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Home My WebLink AboutTR-3856Board Of $outhold Town Trustees SOUTHOLD, NEW YORK PERMIT NO .......... ~.6 .............. D ATE: ... J.~-~-Y'...Z ~,~....]-,.9. 9 o A, ut'horizatio. Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1893; and Chapter 404 of the Laws of the State of New York 1952; and the Southold Town Ordinance en- titled "REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;" and in accordance with the Resolution of The Board adopted at a meeting held on ..J'.~].~...~.~.r. ..... 19....9...0..., and in consideration of the sum of $ ............................. paid by of .......................................................................................... N. Y. and subject to the Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: Construct a bulkhead/retaining wall behind existing rock revetment and fence as submitted in application. The following stipulation must be adhered ~o: Revegetate betwee] t~e high water w~a~ ,~ow.w. at~r, mart~ a~ l' intervals,.. afl ~n accoraance Tne ae?a~Jea specmcat~ons as presenTea in the originating application. IN WITNESS WHEREOF, The said Board of Trustees Eere- by causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of said ,~is dat,e. TERMS and CONDITIONS The Permittee Carl E. Vail, Sr. residing at Wells Avenue, Southold, NY 11971 N.Y., as part of the consideration for the issuance of .the Permit does understand and prescribe to the fol- lowing: 1. That the said Board of Trustees and the Town of Southold are released from any and all damages, or rialtos for damages, of suits arising directly or indirectly as a result of any oper- ation performed pursuant to this permit, and the said Permittee will, at his or her own expense, defend any and ail such suits initiated by third patties, 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 /s valid for a period of 24 mos. which h 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 auth- orization 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 Iow 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 obstmcnon to free navigation, the said Permittee will be required, upon due notice, to remove or alter this work or project herein stated without expenses to the Town of Southold. 8. That the said Board will be notified by the Permittee or the completion of the work auth- orized. 9. That the Permittee will obtain all other permits and consents .that may be required sup- plemental to this permit which may be subject to revoke upon failure to obtain same. TRUSTEES John M. Bredemeyer, III, President Henry P. Smith, Vice President Albert J. Krupski, Jr. John L. Bednoski, Jr. John B. Tuthill Telephone (516) 765-1892 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SCOTT L. HARRIS Supervisor Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 July 30, 1990 Mr. Lawrence Tuthill -. Box 162 Greenport, NY 11944 Re: App. No. 3-4-90-70-4-9 Dear Mr. Tuthill: The following action was taken by the Board of Town Trustees during its regular meeting held on July 26, 1990 regarding the above matter: WHEREAS, Lawrence Tuthill IN BEHALF OF Carl E. VAil, Sr. applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold.~.~applicatio~.dated March 5, 1990 and, WHEREAS said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and, WHEREAS, a public hearing was held by the Town Trustees with respect to said application on July 26, 1990 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 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 Lawrence Tuthill IN BEHALF OF Carl E. Vail, Sr. BE AND HEREBY IS GRANTED PERMISSION UNDER THE WETLAND ORDINANCE TO: Construct a bulkhead behind existing rock revetment and fence as submitted in application. The following stipulation must be adhered to: Revegetate between the high water and low water marks at i foot intervals. This permit will expire two years from the date it is signed if work has not commenced by said date. