HomeMy WebLinkAboutTR-1898 GF Glenn Goldsmith, President �QF so Town Hall Annex
® ®� 54375 Route 25
A. Nicholas Krupski,Vice President ® P.O. Box 1179
Eric Sepenoski Southold, New York 11971
Liz Gillooly Telephone(631) 765-1892
Elizabeth Peeples ® a® Fax(631) 765-6641
COUNTI
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
September 15,, 2022
Martin D. Finnegan, Esq.
Finnegan Law, P.C.
P.O. Box 1452
Mattituck, NY 11952
RE: DEBRA A. ROTH 2012 FAMILY TRUST c/o
WILLIAM M. ROTH, TRUSTEE
570 MASON DRIVE, CUTCHOGUE
SCTM# 1000-104-7-2
Dear Mr. Finnegan:
The following action was taken at the Southold Town Board of Trustees regular meeting
held on Wednesday, September 14, 2022:
RESOLVED, that the Southold Town Board of Trustees APPROVE the request for a
Transfer of Wetland Permit #1898 from Henry & Ann Wong to Debra A. Roth 2012
Family Trust c/o William M. Roth, Trustee, as issued on October 26, 1984.
Any other activity within 100' of the wetland boundary requires a permit from this office.
This is not a determination from any other agency.
If you have any questions, please contact our office at (631) 765-1892.
Sincerely,
4
t
Glenn Goldsmith, President
Board of Trustees
GG/dd
SF�_
gUFFO(,r
Glenn Goldsmith,President �p�� COGy Town Hall Annex
A.Nicholas Krupski,Vice President 54375 Route 25
Eric Sepenoski P.O.Box 1179
Liz Gillooly �,�plY� hone 631 765 1892
Elizabeth Peeples Telephone( )
Fax(631)765-6641
Southold Town Board of Trustees
Field Inspection Report
Date/Time: 1ZT_ Completed in field by: Al-9144-
Martin D. Finnegan on behalf of DEBRA A. ROTH 2012 FAMILY TRUST c/o WILLIAM
M. ROTH, TRUSTEE requests a Transfer of Wetland Permit#1898 from Henry & Ann
Wong to Debra A. Roth 2012 Family Trust c/o William M. Roth, Trustee, as issued on
October 26, 1984. Located: 570 Mason Drive, Cutchogue. SCTM#: 1000-104-7-2
Type of area to be impacted:
�6altwater Wetland Freshwater Wetland Sound Bay
Part of Town Code proposed work falls under: Chapt.275 Chapt. 111 other
Type of Application: Wetland Coastal Erosion Amendment
Administrative Emergency Pre-Submission Violation
Notice of Hearing card posted on property: Yes No Not Applicable
Info needed/Modifications/Conditions/Etc.:
ov 40 -
enoski Se E.ski
�
Present Were. G. Goldsmith N. Kru p p
L. Gillooly E. Peeples
FINNEGAN LACI, P.C.
13250 MAIN ROAD
P.O. BOX 1452
MATTITUCK, NEW YORK 11952
(631) 315-6070
MARTIN D. FINNEGAN, ESQ.
MFINNEGAN@NORTHFORK.LAW
Via USPS Regular Mail E CD E 0 V
D
August 2, 2022 AUG -a 20a
Town of Southold
Board of Trustees Southo6d T��v�
54375 Route 25 Board of Y�usteas
Post Office Box 1179
Southold, NY 11971
Attn: Glenn Goldsmith, President
Re: Transfer of Trustees Permits
570 Mason Drive, Cutchogue.
SCTM 1000-104.00-07.00-002.000
Permit Nos. 1921C; 0083C/5530; 10-88-104-7-2; 1898; 1155
Dear Trustee Goldsmith:
Please consider this letter a request to transfer the referenced permits from
Geoffroy Penny and Henry and Ann Wong to the Debra A. Roth 2012 Family Trust, as
they are the new owner of the subject parcel effective July 14th, 2022.
I have enclosed a copy of the executed deed for your records, along with an
executed Affidavit, Owner's Authorization, Owner's Transactional Disclosure Forrn,
Agent's Transactional Disclosure Form, and an attorney escrow check payable to the
Town of Southold in the amount of$250.00 for the required transfer fees for all five (5)
permits.
