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Capozzi, James
Glenn Goldsmith, Presid o�QSOFFO(,YC � Town Hall Annex A.Nicholas Krupski,Vice President �y` ��� K 54375 Route 25 John M. Bredemeyer IIIy P.O.Box 1179 ZZ Michael J. Domino 1�_ Southold,NY 11971 Greg Williams � p� Telephone(631)765-1892 �Ol Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in field by: Patricia Moore, Esq. on behalf of JAMES & KATHIE CAPOZZI requesting a Pre-Submission Inspection to discuss a proposed pool and trees that will remain and trees to be removed. Located: 1525 Gull Pond Lane, Greenport. SCTM# 1000-35-4-12 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=4 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 ® [ CSC OMC FER 2021 S,C.i,M,N0. DISTRICT: 1000 5EC110N:35 BLOCK: 4 LOT(S)!12 Southold Town Board of Trustees � �•1Taral 'F1� , � 'PWS G toy 1h5, 6 ? `,00 \ R• B MAIN RD. MOM OTMILWSCM ® ' • ti, WNL 12'N� ,•� .�- � Ern "% Y MOOD r�B nNACL `1!P ,y R �n LOf 18 20W SLOT 4 Wr Or g dD$ i ,wdS OWWANN • INC WATER SUPPLr,Nmlc ORYNEUS AND CESSPOOL LOCATIONS 5TIOW ARE fRWr RECD QBSERYAROVS O •.rsAND OR DATA ODTAWW FROM OlNERB FLOOD MAP #36103CO176H t\ AREA.26,635.95 SO.FT. or 061 ACRES EUYARON OARM 5 UNAUMM&O AL IERADaV OR ADMTION TO RRS SURKY ISA WOLADOV OF SECDOV 7209 Or INE NEW YORK STATE EOUCARW LAW. COILS OF THIS SURKY DAY NOT BEARING THE LAND SIMKYOPS GBOSYD SEAL SMALL NOT Bf CM'LOCRED�i0 DE A YAW TRUE COPY. GUARANTEES W&CATED NERLOV SNALL MIN yON ONLY TO DIC PERSON FOR,WOW INC SURVEY IS PREPARED AND ON MS BEHALF ID E ME COMPANY.CDW%a V&VFAL AGENCY AND LENOMO M nlURO1' P 'F\ USRD MENEN AND TO ME AS9O/rES OF D2 LE1mM0 MSRMIIQY,GUARANTEES ARE poo TRANSPERAmS \ ME WITS OR O'YUISMVS 910NN HERC04 FNBY DIF PRpKRfT'ONES TO 7NC SRIUCIURES ARE FOR A VECffW PURPOSE ANO USE DIEREFORE RLEY ARE NOT INTENDED ID MONUMENT TIfO PRP°FRTY ONES OV TO LVIOE R/E LRECRON OF fENQS ADOIRONAL STRUCTURES OR AND OINER AMOKMINTS EASEMENTS AND1W smuRFACE SMUCNRES RECOROCO OR UNRECOYOED ARE NOT suARANRID umtss Furs ALLY EWOEUT ON THE PREUOT'S AT INC RNC OF SURKY \ SURVEY OF LOT 16 CERTIFIED TO JAMES CAPOZZI. NAP OFFORDHAM ACRES KATHIE CAPOZZI• RLMMAR. 7th, 1962 No 3519 CLASS ABSTRACT SERVICES INC: STEWART TITLE: SINATEO ATGREENPORT TOPM OF SOUTHOLD KBNN6YB_M IIOYCNUK LAND 9URVSYING,PLIC SUFFOLK COUNTY,NEW YORK A� Profamtond End 8uneylo[t cud DealLry /LyN Y.&usa f! P.O.Bo=1&7 Agoebosue,N—York 11891 [TI-119-117 scALE1"=30' DATE.AUG. 27, 2019 Na D.saw PRONG(mora-mea Ya(an roe-Lase GoNGECAAL LA 4v5cA VESIcit, D E C E � WE GAPOZZ I 15 .4U-N&btJe� I /. I FEB 4 2021 "GAL.-E.'y&-I'-d [ . E�K2r,sd-�#t47�M� Southold Town V'tL.aoav �.» Board of Trustees H7TI w. h kp4: � r. WWWRI IIt1Q1 _ .: IINE N 6 yon �yr. g1 '10 17.1 ry � l7.fA(c) TO a Nyt{d �i Ile, p ye 4 e 1 e 25 txakh �. ,Y� a ,y p • ty o- It '.'� is ,s. • t �a \!'t ., r .r A' A 1.tA w • �I YO ,yet lm ` `°p. A`iV'r,Q .I,\ �d 6,1P 0 u TOYYN17 Li 4AAW a cAjLL v �\sem zWU p tta row M Nc r B s / ''�. 1M10 •-III1 c.. ' ��vS-.