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HomeMy WebLinkAboutVavas, James Glenn Goldsmith, President ®f S0 Town Hall Annex A. Nicholas Krupski,Vice President ,`®� ®�® 54375 Route 25 P.O. Box 1179 Eric Sepenoski Southold, New York 11971 Liz Gillooly sgs ® Telephone 1) 76 -65-1892 Elizabeth Peeples J Fax(631) 765-6641 c®UIII�,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Chapter 275-8 A. "Presubmission conference. Applicants are encouraged to schedule a voluntary presubmission site visit to discuss the proposed operations with the Board. Discussions in the field are purely advisory and nonbinding, but this meeting is intended to facilitate communication between the applicant and the Board. There will be a $50. for this conference, which may be applied to an application fee for a wetlands permit made within six months of the site visit and which application involves structures that were the subject of the site visit." I HAVE READ THE FOREGOING AND AM AWARE OF ITS CONTENT: g�FFO(� Glenn Goldsmith,President ����� COGy� Town Hall Annex A.Nicholas Krupski,Vice President < 54375 Route 25 Eric Sepenoski ca ? P.O.Box 1179 Liz Gillooly �y • 0�. Southold,NY 11971 Elizabeth Peeples q a�r Ia�v'` Telephone(631)765-1892 Fax(631)765-6641 'Southold Town Board of Trustees Field Inspection Report Date/Time: .fidZZ Completed infield by: Z' Suffolk Environmental on,behalf of JAMES &VICKY VAVAS to discuss a proposed area of placement of fill and keep the fill and grade it out. Located: 3165 Bay Shore Road, Greenport. SCTM# 1000-53-6-7 Type of area to be impacted: Saltwater 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 X Pre-Submission Violation Notice of Hearing card posted on property: Yes No fie/ Not Applicable Info needed/Modifications/Conditions/Etc.: i rca h 4- co ► -Pr nned a0(-2 cN -- 3 II . �eR i A,, QtV 1'YSues w�-44C-, > •4 '�It Present Were: G. Goldsmith k N. Krupski X E. Sepenoski L. Gillooly ,K, E. Peeples ames&Vicky Vavas 3165 Bay Shore Road,Greenport SCTM#: 1000-53-6-7 /10/22 :e w e �r— r *aw aw 4. u„ Al 9 m y � I { I I � 'SURVEY OF PROPERTY _ } LO 55&PART OF LOT 56 MTNDED MAP"A'OF ai ',�ECONIC BAY 0.0 ESTATES Wm° t?�� IP�f FILED:MAY 19. 1933-MAP NO. 1 124 on r-ZSPUBLICDE �� �SP"p RESIDENCE.PUBLIC WATER l SITUATE m RIGHT OF WAY L�" LOT sa � 75.00 TD M.M.W.AS PER MLED MAP M I �RSHAMOMAQUE (GREENPOR`I) N66e 09'00"E Rf-_s:Df,Nf E 145.38 TocuRRFj1TM,Nw. TOWN OF SOUTHOLD �z . �.` `nL �� '� eLXHrAD eT L 9• �P. ��o- r MON FN �o a� . f �5UFFOLK COUNTY,N.Y. ' I 5.5 r 1 0 , co n'✓o culla - aLoFTAX MAP NO.:1000053.0006.00-00700 35 r JA - TLoTAREATOM.H.W; 10.888.24S.F.(0.250ACRES) D Frse. oyx 'PATE SURVEYED:JAN.27.2021 Z X. 55 0METER vfDDED FLOOD ZONE:JAN.29,2021 OZ N I-ELEVATONS REFER TO NAVDBB. mI 7' � STORY SANRARY -NOWELLSWITHIN150OFSUBJECT PROPERTY. 0 Z CONCRM FRAMEi; E: COVERS RESIDENC i o 30 60 i ,� i t 1 _ #3165 :> t; 1 N 44, 0o I m F f Feet `i ��.._.�t "•• �. .. _g_..