Kindly advise our office if you require anything further to process this request.
Very y yrs,
Martin D. Finnegan
MDF/as
Encl.
cc: William M. Roth
`Board of Trustees Ap&ca, ?►n
r
AFFIDAVIT
WILLIAM M. ROTH, AS TRUSTEE OF THE
DEBRA A. ROTH 2012 FAMILY TRUST 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. ;
I
I
Signature of Property Owner Signature of Property Owner
SWORN TO BEFORE ME THIS 14TH DAY OF JULY 72022 2022
i
Notary Public
MARTIN D. FINNEGAN
Notary Public, StatB of New York
No. 0)F16056707
Qualified in Suffolk coon
commiss;n� E_�p;res hfiarch 26, 0�7
'Board of Trustees Apj.ca, )n
A•II'ITEIORIZATION
(Where the applicant is not the owner)
WILLIAM M. ROTH, AS TRUSTEE OF THE
I/We, DEBRA A. ROTH 2012 FAMILY TRUST
owners of the property identified as SCTM# 1000- 104.00-07.00-002.000 in the town of
SOUTHOLD ,New York, hereby authorizes
MARTIN D. FINNEGAN, ESQ. 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-
koo/0_ �
Property Owner's Signa e Property Owner's Signature
SWORN TO BEFORE ME THIS 14TH DAY OF JULY , 2022
Notary Public
MARTIN iN D. RNiNEGAN
Notary Public, Saute of New York
No. 01;16056707
Qualified in Suffolk County
Commission Expires March 26,20
APPLICANT/AGENT/REI-PRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold's Code of Ethics prohibits conflicts or interest on the part or town officers and employees.The pumosc of
this form is to pi-ovide information which can alert tite town of ppssibI6 c ntlaets of interest and allow it to tale whatever action is
necessary to avoid same. WILLIAM M. ROTH, AS TRUSTEE OF THE
YOURNAME: DEBRA A. ROTH 2012 FAMILY TRUST
(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 _^ X
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 X
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 applicantlagendrepresentative)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 a corporation);
C)an officer,director,partner,or employee of the applicant;or
D)the actual applicant.
DESCRIPTION OF RELATIONSHIP
2022
Submitted this 14 y o LY
Signature :4
Print Name WILLIAM M. ROTH AS TRUSTEE OF THE
Form TS 1 y BRA A. ROTH 2012 FAMILY TRUST
APPLIC.ANT/A.GIENT/REA-PRESENT A.' IVE
TRANSACTIONAL, DISCLOSURE FORM
The Town of Southold's Code of Ftttias prohibits conflict%of interest on the part of town officers and employees.The purpose of
this form is-to.provide inforination which can alert the town of 12ossible conflicts of interest and allow it to take,whatever action is
necessary to avoid same.
YOURNAME: MARTIN D. FINNEGAN
(Last name,fitst 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'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
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/agcnVi•epresentative)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 a corporation);
C)an officer,director,partner,or employee of the applicant;or
D)the actual applicant.
DESCRIPTION OF RELATIONSHIP
Submitted this 4th d JULY ;aw 2022
Signature
r
Print Name MA D.FIN EGAN
Form TS 1
1..%W Ults t).,"I A
1111 INDF.NTITE—made flic tisk}of july in Hit:yew 2022
wil-wEEN*
Georsoy i. Peng.residing it 570 Mason Drive,Cutchogue,Nevi,York. 11935
Pan of MV ilml rawc anti
rr WiRfllin %M
ia .Roth,as Trustee or me Debra A.Roth 2012 FarnflyTrust,
:)y ,— c/ /firC>3[1/0
Oraq W OW x"md Part.
%VITNFSSETII.that the parlyol'ill':lirSl p"It,in coll.'alcralioll ol–l"al Dt 4 lar�:anti other Valuable considorzltjoll paid fly 1110
part;offli-.-second part.does lica-chy grant and release tallto the para(11,111C N"ond Fll-L.the llcin�or sure sstus and a,,sig[t,of
the Fifty of the sCcolld[,:art lolv%cr.
