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Home My WebLink AboutTR-480 TOWN OF SOUTHOLD BOARD OF SO'0THOLD TOWN TRUSTEES $OU~HOLD, NEW YORK WETLANDS PERMIT This Wetlands Permit No ..... ~.8..0. .......... has been granted by the Town Trustees according to information furnished in Application No..6.~.?. ......... · ..... filed by Applicant ~To~hn T. Wetze] on July. 21, 88 ..................................................................... 19 .......... A map of the proposed work will be kept on file in the Trustee OFf]ce under the application number given. Permit granted to do the followingwork To constrtzct a 3' x 12' float ---;~- ..... ................................................. w~zi tWO Olllrl[s Location of property on which work to be done ....4..6..3..5.~..P..e..g,p,.s,~.b...~..v..~.,.,...G.~;};b.o.g=e ...................... Creek, Bay or Harbor fronting property Eugene's Crecy Size of work: Length ..... 12' ' Width 3' Height Above High Water Depth Below Low Water Yards to be Excavated Yards to be Filled Manner in which material is to be removed or deposited Intended use of property Residential Conditions if any ................. i ................................................................................................................... Expiration Date Two years from the date the permit i~ si ned Number of Inspections Required 2-Trustees are to be notified when the work is co_replete. Inspection Fees $10. O0 · Liability Policies in the Amount of .................................................. ~. ~.~.~.~. ~.~.~ ............................... The validity of this permit is or mav be subject to the approval of other governmenta~ or municipal authorities. The Town accepts no responsibility in applying for or obtaining such approval. In the 'event that such approval is necessary, the holder of this permit shall not commence operations here- under until such approval has been obtained in writing. The failure to obtain such other approval when required shalI subject this permit to ~mmediate revocation by the Trustees upon receipt by the disapproval.Trustees' of written notice from such other governmental, or municipal authorities of its refusal or TOW, N OF SOUTHOLD BOARD OF $O:'0THOLD TOWN TRUSTEES SOUTHOLD, NEW YORK WETLANDS PERMIT This Wetlands Permit No ..... ~,8.,0. .......... has been granted by the Town Trustees according to 627 ' '" d John T. Wetzel information furnished in Application No...; ................. TUe by Applicant ............................................ ........................................ on ..J...u.l.y....2..1..,. ............. 19...8..8. .... A map of the proposed work will be kept on file in the Trustee Office under the application number given. Permit granted to do the following work To construct a 3' x 12' float with two p. ilin~;s, Location of property on which work to be done ...J.6..3..5.~.~.e..~;.a,~.b...~.y..~.,.,...G.~t~;~.g~¢ ................. . ..... Creek, Bay or. Har.bor fronting property ...,~.,u..g.e..z)..e.'..s...,C.~.e..e...1F. ........................................ . ........................ Size of work: Length ............................................................................................................................. Width ..................................................... ~, ....................................................................... Height Above High Water ............................................................................................. Depth Below Low Water ................................................................................................. Yards to be Excavated ..................................................................................................... Yards to be Filled ......................................................................................................... Manner in which material is to be removed or deposited ......................................................................... Intended use of property Residential Conditions if any ..................................................................................................................................... Expiration Date ~.''w~.~¥''e~?..s~'~.~.m~t.'b~e'~'d~.~.t'~e.~.t~.~.~e~.~..e.~.~.~.~:~ ....................................... Number of Inspections Required ~.g.7~??.`.u.~s~.t.e.~e'.s.~.~..¥.e~.t..~...b~e'~.z3~''t~~.~9.¥.~~te~ Inspection Fees ....