�.SOF C i SCALE: IINCM30 FEET I y, /�r ��� y �'ti"�t LP.J 'm OT 56 4 xO %••' G007' s TANK IU ry ql 00 6 I� I f.� i; Q�•�i� 4,� �.�0•�008I ilgg� %LEAN�.• �- BTAK� "=C.E ROW ON L a STAISA m, NALL y ,� FND. RETURN FNP, y zi i S66-09'00«W I FND. I p� .ems._ Qom, Ln uyrL- ; 1iS. M.M.W.ASPFS!PtL. MAP N , POLE--, n+ PARTOF 14G45• CURRFNi M.MW, m Z LOT 56 , RESIDENCE•PUBUCWATER la Iti441-r't�/�l� ' t I c 0U3 U1 C D1 kl n o ) n a CERTIFIED �.m. JAME9 AND MCKY VAVAS rAlY7� D FIRSTAMERICAN TITLE INSURANCE COMPANY O j WELLS FARGO BANK N.A.ISAOA r; I n narmroN.n+am..wNxnorronnurm.r. •n-., ,n, j ax+a�w�"*anner.,...w,�np,a�eq„a.w xuuwa.en.r.,re•eu s�.riieam '� t! ^ Com'} >oa..ou....na.narvNsrntnn«.uu.er.nnau.r»r..�u N.wr.•..w,.•r.•w i . :i y �+• �w.o,vrnnu.na.,.n.arr.o..r..,.w.,r.Nw..n.. ' ;:•�:'�' rnn.vanwn•n.nen,.e,,.••+can«N•r,.•.n,u rK«.r,...nnrrwuo» �• � , ArJC LAND SURVEYING PLLC Y wrWrw�i•.n,,.CWfi.ilONfr wCa+anwN r.vOWMrritt w.W.W4naAMetM nAw,a+ar+,wr..r8.,...rw..nu..nn.,,N..n rorw-nn•ccwoN.v L k� �l� ai�.r�� p� � �(r�, �*/�. S •uoan•uwaN•.vs,c,,N.,:arN.w.a,..wri.«n+,u.,.,.o,rw..annu,Yc.,�r =� -^14�SVRVE- - , NG."&PLANNIl�\3� nrccnmK+.rnr.+.rtmrvurrrnw lrwnr 4 .I �)fti nr,ano.,oru,.vweown,ruxvnmu.ry.u.c.n.r.nu.•.orw.vw.Nwvu T "'• �!' (ti.� 7v * _ •rnc+Yn.•�unrr+mato.r,..wrnu.oua....�rN.nn.«,«cwns,ar„nr,rru. 77.5 ,R COLEMANdAD,CENTCH;AIY Ito-no''' Vr �+n wr. wNnan�x w.ew.NnN...a ern„a ntn ns. .m.r r>..cYc.mm�.ne.voo,w,.rnnN.n.•Y..a.,mn..,r,.m,,,rn.nr.rr,..er:Nre ' �� ;.PHO[TIE .63.t.,846;997'Hi ;, � .'�---'� � � ,,,'�.r,;,,��NA•L�.tTWUM1Nnr.t..fn.,.vat.mu,�,.Afr.0 N4N.YarMQ1 � I. � I '' ■ _ oa.•euNrnrs.mvenrw•v.rn.omr•..r..,n..nn...en..axea.ermr.�w � REMAIL.A.1C21460SP70NL1NE.NMT �\1/I� ,•.av+nr.,-ccwaw.rn.:.x..wwncw..•.vwUu..c,..eM...,<w,w, ' ,' - �'^or'�tnr:�uum•uy.man.xm.�.,r xrw•rn.tr n.�r,.vn,<.r�:,n..«nrs:.am j ' .w+rsu� cnfimm�a.uacaroar , SURVEY OF PROPERTY LOT 55:&PART OF LOT 56` AMENDED MAP"A'OF �N i,° f 1 • PECONIC'BAY ESTATES 'z 50.0'WIDE t �0 6C RESIDENCE-:PUBLIC(NATER �(+ FILED':MAY 19, 1933-MAP NO. 1 124 m PUBLIC (�; �{�' LOT 54 SITUATE y RIGHT OF WAY ZS.00TOM.H.w.n�PERa,tEDMAP —I PKOFOSED 145.38 TO CURRENT M.H.W. ARSHAMOMA.QUE (GF2EENPORT) A �� xggm •"N66°09'00"E RF s,UC\CE ;qhq BUULKH'RETUND 14AIL p SET TOWN OF SOUTHOLD y ga °�Xo P`I P�E ` MON.FND O• O�<p p,% 5:5' gi3 0°^ :QqJ K!°, SUFFOLK COUNTY.,NX. lf•J v o- n za.3 Ala. 3 p N. ASPHA rvEWAr N•• ..-7 b �., ,.(' •p, WITH CONCRETECURB " 2 O,FL.=1 B6 N 250 RYe: •a1 Q 35.0' [) TAX MAP NO.'. LOOOA53.00 06.00-007.000 �, 35.O1FY.5B. J mk til g LOT.AREATO;M.H.W 10;888:24 S:F.(0.250 ACRES) x' q< _ WATER i a 0 u { 53.p' <; O QATE:SURVEYEQ:JAN.-27,2021 n. q' n METER 1 z m A N s ,r n N. O'R t I m e CO ADDED FLOOD ZONE:JAN.29,2021 m O' I n s v`c 41 . PL NDy� D°. , ° W ,.m s 7' STORY ". ? -ELEVATIONS,REFERTONAVD88. r ny y� I v i SANITARY •-'+.,�J w FRAME.. -NO WELLS WITHIN'1 SO'OF:SUBJECT PROPERTY: a7 q .q 9 (' �. to cove �' P- N RESIDENC tD, I: ;m ��.,.O: #3165 n v a Rl 44,3 0 30 60 `1 I �,.. (t;) Com ° .,. ..