ALL that certain plot,peck,or parcel ill 1.111LI.lVill)the flat i lilt :it it!onlicowitient,ilwwon vi-cvied, -laid tving in the
hamlet ofiCtItchogue,Town cit'Southold.County orSti[Tolk and State ol'New York,and more
parlicularly descHhed M Schedule A attached hereto and made a part hercof.
Premises- 570 Niason Drive.Cutchogue,New York 11935.
Southold-Town 9
13oard 01"Ifust e
TOGETHER it lilt all right,Wk aW Mr-cm d MqA4 be NMY of to OM"M OC an MW M any qwcK Mal MW%Oniblig tile
'14 wiiii ill, gllls(11 tile
above-timlibcd prenl1w,lo tile center line,thercol:TO(;[-',*1'1!1,-, -appurienanec,and all Illoe'late anti IiL
lmn}of Ill,:iirm pari in and to�.Ijtl 1,rvmisv,,;TO HAVE ANDTO HOLD the prelilisc,fl-,:Icill granted unto the Fifty of 111i:
Second Far[,dic lwil—a- ontic pally of iliv secontl Fiat
AND Ili,:para ui On:br,I po onenm-HM Ow Fay of the firs part llas not dolic,'.'tiflored any dlillg ,klicichi tile'ald
1111-olke,hay.,been incuoilvivd in any day %Oialv,cr.r\cvfal;I\alon,--ini
AVD the party of the fis,l 13,Wdw Lien lAwunman,dial illv pally oftlic fi-I Pattitill
r1r.'I lot Illeplarpo":of jlaylllg Ille Cost of tile 1111protellivill and will apply the ;title filq to the payralLill tal the e.o't of the
itrifirovollent before u,ing any p:Irtol'ifle(('I'll of tile',;lllle for ane other pulpo'e.
The%koral"party",hail beo"weif a Wit wA TWO-..he the wive A to nuk—w wwk -
IN,wrrNESS MIEREOF.the pang of(lie first part it;,,,duly v\ccuicd(]it,deed ihcdu,� ;air,!year firm aliwx itnitell.
......... ... .................................-
.1
FIDELITY NATIONAL TITLE INSURANCE COMPANY _ TITLE NO.7404-014383
SCHEDULE A-1
(Description of the Land)
For Tax Map ID(s): 1000-104.00.07.00-002.000
AMENDED 7/13/2022
ALL that certain plat.piece or parcel of land.situate,lying and being at Bayview,in the Town of Southold.County of Suffolk
and State of New York,bounded and described as follows:
BEGINNING at a found concrete monument on the Southerly line of Mason Drive said monument being distant 678.06 feet
Westerly from the intersection formed by the Westerly line of said Broadwaters Drive and the Southerly line of Mason
Drive:
THENCE South 12 degrees 08 minutes 10 seconds East 326.50 feet to tie line along mean high water mark of Haywaters
Cove:
THENCE Southwesterly along said high water mark of Haywaters Cove along two(2)tie lines:
1. South 72 degrees 16 minutes 52 seconds West 42.75 feet:
2. South 63 degrees 32 minutes 56 seconds West 12154 feet to lands now or formerly of Patrick Sweeney:
THENCE,along said lands,North 8 degrees 05 minutes 30 seconds West 337.03 feet to the Southerly line of Mason
Drive:
RUNNING THENCE along said Southerly line of Mason Drive the following two(3)courses and distances:
1.North 62 degrees 24 minutes 30 seconds East 65.76 feet:
2.North 72 degrees 24 minutes 30 seconds East 73.49 feet to the point and place of BEGINNING.
THE POLICY TO BE ISSUED under this commitment will insure the title to such buildings and improvements on the
premises which by law constitute real property.