$..1..0.:..0..0. ...................................................................................................................... - Liability Policies in the Amount of ......................................................................................................... The validity of this permit is or may be subject to the approval of other governmental or municipal authorities. The Town accepts no responsibility in applying for or obtaining such approval. In the · event that such approval is necessary, the holder of this permit shall not commence operations here- under until such approval has been obtained in writing. The failure to obtain such other approval when required shall subject this permit to immediate revocation by the Trustees upon receipt by the Trustees- of written notice from such other governmental or municipal authorities of its refusal or disapproval. FRANK A..KUJAWSKI, JR., President ALBERT J. KRUPSKI, JR., Vice-President JOHN M. BREDEMEYER, III JOHN L. BEDNOSKI, JR. HENRY P. SMITH TELEPHONE (516) 765-1892 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 728 Southotd, New York 11971 March 9, 1989 John T. Wetzel 4635 Pequash Ave. Cutchogue, N.Y. 11935 Re: Amendment of permit No. 3671 Dear Mr. Wetzel: The following action was taken by the Board of Town Trustees during their regular meeting held on February 28, 1989 regarding your request to amend the above permit. RESOLVED that the Town Trustees Approve the request of John T. Wetzel to amend permit number 3671 to reflect construction of 3~ x 16' catwalk, eliminate 3' x 12' float, install 4 pilings to secure catwalk. This letter is to notify you that we will amend permit on payment of fees for work to be done and the amended permit shall take effect as soon as payment is received. Ail other terms and conditions in the original permit granted shall remain. Fees due: $ 36.00 ~ Catwalk, (portion below MHWM) 100.0D 4 pilings to support 10._O0~. Inspection fee /~ / ~Total fees due Mooring anchor installation will require a mooring application, enclosed, and a fee of $25.00. Very truly yours., Frank A. Kujawski, Jr., President Board of-Trustees THIS PERMIT IS CONDITL D AGAINST THE USE OF TBZ OTHER ORGANO-TIN BOTTOM PAII~£S E~XCEPT WHERE EX~KESSLY PERMITTED IN WRITING BY THE TOWN TRUSTEES. Board OfSouthold Town Trustees ~~ SOUTHOLD, NEW YORK Pursuant fo 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 Soufhold 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 .....5...u...1.y......2...1..~.... 19...8...8..., and in consideration of the sum of $...1...0...1..:..0...0....L ....... paid by John T. Wetzel of ....C....u...t..c....h.p..g..u...e.. .......................................................... N. Y. and subject to the Terms and Conditions I~sted on the reverse side hereof, · of Southold Town Trustees authorizes and permits the following: Construction of a 3' x 12' float with two pilings. all in accordance with the detailed specifications as presented in the originating application. IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporate Seal to be affixed, and these presents to be subscribed by'a majority of said Board as of this date. ' Please tear off and return to the Trustee Office. TELEPitONE (516) 765-1801 Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL To: Southold Town Trustees From: Southold Town CAC Dated: May 20, 1988 The CAC made the following recommendations at their regular meeting held May 12, 1988: No. 622 - Dr. Edouard P. Beaugard - Recom'~nend approval. No. 623 - Sanford Hanauer - Recommend approval. No. 624 Gus Mueiler - Recommend approval. No. 625 - Clifford Eginton - Tabled No. 626 - Goldsmith's Boat Shop - Recommend approval. No. 627 - Joan and John T. Wetzel - Recommend disapproval. There is not enough space to allow for each homeowner to have a dock. Suggest the neighbors get together and build one dock and share it. If you have any questions, please do not hesitate to contact me. / Linda J. Cooper Frank A. Kujawski, Jr., Pres. HENRY P. SMITH JOHN M. BREDEMEYER, III John Bednoski, Jr. ALBERT KRUPSKI, JR., Vice-President TELEPHONE (516) 765-1892 BOARD OF TOWN TRUSTEES TOWN OF $OUTHOLD Town Hall. 53095 Main Road P.O. Box 728 Southold, New York 11971 April 27, 1988 Mr. & Mrs. John T. Wetzel 373 Plymouth Street West Hempstead, New York 11552 Re: Application No. 627 Dear Mr. & Mrs. Wetzel: The following action was taken by the Board of Town Trustees during their regular meeting held on April 21, 1988 regarding the above matter. RESOLVED that the Southold Town Trustees TABLE the application of Joan and John Wetzel pending receipt of a map in scale showing the neighboring structures. The property will have to be staked for further inspection by the Board. ~ery truly yours, Frank A. Kuj~wski, Jr., Pres. Board of Towh Trustees FAK:ip cc: Bldg. Dept. D.E.C., Stony Brook file BOARD OF TOWN TRUSTEES TO;~ OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 728 Southold, New York 11971 TELEPHONE (516) 765'1892 APPLICATION IS HEREBY MADE TO THE TOWN TRUSTEES' OF THE TOWN OF SOIJTHOLD, SIJFFOLK COUNTY, NEW YO'RK FOR THE ISSIJANCE OF A PERMIT PURSUANT TO THE LAWS , ORDINANCES AND REGIJLATI ONS GOVERNING TH1=' COASTAL AND INTERIOR WETLANDS, FLOOD PLAINS AND DRAINAGE AREAS OF THE TOWN OF SOUTHOLD, AND THE ISSUANCE OF PERMI TS PURSUANT TO CHAPTER 32 OF THE CODES OF THE TOWN OF SOUTHOLD. APPLICAT'ON NO. ~'~.