-eeL'ra'R ��q�......�TOF Feet '� t O-. R�'.r .o•� oENrRANCE /rp� I OT56 ti m SCALE: INCH- 30l FEET. LPA .•�....,. x9� KHrh� NAIL m ..�..... r .. - BUL ° ,TY gqi Iu qq`*_rPILLAR- '3 E HEDGEROW ON LINE STAK RETURN FND. > h .1h\..JJ 9 mp 0 25 '� FND.. FND. g 3,f NeR` B� 0'- $ / S66 09 00"VV 1_j r 0 T .H.W AS PER FILED MAP �,. 145.0 OCURRENTM.H,W. ; N Pa4e PART OF I 1 v O `0'p` 'LOT 56 010191 L'�@,1. .... a m; RESIDENCE;PUEI:,IC WATER alo o,o v t - z z C xI o Go01 CERTIFIED TO n A u+ 'JAMMAND ACKYVAVAS. o °FIRSTAMERICAN TfTLE INSURANCE^.COMPANY A WELLS FARGO BANK N.A.ISAOA "' 1 un �wxn�n m r m _ k J �. _,�.. en �tu.o u. p rt P ' °u�2 n a ram A ALI No 7j sl"ll r is r i � aH +wcy' ' .�. '1� ENiA1L.AJC2@OPTONLI14E.NT r^ Suffolk Environmental Consulting, Inc. Newman Village Suite E 2310 Main Street PO Box 2003 . Bridgehampton NY 11932-2003 t 631.537.5160 f 631.537.5291 Bruce Anderson,M.S.,President HAND DELIVERED C an E2 May 10t11, 2022 Board of Trustees` 23 20 Town of Southold P.O.Box 1179 . Southold Town Southold,NY Board of Ttustees 11971 RE: VAVAS Property—On-Site Meeting Situate: 3165 Bay Shore Road • Greenport West, Southold SCTM#: 1000—053.00—06.00—007.000 Dear Members of the Board, Thank you for taking the time to meet with me at subject property to discuss the usage of the excavated material resultant from the installation of the various improvements outlined in Trustee Permit No. 9995 issued September 151h, 2021. As discussed, the owner(s) of the subject property will be grading the excavated material across the expanse of the parcel in a manner consistent with the grades of both neighboring parcels to the northwest and southeast. Grading will also be preformed in a way that prohibits excessive runoff towards the adjacent waterbody (Pipes Cove). Should grading be performed in this manner,it is our understanding that no permit is necessary for the on-site storage and use of excavated material during the course of construction. Again, thank you for your time and consideration regarding this matter. Yours Truly- --Robert W. Anderson C.c. J. &V. Vavas S.Bishop Suffolk Environmental Consulting, Inc. Newman Village Suite E 2310 Main Street PO Box 2003 ® Bridgehampton NY 11932-2003 t 631.537.5160 . f 631.537.5291 Bruce Anderson,M.S,,President HAND DELIVERED March 241h, 2022 VE r Board of Trustees to 2S Town of Southold P.O.Box 1179 - Southold,NY Raaraof7rustees 11971 RE: VAVAS Property—Proposed FillStorage/Request for On-site Situate: 3165 Bay Shore Road - Greenport, NY • 11944 SCTM#: 1000—053.00—06.00 007.000 Dear Members of the Board, This firm represents the owner(s) of the above referenced property,who will be seeking a e, wetland permit for the storage and/or usage of the on site excavated material thereon.Prior to making an application,we hereby request a Pre-submission On-Site Meeting in order to illicit comment from the entire Board pertaining to this project.Attached herewith,please find