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Appendix A - County Referral For
Appendix A – Suffolk County Planning Commission Guidebook
Suffolk County Planning Commission
Submission Cover Form For Planning and Zoning Referrals
Municipality: Town of Southold
Hamlet: Local Case Number:
District: Section: Block: Lot: Local Meeting Date: 9/8/2020
Application/Action Name: Public Hearing: Yes No
Type of Referral: SEQRA Action:
Referring Agency:
Draft EIS Positive Declaration
New EAF
Planning Board or Commission
Final EIS Negative Declaration
Expansion Lead Agency
Zoning Board of Appeals
Modification Draft Scope
Findings
Town Board/ Village Board of
Trustees
Brief description of application or proposed action: Change of Zone on Town Board’s own motion. Resolution 2020-500 is attached.
Type of Action Please check appropriate box below if action is located within the Suffolk County Pine Barrens Zone, within one
mile of a nuclear power plant or airport or within 500 feet of:
• A municipal boundary;
• The boundary of any existing or proposed county, state, or federal park or other recreation area;
• The right-of-way of any existing or proposed county or state road;
• An existing or proposed county drainage channel line;
• The Atlantic Ocean, Long Island Sound, any bay in Suffolk County or estuary of any of the foregoing bodies of water,
• The boundary of county, state, or federally owned land held or to be held for governmental use;
• The boundary of a farm located in an agricultural district.
Comprehensive Plan (Adoption or Amendment) Subdivision
Zoning Ordinance or Map (Adoption or Amendment) Use Variance
Code Amendment Area Variance
Official Map Special Use Permit/Exception/Conditional Use
Moratorium Site Plan
Note: The above represents a summary of the required actions subject to referral to the Suffolk County Planning Commission. The provisions of
GML and Laws of Suffolk County must be used to verify which actions are subject to referral and the related procedural requirements.
Additional Application Information
• Action Previously Referred to Suffolk County Planning Commission Yes No (If yes, Date )
• Adjacent Municipality Notified (see NYS GML 239 nn) Yes No N/A
• Located Within Long Island Pine Barrens Zone Yes No
• Workforce/Affordable Housing Yes No N/A
• Energy Efficiency Yes No N/A
• Zoning Board of Appeals Approval Yes No N/A
• Suffolk County Department of Health Approval/Comments Yes No N/A
• New York State Dept. of Environmental Conservation Approval/Comments Yes No N/A
• New York State/ Suffolk County Dept. of Public Works Approval/Comments Yes No N/A
• Suffolk County Sanitary Code Article 6, Groundwater Management Zone - I II III IV V VI VII VIII
Contact Information
Municipality Contact Name:
Department/Agency: Town Clerk’s Office Elizabeth Neville & Lynda Rudder
Phone Number: 631 765-1800
Email Address: Applicant: e.neville@town.southold.ny.us & Lynda.rudder@town.southold.ny.us
Contact Name: Applicant
Address: