prior 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 ✓ No 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 ✓ No Does the structure (s) on property have a valid Certificate of Occupancy? ✓ Yes No Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? ✓ No Yes If yes, provide explanation: Project Description (use attachments if necessary): �L 114 "fM/!e- Q., 4C_ P11,ce- X L<.��P4•ti•cd? �F �[57iny ,oard of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Zovy.oma a a r 64 ce c s t,n S ArtL-Ce,,r� S L _ 0•) a m'C LG,vrL r;aH -C lQC- eeJ I1teadZ C4RJv,,.cd a4- Area of wetlands on lot: square feet Percent coverage of lot: ..., % Closest distance between nearest existing structure and upland edge of wetlands: r 1O feet Closest distance between nearest proposed structure and upland edge of wetlands:I pp feet Does the project involve excavation or filling? `- No yes r If yes, how much material will be excavated? N t cubic yards How much material will be filled? ti 4 cubic yards Depth of which material will be removed or deposited: Nle feet Proposed slope throughout the area of operations: 0- � Manner in which material will be removed or deposited: N(!q 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):Ked-fel 0"4 lou{ Ir(4k S•1 t-Fcn-. Board of Trustees Applicati__ AFFIDAVIT `7«v'•¢ �c `"� L tr S 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 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. 4Si :of:Pr:op7erty Owner Signature of Property Owner SWORN TO BEFORE ME THIS U DAY OF �Ct be ,20 /9 ~ Notary Public H E, ERRERA c-State of New York 01ER6130990 in Queens county on Expires Jul 25.2021 Board of Trustees Application AFFIDAVIT L el S BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS)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 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. Signat� a of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS` DAY OF s� 20 I Notary Public E LEN ERRERA c-State of New YorkOlER6130990 in Queens County on Expires Jul 25.2021 bard of Trustees Applieatior AUTHORIZATION (Where the applicant is not the owner) I/We, *%,t4 rT- Lers owners of the property identified as SCTM# 1000- )017 - 4 - ` q. I in the town of -���a*l_ New York,hereby authorizes y 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, Pro a Owner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS DAY OF A 770 be?"- , 20 19 Notary Public HELEN ERRERA Notary Public-State of New York N0.01ER6130990 Qualified in Queens County Poly Commission Expires Jul 25,2021 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics tnohibits conflicts of interest on the Hart of town officers and entip gyms.The Qrtrposc of this form is to provide information which can alert the town of possible conflicts of Itimmst and allow it to takewwhatever action is necessary to avoid same. YOUR NAME: 1 t(S, Y^ (Last name,first name,siniddle 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 (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"includes by blood,marriage,or business interest"Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO / J 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(die applicantlagent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or 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 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); Bj the legal orbeneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation), C)an officer,director,partner,or employee of the applicant;or D}the actual applicant. DESCRIPTION OF RELATIONSHIP 14. or Submitted th' _ -- - 20 Signature Print Name %D Uel ks Form TS I A,PPLICANTIAGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM e t nwn n7-.nninitlg s`ode of Ethics prohibits2onflicts of interes(on the part oftown offiots and emovees The nurnosc 2f this 's to proyidA inf ld n i can alert the town of posiWe corifficts ofirmS and all w it to mm whaivericile s n1cessary to avoid same. YOUR NAME: 1 t r$. (Last name,first name,.rpiddie 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 of official map Planning Other (lf"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? "Relationsitip"includes by blood,marriage,or business ihteresL"Business interest'means a business, including a partnership,in which the town officer or employee t,-is even a partiol ownership of(or employment by)a corparation in which the town officcr or employee 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 appliclttt/agent/representative)and the town officer or employee.Either check the appropriate tine A)through D)andfor 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 5%of the shares of the corporate stock of the applicant (whets 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); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted thi 20 Signature Print Name �D"�a? Form TS 1 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Tout of Southold's Com of Ethics prohibits conflicts of interest on the part of sown officers and em to yces ie urMLe of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary t-Q avoid same. YOUR NAME: L t►S , sj�h (Last name,first name,ipiddle 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 _mm Other (If"Other,name the activity.) Do you personally(or through your company,spouse,sibling;parent,or child)have a relationship with any officcr or employee of the Town of Southold? "Relationship"includes by blood,ntarriape,or business interest.'Business interesi'means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owm more than 5 of the ares. 