__-~___ DATE OF ^PPL'CATION____iLiSi gZ' IDENT,TY OF APPLICANT ~O..~f0 ~ JOi~ ~ ~r}~ '~ ' ~ --!/4T~. PHONE N AGENT PHONE N~ LOCATION OF PROPERTY FOR WHICH. PERMIT WANTED HOME ADDRESS OF PERMIT APPLICANT IF DIFFERENT FROM AFORESAID LOCATIOr CREEK, BAY OR HARBOR SIZE OF P'ROPOSED WORK LENGTH ~ tie [ GHT ABOVE H I Gh WATER 14.161;2 (2/87)-- 7c 617.21 Appendix A SE! State Environmental Quality Review FULL ENVIRONMENTAL ASSESSMENT FORM Purpose: The full lEAF is designed to help applicants and agencies determine, in an orderly manner, whether a projE or action may be significant. The question of whether an action may be significant is not always easy to answer. Freque~ ]y, there are aspects of a project that are subjective or unmeasureable. It is also understood that those who determi significance may have little or no formal knowledge of the environment or may be technically expert in environment analysis. In addition, many who have knowledge in one particular area may not be aware of the broader concerns affecti~ the question of significance. - The full EAF is intended to provide a method whereby applicants and agencies can be assured that the determinatic process has been orderly, comprehensive in nature, yet flexible to allow introduction of information to fit a project or actio Full EAF Components: The full EAF is comprised of three parts: Part 1: Provides objective data and information about a given project and its site. By identifying basic proje( data, it assists a reviewer in the analysis that takes place in Parts 2 and 3. Part 2: Focuses on identifvin§ the range of possible impacts that may occur from a proiect or action. It provide guidance as to whether an impact is likely to be considered small to moderate or whether it is a potentiall,~ large impact. The form also identifies whether an ~mpact can be mitigated or reduced. Part 3: If any impact in Part 2 is identified as potentially-large, then Part 3 is' used to evaluate whether or not th( impact is actually important. DETERMINATION OFSIGNIFiCANCE_Typel Identify the P°rti°ns of EAF completed for this project: __ ,~~ Par and ~1~,~ Acti°ns information, and considering both the magitude and importance of each impact, it Js reasonaoly determined by the 'ead~ that: if appropriate), and any other supporting ,,~ A. The proiect wiI[ not result in any large and important impact(s) and, therefore, - ~ have a significant mpact on the environment, therefore a negative declaration is one which will not will be prepared. [] B. Although the project could have a significant effect on the environment, there will not be a significant effect for this Unlisted Action because the mitigation measures described in PART 3 have been required, therefore a CONDITIONED negative declaration will be prepared.* [] C. The prolect may result in one or more large and Important impacts that may have a significant impact on the environment, therefore a positive declaration will be prepared. * A Conditioned Negative Declaration is only valid for Unlisted Actions Na of Action Name of Lead Agencv P/nt/or Type Name of ~esZo~sib~e Of~ . -- Date 5. 'Approximate percentage of p,oposed proiect site with slopes: ~0-10% ~/ % [-110-15% "' 1~15% or greater % 6. Is project substantially contiguous to, or c~o~tain a building, site, or district, listed on the State or the Natior~a Registers of Historic Places? []Yes ~No 7 Is project substantially contiguous to a site listed on the Register of National Natural Landmarks? t-tYes [~N~ 8. What is the depth of the water table? ~ (in feet) 9. Is site located over a primary, principal, or sole source aquifer? I--lYes 10. Do hunting, fishing or shell fishing opportunities presently exist in the project area? ~Yes F-INo 11. Does project site contain any species of plant or animal life that is identified as threatened or endangered i-lYes [~o According to Identify each species 12. Are there any unique or unusual land forms on the project site? (i.e., cliffs, dunes, other geological formations I-lYes [~No Describe 13. Is the project site_~resently used by the community or neighborhood as an open space or recreation area~ r--iYes ~No If yes, explain 14. Does the present~.te include scenic views known to be important to the community? [2lYes 4,ZNo 15. Streams within or