FOR CONVEYANCING ONLY: Together with all the right.title and interest of the party of the first part, of in and to the
land tying in the street in front of and adjoining said premises
END OF SCHEDULE A
Comm.tment for?xe Insurance Pnnfed 07 13 22 @ 03 02 PM
S&-edule A-1 Gescnpwn !:r-F7-FRvh-G 1030431004-SPS-1-22-7404.014383
0
State of New Turk.County tif Suffolk I Sfute of:dew York,County of Suffolk
77;
On ck-/(/day o1july in the year2022 On lite day of in the year
hetore Me.the Up&-migned,rxrsonallv apt ared Ix-fore me,the undersigned.Ivry rally apricared
Geoffiroy L.Penliv
personally known in nit:or proved to ne on the ha%is of satisilictOry rierNonally known to tile or pritived it)me on the Nods of salisficlory
evidence to be the individtull(s)whost.,name(s)is(are)l-.ubs-Lrj1x-d to the evidence to tv dee individual(.0 whose nunw(%)is(art)subscribed it)the
within instrument and acknowledged to me that he/she/they executed within instrunwrit and acknowledged io me ifutt he/she/they executed
the same in hi.Awr/their capaciqiti,sut by III-Aierifficir file sane in his/heritheir capacity-fics). and flim h}• hisilier/their
'V
siatu rldi'�. and that
the rwrson uIxin signature(s)on the instrument.tile individual(s).or the lierson upon
t)halt or'%%-Ilich MAjjtaj\jApM3�M.executed lite instrunicni. F&-hair or which site individunlWacted.eXCCULLd the insirunicin.
I
NOTARY PUBLIC.
[ STATE
OF NEW
Y
ORK'
Registrapon 02JAM52586
=Zn.Slit, Ccun1CX-niFt--y 1
ACXV0H*LE1JG%1E,%TF(?1Z%1 FOR USE
pckv YmASub,cribing VVirm-Arb),,kh-dwift'll,
State of New York.County fir ..................................................ls.L:
16.1ph-tv I'vout.k WI Sana Collkin.hol-I'l."'.011,11i,Ipdav,
Oil[lie day of in Ile year Oil the day of' in the year
before me,the undersigned. r
I tied.lxonallyaprared hef(Ire ase.lite undersipecl.perstinallyaplicared
the subscribing witness to the foregoing instrument.with whoul I am
Nrsonally acquainted.who.Icing by tilt!duly swam.did deriose and Pe r-Afflully known fit nw or proved Ni me oil the hail ofs -I; lory
%
say that lic/slic/thev rusidds)in evidence it)he tile individual(s)whosenatric(s)is(are).ubs -d to the
within instrunient and acknowledged to me that he/she/they executed
I ij*f1le place I)ftesidence is Ill(I c-ily.jil(-Incle themirti apulorret number. tile sanic Ili hisAwr/their catilacily(ics).dult by hi.Aler/their%ign.1ture")
inst(in the instrument.the individual(s).or the ff�r%on upon W,inifor which
I
if(aq,thereqft.that helslicAlley know(�) lie individual(s)acted,execuled lite runumt.and thatsuch individual
to he the individual described in and wilt)cxcLutLd tile foregoing made such appearance},-fore the undersigned in the
instrument:that said subseribift witness%%3N Prc%.L-ni itudsaw.aid
extz"Itc the same:and that mid wiluess at the Name time sub%critwd (hiserr the vity or ntkrrl,rdirirrtl xrrhJirixinu and rhestate or romini-Ili-
hi.0- terlibeir naine(.►as a witness 1herviO. other plave the acknolvici(9111cur Was firk-CII).
BARGAIN&SAix.Di.-t:.i)
Won CI Al N%NINA(i%I%N I 41;tVN task.NI IN
THI-E No. Div.Tuinl too
,SF.cim 129.00
13 l.ocK 01.00
Wr 006.000
Cov-,-ry Olt 170WN Suffolk
TO
Fidelity National Title Insurance Company
REI VRN HYMAII.to
FIDELITY NATIONAL Tnix
isINSVItANCE COMPANY
ft"l-1.0111 111.1.1
/-�,Fidelity
I;W I-t-1 I'M
O
z
D
O
IE
cc
U.
0
LU
S
:3
0:
0
U)
iE
ALL MOORINGS AND STAKES MUST DISPLAY VISIBLE MOORING NUMBERS
ALL DOCKS AND BULKHEADS MUST DISPLAY VISIBLE PER,lIT NUMBERS
Board Of $outhold Town Trustees
SOUTHOLD, NEW YORK
Mooring ~ N/A
PERMIT NO .........]:...8..!.9..,.8. ................ DATE: ...0..~.~.~....2...6...,.......Z 9 8 4
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 Southold Town Ordinance en-
titled "REC=ULATINC= AND THE PLACINC= OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS and the
REMOVAL OF SAND, C=RAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN WATERS;" and in accordance .with the
Resolution of The Board adopted at a meeting held on ..oct'....25.1, .....