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Two inspections are required and the Trustees are to be notified upon completion of said project. Please return to the Building Department for a determination on the need for any other permits which may be required for this project. Permit will be issued upon payment of the following fees for work to be done below Mean High Water Mark: No additonal fees Very truly yours, Jo~edemeyer, III President, Board of Trustees JMB:jb cc: Bldg. Dept. Conservation Advisory Council file Telephone (516) 765-1501 Town Hall. 53095 Main Road P.O. Box 1179 Southold, New York: 11971 To.' From: Dated: Re: SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL Southold Town Trustees Southold Town CAC April 24, 1990 Wetland Application Recommendations The following recommendations were made by the Southold Town Conservatio, n Advisory Council at its meeting held Monday, April 23, 1990: On a motion by John Holzapfel, seconded by Margaret Feeney, it was RESOLVED to recommend to the $outhold Town Trustees disapproval of Wetland Application No. 3-4-90-70-4-9 submitted by Larry Tuthill on behalf of Carl Vail to construct a bulkhead behind existing rock revetment and fence. The CAC recommends disapproval because no need is shown for the bulkhead. Wells Road, Southoid Vote of Council: Ayes: All Motion carried. On a motion by Stephen Angell, seconded by John Holzapfei, it was RESOLVED to recommend to the Southold Town Trustees approval of Wetland Application No. 4-1-90-115-10-6 submitted by James A. Maione¥ to put in a floating dock. 505 Bungalow Lane, Mattituck. Vote of Council: Ayes: All Motion carried. On a motion by John Holzapfel, seconded by Bruce Loucka, it was RESOLVED to recommend to the Southold Town Trustees disapproval of Wetland Application No. 3-7-90-113-4-1 submitted by Clifford Corr{ell for C & D Real~y to construct a single family dwelling on Mattituck Creek. The CAC recommends disapproval at this time because a better map needs to be submitted; the house was not staked; all wetlands were no identified on the map; and the Council has questions concerning the wells all ready in place and the location of the septic system. Cox Neck Road, Mattituck Vote of Council: Ayes: All Motion carried. TRUSTEES ,n M. Bredemeyer, III, President rtenry P. Smith, Vice President Albert J. Krupski, Jr. John L. Bednoski, Jr. John B. Tuthill Telephone (516) 765-1892 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SCOTT L. HARRIS Supervisor Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 June 15, 1990 TO: FROM: RE: Scott L. Harris, Supervisor John L. Bredemeyer, III, President ~ Carl E. Vail, Sr. wetland permit c~rono- logy to date Week of 7/13/87: Trustees inspect site on complaint of erosion and problems with drain pipes. 7/19/87: Application for a 91' concrete retaining wall with a 25' return is received from Carl E. Vail, Sr. 8/28/87: CAC. Trustees table application for joint inspection with 9/17/87:. Letter of Henry Smith, President, to Carl E. Vail "drain pipe must be removed". 9/21/87: CAC recommends disapproval of application. 9/25/87: Negative Declaration issued pursuant to SEQRA. 10/29/87: Public Hearing with Mr. Vail present. Permit issued with modification to stone revetment and plantings required. .~ 10/17/89: Inspection on site at the request of Mr. Vail. 10/29/89: Permit expires this date. No action on site to date. 11/6/89: Carl Vail submits plan of Rambo, Inc. for revetment retaining wall and requests approval of same. 11/17/89: Board reactivates permit, subject to Rambo, Inc. plan submitted (avoiding applicant refiling and permit costs). 12/27/89: Violation issued for construction not in accordance with approved plans. Bulkhead being built by Larry Tuthill is wooden structure. 1/25/90: work. Carl Vail submitted application to cover illegal 1/29/90: Application is returned by Board of Trustees along with filing fee. Applicant is instructed to construct in conformance with the permit he requested. 2/20/90: Inspection by Bay Constable reveals that the illegal bulkhead was removed and beach restored to prior state. 3/22/90 Larry Tuthill, as agent, submits new application for Carl Vail. 3/23/90: SEQRA. Application tabled pending coordination pursuant to 4/24/90: CAC again votes disapproval. 