contiguous to project area: a. Name of Stream and name of River to which it is tributary 16. Lakes. ponds, wetland areas within or contiguous to project area: a. Name b. Size (In acres) 17. Is the site served by~xisting public utilities? I-lYes ~No a) If Yes, does sufficient capacity exist to allow connection? I~Yes []No b) f Yes, will imorovements be necessary to allow connection? l--Yes ~No 18 Is the site located in an agricultural district certified pursuant to Agriculture and Markets Law, Article 25-AA Section 303 and 304? ~Yes [~No 19 Is the site located in or substantially contiguous to a Critical Environmental Area designated pursuant to Article 8 of the ECL, and 6 NYCRR 6177 [~es ~No 20. Has the'site ever been used for the disposal of solid or hazardous wastes? ~Yes [2~q~' Project Description Physical dimensions and scale of project (fill in dimensions as appropriate) a. Total contiguous acreage owned or controlled by project sponsor . b. Project acrea~4e to be developed: ~ acres initially; c. Project acreage to remain undeveloped ~ acres. d Length of aroiect, in miles: ~~*4J (If appropriate) e. f the proiect is an expansion indicate percent of expansion proposed f Number of oi~i-street parking spaces ex~sting g. Maximum vehicular trips generated per hour ~' h. If residential: Number and type of housing units: One Family Two Family Initially Ultimately i Dimensions (in teet) o~ largest proposed structure j. Linear feet of frontage along a public thoroughfare project will occupy i~? acres. acres ultimately. Condominium .~ ~Z length. ft. height; ~ width: Multiple Familv proposed (upon completion of project)? 2~.',~pprovals Required: Submittal Type Date City, Town, Village Board l-lYes [-1No City, Town, Village Planning Board [Yes F1No City, Town Zoning Board [~es I-]No City, County Health Department ["qYes [--]No Other Local Agencies ~'es I-]No Other Regional Agencies [S;-Y, es []No State Agencies []Yes I-INo Federal Agencies [~es i'-lNo C. Zoning and Planning Information 1. Does proposed action involve a planning or zoning decision? [-]Yes If Yes, indicate decision required: [-]zoning amendment I'-]zoning variance [-Ispecial use permit l-lsubdivision F3site plan Flnewtrevision of master plan i-]resource management plan I-tother 2. What is the zoning classification(s)of the site? ..... 3. What is the maximum potential development of the site if developed as permitted by the present zoning? 4. What is the proposed zoning of the site? · 5. What is the maximum potential development of the site if developed as permitted by the proposed zoning? Is the proposed action consistent with the recommended uses in adopted local land use plans? []Yes What are the predominant land use(s) and zoning classifications within a Y~ mile radius of proposed action? 8 I~. the proposed action compatible with adjoining/surrounding land uses within a ~,~ mile? ~Y~s l-Ih 9 If the proposed action is the subdivision of land, how many lots are proposed? a. What is the minimum lot size proposed? 10. Will proposed action require any authorization(s) for the formation of sewer or water districts? l-lYes 11. Will the proposed action create a demand for any community provided services (recreation, education, polic fire protection)? []Yes a. If yes, is existing capacity sufficient to handle projected demand? [l-lYes [-iNo 12. Will the proposed action result in the generation of traffic significantly above present levels? i-lYes [-iN, a. If yes, is the existing road network adequate to handle the additional traffic? [l-lYes I-1No D. Informational Details Attach any additional information as may be needed to clarify your project. If there are or m~ay be any adver_~ impacts associated with your proposal, alease discuss such impacts and the measures which you propose to mitigate avoid them. · · E. Verification I certify that the information provided above is true to the best of my knowledge. Applicant,'Sponso. r Name / ~ / ~ ....... :¢ ..... Signature ~.~.o"~.'~l ~ ~,'~.~ ~L, ., ~, Title If lhe action is in lhe Coastal Area, and you are a state agency, complete the Coastal Assessment For~ before proceedin with [his assessment. IMPACT ON WATER 3. Will proposed action affect any water body desi'gnated as protected? (Under Articles 15, 24, 25 of the Environmental Conservation Law~ E~L) FqNO ,~ES Examples that would apply to column 2 · Developable area of site contains a protected water body. · Dredging more than 100 cubic yards of materiai from channel of a protected stream. · Extension of utility distribution facilities through a protected water body. · Construction in a designated freshwater or tidal wetland. · Other impacts: 4 Will proposed action affect any non-protected