~.19..8....4....i., and in consideration of the sum of $ ...... .5.....i.0...0......' ........ .paid by
................................................ .~...~...~..~.n..~ .......................... '.: ................ :::3..: ...................
of .... g~..~..h.~..e. .......................................................... N. Y. and subject to the
Terms and ConditiOns listed on the reverse side hereof,
of Southold Town Trustees authorizes and permits the following:
Application approved under the Grandfather Clause to
secure a Dermit for a bulkhead and floating dock all
,in accordance.with the'-application sukmitted.- " .....
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 fo be affixed, and these presents to
be subscribed by a majority of the s, Board as of this dat,e.
TERMS ~nd CONDITIONS
- The ?ermlttee Mr.
570 Mason Drive, Cutchogue Iq. ¥., ~
~esidlng at
part of the comiderafion for the issuance of dae Permit does understand and prescribe to the fol-
lowi g: 1 - That the Southold Trustees Permit must be prominently
n . ' es effected thereby during the period of
displayed on 'the premls ....... ~A,~ ~_ --l~ed from ,nv and work
-':,", ' d of Trustees ann me xown or ooumu~u ~ -~ ' uncle
,.:.-.?.;...,, · ..7 'l'hat the smd Boar ................. it of any otmr-
'7 ~..'<...,.,t all damages, or d.~im~ for damages, of stats ammg ~a~'uy or mmrecuy aa ~ -~ ~ -- the
~ %atica performed pursuant to this permit, and the said Permittee will, at his or her own expeme,
":'defend any and all such suits initiated by thLrd parties, and the said Permittee assumes full liability perm±'
with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold
3~ That this Permit is valid for a period of 1 ? _ mos. which is considered to be the
sufficient time required to complete the work involved, but should ciroamstances warran% request
for an extension may be made to the Board at a later date.
-to maintain the structure or project involved, to provxde evxaence to anyone
...; ... orization was originally obtained.
its agents, and non-compliance wxth the prov~xo.n~, o_t the,. originating appxx~u~,~,
~,evocation of this Permit by resolution of the satd Boaza. . . ~ ".~-
6. That there will' be no unreasonable interference with navigation as a result of the work
herein audmrized.
7-. That the~e shall be no interference with the right of the public to pass and repaxs along
the beach between high and Iow water marks. .: . '.' -..
8. That i~ future operations of the Town of Southold require the removal and/Or alteration~
in the location of the work herein authorized, or fi, in the opinion of the Board of Trustees, the
: work shall cause unreasonable obstrucnon to free navigation, the said Permlttee will be requi~ .
upon due notice, to remove or alter this work or project herein stated without expenses to the '~Town.
of Southold. ·
9. That the said Boird will be notified by the Permittee ct the completion of the work anth-
orized. {See tear off sheet:.} ... ' '
10. 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 failur~ to obta;n same. -.. ~-:-
..-- ..
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 728
Southold, New York 11971
October 26, 1984
TELEPHONE
(516) 765-1892
Mr. Henry Wong
570 Mason Drive
Cutchogue, New York 11935
Dear Mr. Won~:
Enclosed please find your permit, which was granted
under the Grandfather Clause for your structure in
Please post your permit
Haywater Cove, Cutchogue.
number clearly.
Attachments
Very truly yours,
Henry P. Smith, President
Board of Town Trustees
Ilene Pfifferling
Secretary to Board
Name of Creek:
Haywater _eve
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 728
Southold, New York 11971
TELEPHONE
(516) 765-1892
GRANDFATHER APPLICATION
bulkhead
1. Name of Applicant:
2. Address of Applicant:
3. Telephone Number:
4. Year of Construction:
6. Mark off on the map attached, where your property is located
Signature:
Please note re 0 filing fee, which is a one time
fee, for this application.
Mooring Applications- $5.00 Application Fee and a $5.00 annual renewal
fee each .year.