4/25/90: Trustees discuss application with Larry Tuthill and Mr. Vail. Issue Negative Declaration subject to removal of drain pipe onto beach and submission of licensed survey showing proposed structure and elevations. 5/29/90: Survey received. 5/31/90: Request of Supervisor for review of file. FutUre: 6/21/90: Anticipate scheduling of Public Hearing for 7/26/90. 7/26/90: Anticipate vote after Public Hearing. Omitted from chronology were letters sent to/from Vails and their neighbors concerning the drain pipe onto the beach. To date the application and file are notably complete ~d all Board actions follow in timely sequence with most all action happening at minimum legal intervals required for Board action. Mr. Vail has been afforded efficient and courteous Board action from three administrations, including the waiver of $150.00 fee for a reactivated application, the return of $150.00 filing fee not generally returned for a filed application, and a Board not inclined to pursue his violation for a monetary fine (as other environmental agencies do!) If we may be of further assistance, please do not hesitate to contact us. cc: Trustees File TRUSTEES John M. Bredemeyer, III, President Henry P. Smith, Vice President Albert J. Krupski, Jr. John L. Bednoski, Jr. John B. Tuthill Telephone (516) 765-1892 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SCOT'F L. HARRIS Supervisor Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 June 25, 1990 Mr. Larry Tuthill Box 162 Greenport, NY 11944 RE: Carl E. Vail, Sr. Application Dear Mr. Tuthill The Southold Town Trustees have scheduled a public hearing on the Carl E. Vail, Sr. proposed wooden retaining wall for Thursday, July 26, 1990. In order to facilitate favorable Board action on your pending application for Mr. Vail, we have waived the requirement for a permit for the removal of the drainpipe leading onto the beach. Should the pipe be removed in time for the Board's Tuesday, July 17, 1990 field surveys, kindly notify this office so that we may inspect the restored site. Very truly yours, John M. Bredemeyer, III President, Board of Trustees JMB:jb cc: Carl E. Vail, Sr. Trustees TRUSTEES John M. Bredemeyer, III, President Henry P. Smith, Vice President Albert J. Krupski, Jr. John L. Bednoski, Jr. John B. Tuthill Telephone (516) 765-1892 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SCOTT L. HARRIS Supervisor Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 June 20, 1990 Larry Tuthill 1215 Inlet Lane Greenport, NY 11944 RE: Carl E. Vail, Sr. Dear Mr. Tuthitl: Before the Board of Trustees can consider approving your pending ~pplication for Mr. Vail, we must receive a request in writing from Mr. Vail to withdraw his existing permit to construct a rock revetment on his property in Southold. Thank you for your cooperation in this matter. c~rely, '-~ t_ ~ John M. Bredemeyer, ~II President, Board of Trustees JMB: j mt cc: Carl Vail TRUSTEES John M. Bredemeyer, III, President Henry P. Smith, Vice President Albert J. Krupski, Jr. John L. Bednoski, Jr. John B. Tuthili Telephone (516) 765-1892 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD ScoTr L. HARRIS Supervisor Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 June 11, 1990 Mr. Carl E. Vail, Sr. Wells Avenue P.O. Box 177 $outhold, NY 11971 Dear Mr. Vail: I had the opportunity to speak with Mrs. Serrell the other --evening.(6/17/90) and she indicated in her response to my letter of J~ne 4, 1990, that her home no longer discharges into the pipe leading onto your beach. She indicated she does not own the property where the pipe is and has no objection to the Trustees requiring the pipe being removed. Sincerely, John M. Bredemeyer, III President, Board of Trustees JMB: jb cc: Trustees Mr. & Mrs. W. Serrell Larry Tuthill TRUSTEES John M. Bredemeyer, III, President Henry P. Smith, Vice President Albert J. Krupski, Jr. John L. Bednoski, Jr. John B. Tuthill Telephone (516) 765-1892 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SCOTt L. HARRIS Supervisor Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 June 4, 1990 Mr. & Mrs. W. Serrell 2835 Wells Avenue Southold, NY 11971 Dear Mr. & Mrs. Serrell: Your