-y��O'� NEi / m z p .OWN Of �e � '\ nAttEs�tFiN SOIRHOID � �\ 3-A a NOTICE CP°"'�r. COUNTYOFSUFFOLK © K °" T SOUTHOLD SELTIONNO -- _ Real Property Tax Service Agency v �a 035- � Ce�mty GnYr Ytltat NI LAW 0 F F I C Y-kA-T-R fCFA-C.-M-0-0-R--F7 51020 MAIN ROAD SOUTHOLD NY 11971 631.765.4330 D C E 0 VE - FED 4 2021 M, EMORAND U Boa FE —P PATRICIA C MOORE (BY--n C p7_ aoa - Mc- -COMMENT. S�- Ap J"'Jc- g r APPLICANT Y 'TRANSACTIONAL DISCLOSURE FORM (FOR SUBMISSION BY 0WNER-add-4WNER-9 AGENT) The Town of Southold=s Code of Ethics prohibits conflicts of interest on'the parr of Town officers and employees The purpose of this form is to provide'information, which c6b alert the T.oivn of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME:CAPOZZI, JAMES & KATHIE AND.-MOORE, PATRICIA C: ' (Last name, first name, middle initial, unless you are applying in the name of someone else or other entity, such as a company. If so, indicate the other person or company name.) NATURE OF APPLICATION: (Check all that apply.) Tax Grievance Variance Special Exception If AOther@, name the activity: Change of Zone Approval of Plat Exemption from Plat or Official Map Other Trustees X 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? ARelationship@ includes by blood, marriage, or business interest. ABusiness 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_X Complete the balance of this form and date and sign below where indicated: Name of person employed by the Town of Southold: Title or position of that person: i - Describe that relationship between yourself(the applicant) and the Town officer or employee. Either check the appropriate line A through D (below) and/or describe the relationship 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 a corporation); C) an officer, director, partner, or employee of the applicant; or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this y of ja2, 2oz-C:) Signature: James Capozzi at C ozzi I • Patricia C. Moore Board of Trustees Application _County of Suffolk State of New York JAMES CAPOZZI AND KATE= CAPOZZI BEING DULY SWORN DEPOSES AND AFFIRMS THAYHE/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 I OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREETROM 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. I James Capozzi I v�- K hie Capozzi Sworn to before me this �s day of March, 2020 ,Notary Public Christine L.LeSueur Notary Public,state of New York No.01 LE6260681 Qualified in Nassau County Commission Expires April 30,2020 Board of Trustees Application AUTHORI ZATI O14 (where the applicant is not the owner) JAMES CAPOZZI and KATHIE CAPOZZI, as owner of premises 1525 GULL POND LANE, GREENPORT NY (sctm: 1000-35-4-12) residing at 14 Meadow Lane, East Williston NY 11596 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) JAMES CAPOZZI L ' owners signature) ( II ) KATHIE CAPOZZI SWORN TO BEFORE ME THIS DAY OF MARCH,2020 Notary Public Christine L LeSueur Notary Public,State of New York No,01 LE6260681 Oualifled In Nassau County CoMmission Expires April 30,2020