existin, g,9,r new body of water? ~,~"N O I-lYES Examples that would apply to co]umn 2 · A 10% increase or decrease in the surface area of any body of water or more than a 10 acre increase or decrease. · Construction of a body of water that exceeds 10 acres of surface area. · Other impacts: 5. Will Proposed Action affect surface or groundwater quality or quantity? ]~O ,~YE$ Examples that would apply to column 2 · Proposed Action will_require a discharge permit. · Proposed Action requires use of a source of water that does not have approval to serve proposed (project) action. · Proposed ,Action requires water supply from wells with greater than 45 gal[ohs per minute pumping capacity. · Construction or operation ceusing any contamination of a water supply system. · Proposed Action will adversely affect groundwater. · Liquid effluent will be conveyed off the site to facilities which presently do not exist or have inadequate capacity. · Proposed Action would use water in excess of 20,000 gallons per day. · Proposed Action will likelv cause siltation or other discharge into an existing body of water to tr;e extent that there will be an obvious visual contrast to natural conditions. · Proposed Action will require the storage of petroleum or chemical products greater than 1,100 gallons. · Proposed Action will allow residential uses in areas without water and/or sewer services. · Proposed Action locates commercial and,;or industrial uses which may require new or expansion of existing waste t~eatment and/or storage facilities. · Other impacts: 6. Will proposed action alter drainage flow or patte4~or surface water runoff? /~0 ~YES Ex-zmples that Would apply to column 2 · Proposed Action wouJd change flood water flows. 1 2 3 Small to Potential Can Impact E Moderate Large Mitigated Impact Impact Project Chart! [] [] I--lYes F-iN [] [] []Yes I--JN [] i [] []Yes l--iN [] I--lYes [-']N , [] ' i [] ~Yes l-iN [] [] I--lYes I--IN [] [] []Yes F-iN [] [] []Yes []N i [] [ [] []Yes l--iN [] [] []Yes [~ F-} []Yes []N [] [] []Yes I--~N [] [] []Yes l-qN [] [] I~Yes E-iN [] [] []Yes l--iN [] [] []Yes E--IN [] [] []Yes- . E~]N [] [] []Yes []N [] []' [--]Yes []N [] i [] []Yes []N, '[] ~ ~Yes l-IN, Construction activity would excavate or compact the soil profile of agricultural land. The proposed action would irreversibly convert more than 10 acres of agricultural land or, if located in an Agricuitutal District. more than 2.5 acres of agricultural [and. /he proposed action would disrupt or prevent installation of agricultural land management systems (e.g., subsurface drain lines, outlet ditches, strip cropping); or create a need for such measures [e.g. cause a farm field to drain poorly due to increased runoff) Other impacts: IMPACT ON AESTHETIC RESOURCES~_/,' 11 Will proposed action affect aesthetic resources? 1~O I-lYES (f necessary, use the Visual EAF Addendum in Section 617.21, Appendix B.) Examples that would apply to column 2 · Proposed land uses, or prolect components obviously different from or in sharp contrast to current surrounding land use patterns, whether man-made or natural. · Proposed land uses, or project components visible to users of aesthetic resources which will eliminate or significantly reduce their enjoyment of the aesthetic qualities of that resource. · Project components that will resutt in the elimination or significant screening of scenic views known to be important tO the area. · Other impacts: IMPACT ON HISTORIC AND ARCHAEOLOGICAL RESOURCES 12. Will Proposed Action impact any site or structure of j~istoric, pre- historic or paleontological importance? 'i~NO r-lYES Examples that would apply to column 2 · Proposed Action occurring wholly or partially within or substantially contiguous to any facility or site listed on the State or National Register of historic places. · Any impact to an archaeological site or fossil bed located within the project site. · Proposed Action will occur in an area designated as sensitive for archaeological sites on the NYS Site Inventory. · Other impacts: IMPACT ON OPEN SPACE AND RECREATION 13 Will. Proposed Action affect- the quantity or quality of existing or future open spaces or recreational opportunities? / Examples that would apply to column 2 '~O OYES · The permanent foreclosure of a future recreational opportunity. · A major reduction of an open space important,to the community. · Other impacts: 9 Small to PotentiallCan !mpact Be Moderate Large Mitigated By Impact Impact Project Change [] [] E~Yes [~]No [] [] ~]Yes [-']No [] [] I--iYes i-]No [] iq. I-lYes ['-]No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes. ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No IMPACT ON GROWTH AND CHARACTER OF COMMUNITY OR NEIGHBORHOOD 18. Will proposed action affect the character of the exis inC,~,community~ [xamp~es that would apply to column 2 · The permanent population of the city, town or village in which the project is located is !ikeiy [o grow by more than 5%. · The municipal budget for capital expenditures or operating services will increase by more than ,5% per year as a result of this pro. ect. · Proposed action will conflict with officially adopted plans or goals. · Proposed action will cause a change ir, the density of land use. · Proposed Action will replace or eliminate existing facilities, structures or areas of historic importance to the community. · Development will create a demand for additional community services (e.g. schools, police and fire, etc.) · Proposed Action will set an important precedent for future projects. · Proposed Action will create or eliminate employment. · Other impacts: i Small to Moderate Impact Potential Large Impact Can Impact E Mitigated B! Project Chart! E~Yes (--]Nc L--~ Yes [~Yes [~Yes [--] Nc [~Yes l--]Nc [~Yes [--]No ~Yes I--1No E~Yes [~No ~tion in Part 2 Is Identified as a Potential Larg~ Impact or --EVALUATION OF THE I APORTANCE OF iMP&,3TS Responsibility of Lead Agency Part 3 must be prepared if one or more impact(s) is considered to be potentially large, even if the impact(s) may mitJ§ated. Instructions Discuss the following for each impact identified in Column 2 of Part 2: 1. Briefly describe the impact. 2. D:escribe Iif applicable) how the impact could be mitigated or reduced to a small to moderate impact by project change(s). 3. Based on the information ava able decide if it is reasonable to conclude that this impact is important. To answer the question of importance, consider: ' The probability of the impact occurring · The duration of the impact · Its irreversibility, including permanently lost resources of value · Whether the impact can or wilt be controlled · The regional consequence of the impact · Its potential divergence from local needs and goals · Whether known obiections to the project relate to this impact. (Continue on attachments) 11 617.21 SEOR Appendix B State Environmental Quality Review V,isual EAF Addendum This form may be used to provide additional information relating to Question 11 of Part 2 of the Full EAF. (To be completed by Lead Agency) Distance Between Project and Resource (in Miles) 0-l/4 1/4 -I/2 1/2-3 3-5 5+ Visibility 1. Would the project be visible from: · A parcel of land which is dedicated to and available to the public for the use, enjoyment and appreciation of natural or man-made scenic qualities? · An overlook or parcel of land dedicated to public [] [] .... [] [] [] observation, enjoyment and appreciation of natural or man-made scenic qualities? · A site or structure listed on the National or State [] [] [] [] [] Registers of Historic Places? · State Parks? [] [] [] [] [] · The State Forest Preserve? [] [] [] [] [] · National Wildlife Refuges and state game refuges? [] [] [] [] [] · National Natural Landmarks and other outstanding [] [] [] [] [] natural features? · · National Park Service lands? [] [] [] [] [] · Rivers designated as National or State Wild, Scenic [] [] [] [] [] or Recreational? · Any transportation corridor of high exposure, such [] [] [] [] [] as part of the Interstate System, or Amtrak? · A governmentally established or designated interstate [] [] [] [] [] or inter-county foot trail, or one formally proposed for establishment or designation? · A site, area, lake, reservoir or highway designated as [] [] [] [] [] scenic? · Municipal park, or designated open space? · County road? · State? · Local road? 2. Is the visibility of the project seasonal? (i.e., screened by summer foliage, but visible seasons) [] Yes [] No during other 3. Are any of the resources checked in question 1 during which the project will be visible? L_! Yes L_No Used by the public during the time of year COUNTY OF SUFFOLK ) STATE OF NEW YORK )SS: J~ . ' BEING DULY SWORN DEPOS[ 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, THAT THE 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 SOUTMOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS AR1S]NG UNDER OR BY VIRTU~ OF SAID PERMIT, IF GRANTED. in comDleting this application I hereby authorize the Trustees~ agent ~r representative to enter onto my property to inspect the . /~IGNATUR~ OF AmmLICANT NOTARY PUBL I C EXAMINED APPROVED "WETLANDS" PERMIT (CHAPTER 97) APPROVED "BOAT,DOCKS, WHARVES" PERMIT (CHAPTER 32) DISAPPROVED "WETLANDS PERMIT" (CHAPTER 97) DISAPPROVED "BOATS,DOCKS, WHARVES" PERMIT CONDITIONS, IF ANY (CHAPTER 32) EXAMINING BODY SIGNATURE OF CHAIRMAN COMPUTATION OF FEES -4 C ,-! 0 C 0