neighbors, the Carl E. Vail, Sr.'s, have applied to this Board for a wetlands permit to construct a retaining wall on their property. Although the structure applied for is relatively minor in scope, the Trustees have discovered a discharge pipe on your common property line, which drains driveways, roof and yard areas of your properties. It is Trustee policy to request removal of such pipes where they are in the active Construction zone for new projects. To help protect our Creek and help the Vails, we are asking you to cooperate with the Vails and make appropriate provisions for driveway and ~oof drainage into drywells so that this project may go forward. Not only does the discharge pipe promote pollution of the creek, but it may also promote some of the erosion in that area. Your prompt cooperative resolution of this matter with the Vails would be a good sign of Southold's interest in really cleaning up our surface waters. If our Board can be of any ~assistance to you please do not hesitate to call us. John M. Bredemeyer, III President, Board of Trustees JMB: jmt cc: Trustees Mr. Vail Mr. Tuthill TRUSTEES John M. Bredemeyer, III, President Henry P. Smith, Vice President Albert J. Krupski, Jr. John L. Bednoski, Jr. John B. Tuthill Telephone (516) 765-1892 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SCOTt L. HARRIS Supervisor Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 June 4, 1990 Mr. Carl E. Vail, Sr. P.O. Box 177 Wells Avenue Southold, NY 11971 Dear Mr. Vail: Enclosed please find a letter for your use in gaining neighbor cooperation on your proposed project. Presently your project is ready for an environmental assessment. Prompt resolution of the drain pipe would certainly improve the chances of favorable consideration by this Board. rely, John M. Bredemeyer, III President, Board of Trustees JMB: j mt TRUSTEES !ohn M. Bredemeyer, !II, President Henry P. Smith, Vice President Albert J. Kmpski, Jr. John L. Bednoski, Jr. John B. Tuthill Telephone (516) 765-1892 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SCOTT L. HARRIS Supervisor Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 ' Jan-uary 29, -1990 Mr. Carl E. Vail, Sr. Wells Avenue, P. O. Box 177 Southold, NY 11971 Dear Mr. Vail: At the January 25 meeting of the Southold Town Trustees, your new application to construct a bulkhead-like structure on your property in Southold was rejected, and the Board is hereby returning your application fee. Since the project you have commenced has a valid trustee permit, we are requesting that you complete construction to the terms and conditions of that permit. In the alternative, if you do not wish to continue permit construction according to plan, we would expect you to restore the beach to the condtion that existed prior to the issuance of the permit. In any case, the BOard would encourage you to cap or seal the drain pipe currently exiting your property onto the beach. If you have any questions with respect to this matter, please do not hesitate to call our office. Sincerely, John M. Bredemeyer, III President, Board of Trustees JMB :jb cc: Trustees Bay Constable CAC Larry Tuthill i ~ -~,~¥ 16) 765-1892 BOARD OF TOWN TI{USTEE~?~Vq TOWN OF SOUTHOLD Town Hall, 5309S Main Road P.O. Box 728 Southold, New York 11971 APPLICATION IS HEREBY MADE TO THE TOWN TRUSTEES, TOWN OF SOUTHOLD, SUFFOLK COUNTY, NEW YORK, FOR THE ISSUANCE OF A PERMIT PURSUANT TO THE LAWS, ORDINANCES AND REGULATIONS GOVERNING THE COASTAL AND INTERIOR WETLANDS, FLOOD PLAINS AND DRAINAGE AREAS OF SOUTHOLD TOWN, AND THE ISSUANCE OF PERMITS PURSUANT TO CHAPTER 32 OF THE CODE OF THE TOWN OF SOUTHOLD. APPLICANT' S NAME: MAILING ADDRESS: AGENT: TEL NO. AGENT ADDRESS: PERMIT REQUESTED TO: Y LOCATION OF PROPERTY FOR REQUESTED PERMIT: HAMLET: - / CREEK, BAY OR HARBOR FRONTING PROPERTY: SIZE OF PROPOSED WORK: LENGTH: WIDTH: ~" ~ 1.4.!'