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 y Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or 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 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); E3)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is nota corporation); C}an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of ac-4,C, 241 Signature Print Name Form TS I APPLICANUAGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town wm of Southold's Code of Edt cs Prohibits conflicts of interest on the of town officers and employees.The ntttppse of this form is to amvide information which can alert the town of Mssiblc conflict-a of interest and allow it to take whatever action is accessary to avoid same. ..-r- YOUR NAME: ! �'� n�o ..► ��f�-i 5 (Last name,first name,t{»ddle initial, ,less 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 (If"Other',name the activity.) Do you personally(or through your company,spou%c,sibling,patent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriace,or business interest-"Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or empio}nent by)a corporation in which the town officer or employee owns more than 51',.of the ares. 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 applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or 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 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 it corporation); C)an officer,director,partner"or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this 2 dam l-4 20 14 Signature _ Print Name 5r,,iFi h -, _ Form TS I — APk'LICANTIAGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM L£1 — The'Town of CnutholJ's CMtP of Ethics tnuh' 't.conflict of interest ;;^yet of town oflicrrs artd e:mle nloc; to to � s s•R this form isia� liL°rntntion which car+.alert the toren of r+ossi 1 confhc4c of iulerest an allow it to Iahe NvIlatevec actkn� nl'1_ to_3 nrd S`t�l_C' YOUR NAME: _ �� t `t o• `J !'t (Last name,Srat� name,ll►iddle initial, .less 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 (If"Other',name the activity.) -- Do you personalty(or through your company,slxiuse,sibling,parent,or child)have a relationship with any officer or emptm•ee of the Town of St wthotd? "Relationship"include by blood,niarriagc,or business iotcrest."Business interest'by)a c a business, including a partnership,in which the town officer or employee has even a partial onnership of(or cntplo)ment by)a corporation in which the town officer or employee owns more than i"„of the s ares. 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 appficanVagcnt/represenlative)and the town officer or employee.Either check the appropriate tine A)through D)and/or 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 516 of the shares of the corporate stock of the applicant (when the applicant is a corporation); �t3)the legal or beneficial owner of any interest in a non-corporate entity(when the -- applicant is not is corporation); _C)an officer.director,partner.or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this 2`� -dav ofSej!420 114 Signature - - Print Name �{Fr Form TS 1 October 30, 2019 Town of Southold Trustees Town Hall Annex Building 54375 Rte. 25 P.O. Box 1179 Southold, New York 11971 PFE C E E RE: 1150 GRAND AVE. -MATTITUCK NQV — 6 2��9 SUM No. 1000-107-8-44.1 EMERGENCY PERMIT APPLICATION southoid Town Tr to Dear Trustees: Boat, of We hereby submit one (1) original and three (3) copies of the proposed project plans, applications and check for above referenced project approval. By way of this application we hereby request and emergency administrative permit to replace the existing failing block cesspool with a new I/A style system. The new system to be placed further landward of existing and be in conformance with the SCDHS standards for both installation as well as discharge rates. If you should have any questions or require anything further, please do not hesitate to call me at 631-484-9332. Very truly yours, / , A, Jeffrey Patanjo P.O. Box 582 Bohemia, NY 11716 Cantrell, Elizabeth From: Cantrell, Elizabeth Sent: Wednesday, September 25, 2019 10:15 AM To: 'Jeffrey Patanjo' Subject: RE. 1150 Grand Ave - Mattituck Emergency Permit Application Jeff, Mike Domino reviewed your attachments and determined that photographs of the failing/collapsed sanitary needs to be submitted (as with any emergency permit application), but otherwise your packet is appropriate enough for this emergency permit request. The fee is$50.00 for an emergency permit application. Please remember to have both Mr. & Mrs. Leis complete the authorization forms. Elizabeth From:Jeffrey Patanjo <jjpatanjo@gmail.com> Sent:Wednesday,September 25, 2019 8:28 AM To:Cantrell, Elizabeth <elizabethc@town.southold.ny.us> Subject: RE: 1150 Grand Ave- Mattituck Emergency Permit Application Thank you. Jeffrey Patanjo P.O. Box 582 Bohemia, NY 11716 C: 631-484-9332 From: Cantrell, Elizabeth Sent:Wednesday,September 25, 2019 8:23 AM To: 'Jeffrey Patanjo' Subject: RE: 1150 Grand Ave- Mattituck Emergency Permit Application Hi Jeff, I expect to see Mike today. I will show him your plans/application and get back to you with any concerns. Elizabeth From:Jeffrey Patanjo<jjpatanjo@�mail.com> Sent:Tuesday, September 24, 2019 10:03 PM To: Cantrell, Elizabeth <elizabethc@town.southold.nv.us> Subject: 1150 Grand Ave - Mattituck Emergency Permit Application Elizabeth, Attached are the documents I have for the emergency sanitary system failure application we were discussing at the work session.Can you take a quick look and let me know what else I need and what the check amount would be so I can send to client and have him sign everything. i Thanks a bunch, Jeff Jeffrey Patanjo P.O. Box 582 Bohemia, NY 11716 631-484-9332 JJPatanjo@gmail.com ATTENTION: This email came from an external source. 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