~-4 f2/87)--Text 12 PROJECT I.D. NUMBER 617.21 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART l--PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 3. PROJECT LOCATION: Municipality ~'~ Q~ County SEQR 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) 5. IS PROPOSED ACTION: -' [~New [] Expansion [] Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially ' ~ ~ acres Ultimately acres WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes If No, describe briefly No 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ~Residential [] !ndustrial [] Commercial Describe: [] Agriculture [] Park/Forest/Open space [] Other 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? Yes ¢[~No If yes, list agency(s) and permit/approvals .. 11. DOES ANY ASPECT OF THE ACTIOH HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ,.~ Yes [] No If yes, list agency name and permit/approval 12. AS A RESULT~OF. PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? Yes J;41 No \ I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Date: l If the action is in the Coastal Area, and you are ~ state agency, complete the ] Coastal Assessment Form before proceeding with this assessment OVER 1 .he review process and use the FULL A. ~D~ES ACTION ~CEED ANY TYPE I TH ~OLD IN 6 NYGRR, PART 6~T.127 If yes, coordin ~ ~es ~ No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYGRR, PART 6~7.67 If No, a negative declaration may be superseded by ~nother involved agency. , ~ Yes ~ No COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or'groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or dlsposal, potential for erosion, drainage or flooding problems? Exptain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation Or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not identified in C1.C57 Explain briefly. C7. Other impacts (inclUding changes in use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL iMPACTS? [] Yes [] No If Yes, explain briefly PART Ill--DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its fa) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adveCse impacts have been identified and adequately addressed. [] Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. [] Check this box if you 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 impacts AND provide on attachments as necessary, the reasons supporting this determination: Print or [ype Name or k~esponsible OJf~cer in Lead Agency T~tle or Responsible Officer S~gnalure o! Preparer fl! d~fferent Irorn responsible Olrlcer) Signature ol Responsible Officer m Lead Agency 2 ~pp. Page 2. YDS. TO BE EXCAVATED: YDS. TO BE FILLED: MANNER IN WHICH MATERIAL WILL BE REMOVED OR DEPOSITED: I 2 o ;7 WIDTH OF CANAL, CREEK OR BAY FRONTING PROPERTY: DEPTH AT LOW TIDE: DISTANCE TO NEAREST CHANNEL: AVER. RISE IN TIDE: DISTANCE PROJECT EXTENDS BEYOND SIMILAR PROJECTS IN AREA: AREA ZONING: L~Z- 'i IS P~OJECT FOR P~IVATE OR BUS. USE: INT~.N~.~ ~. O~ ~O~.~: f~&W, / DESCRIBE KNOWN PRIOR OPERATIONS CONDUCTED ON PREMISES: HAS ANY PRIOR LICENSE OR PERMIT BEEN ISSUED TO ERECT STRUCTURES, DREDGE, OR DEPOSIT FILL ON SAID PREMISES: ; ~ HAS ANY LICENSE OR PERMIT EVER BEEN REVOKED OR SUSPENDED BY A GOVERNMENTAL AGENCY: /~ DESCRIBE FULLY THE REHABILITATION OF PROPERTY: DESCRIBE PROPOSED CONDITION OF PROPERTY AFTER WORK IS COMPLETED. AN ADDITIONAL SURVEY OF PROPERTY SITE IF NECESSARY: INCLUDE ARE THERE ANY COVENANTS OR RESTRICTIONS IN YOUR DEED WHICH WOULD PROHIBIT THIS PROJECT: /W~ WRITTEN CONSENT OF OWNER IF NOT THE SAME AS APPLICANT: COUNTY OF SUFFOLK STATE OF NEW YORK ) BEING DULY SWORN DEPOSES AND SAYS THAT HE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS, AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS KNOWLEDGE AND BELIEF, AND THAT WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE TOWN BOARD OF THE TOWN OF SOUTHOLD. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING' UNDER OR BY VIRTUE OF SAID PERMIT, IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT OR REPRESENTATIVE, TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. C~ ~at~re of Applicant SWORN TO BEFORE ME THIS. EXAMINED BY APPROVED NOTARY PUBLIC DAY OF ~ , 19 f~ HELEN K. DE VOE NOTARY PUBUC. ~ of New Yod[ ~. 4707~78, Suffot~ County,~ ,~ T~m Expires ~&rch 30.19...i~ DISAPPROVED CONDITIONS (If any) SIGNATURE OF CHAIRMAN COMPUTATION OF FEES Approved 2/27/85 '/ ~u/K -/ 4 ..)OC/,¢' E ¥' ~ L/ I.:F O L k" TA >( 3 .m.,e[,