the following: 1) Pre-submission On-Site Acknowledgment, (one [1] original); 2) Owner Affirmation, (one [1] original); 3) Owner Endorsements, (one [1] original); 4) Owner's Open Government Disclosure Form,(one [1] original ea.); 5) Agent's Open Government Disclosure Form,(one [1] original); 6) Sketch depicting the proposed locations of stored top-soil/excavated material, (one [1] original) and; 7) Check made payable to the Town of Southold in the amount of fifty-dollars ($50.00) in satisfaction of the requisite fees. Thank you for your time and consideration'regarding this matter. Should you have any questions or concerns,please feel free to contact this Office at any time. ` ;r p EE I V E S URVEY=OF PROPERTY LOT 55:&PART OF LOT 56' m So Id Town g1 4MENDED MAP'4"OF c o Boar J of Trustees P` eJO PECONiC BAY ESTATE'S 'rz W.O'WIDE �QtgG RESbENCE•PUBLIGWATER FILED iVIAY`]9,.1933-:MAP NO.1 124 O m PUBLIC . '1( LLST`54 I " S��' i n RIGHT OF WAY 75.00 TO M.H.W.AS PER FILED MAP U!'i "-{ j f PROPOSED l4E.39TOCURRENTM:H.W.. m I; es 1V 66°09'00'E RrSinENCE 'BULKHEAD D RERJRN : NAIL ARSHAMOMAQUE (GREENP:ORT)' UTIL k TOWN'.OFsOUTHOLD MON.FNq a�, ,of�mo ^z 5.51 gm3 eo as 'SO SUFFOI:K COUNTY„N.Y. m24.3. - m I_ 0 WITH CO$a.`O''.CURB O _ q ,� ..G FL 1 O.ON U a .25':0 RYvTB. =e.W.k, ;(} j"�. .b. !n l A l TAX MAP'1V0 ;]000-053:00 06.000.07,000 N r I I I t G), w ^ o LOT AREA TO MrH:W:;f 0;888:24.SF.(0.250 ACRES) - 6' a , m 63T 55 t,W V� 35:0`F.Y.SB, m [y N(�I 0. 9 WATER, yb If'..' _ t7 �. f .. I.1.�1 9' .N.�.H METER• n n 'O 9.m-DI' '. ".�' O. 'DATE SURVEYED:JAN:27.202:1 z �, x Q'o, r t a c R (p ADDEDFLOOD JAN.29,2021; m O { �`+h s�av F$ 9*; P NOS qa 0> �, i oo i1J m,$ 6QZk�': r m [ o. C x (°m r.,l NRY' 1 STORY j i e"� m �° W -E:LEVATIONSREFERTO.NAVD86. r eh 5` o$ .Z. concRt_7F - "\ =; a R°FRAME n C O NO,WELL5 WITHIN 150'OF SUBJECT PROPERTY: n e 9I N. covERs 1 \, IDENC s,' lo.o I } m 0; a w 165 ,.I 44.3 e9 I 9 o: M 0. 30 60 m; I. l.`�) l x Qx9 r,OF C q s #3 1'7� ,.rM .'CELT.4R:.:: , Z :Feet /lJ O \" �o n oErrrRANCE Jj I OT 5G N_ m S CALE: F F INCH= 3`'0`FEE7 O 5� _N �En^, Q0p2 AN 4�go .^- • .. 11�. I. 0` IP HEDGE ROW ON LINE BA NAIL > STAKN5.T .�. x 'RN .FND. w E�� g: ^ 0• NO 025 ._:/ FND: FNDr¢;. ZT S66°09'00"W ]755.0ASPER'FILED MAP �J . m• U71L'� URRENT M H W ; pl.. POLE, oA PART OF I vq `F. ?fCf]�A a (� O. LOT rlrO oz m y n RESIDENCE-PUBLIC WATER oIl MAI�'-jj%Z_ #Sf N N W< IT m _ CERTIFIED TO.; & JAMES AND VICKY VAVAS; �I IRSTAMERICANTITLE INSURANC o • F N E-COMPANY 1 1= lflV,•.;. - D WEL[SFARGO.BANK,N.A.ISAOA, ,y - m Lr!iore?S 'tm{I . `� iCOt+IMGt1'2 9T.In LAttO YEY 'i1LC.KLRV[YG -.E(t410 _ 'Ni ? NUTilO Q nt :RATION OR! ITICR.TOP 5[N MAuvh CM4Y l.Ilt,I�A 17 ANtt � ' � � ..LRVEYO�STA.I3A`JILhAT Oh nr®CCY�NTNTI,sU knM1 �F.p,Y N[V.'YORRST'T�`f•'JU.^.FttO _� inW 'MI [.• ?OILYUCUNOARYStiHVKY M1tAF51Y1tN Mk,Y+UltV4Y0 4LNU6*v EYLN.a,LGi::4UINt lNUtAIYti a ORE TC fl tl tME&URO'lYOR50i IC NAI.Nn.h N[G•9.4 h - U a COMMrJgIO Rio^^+6UU tix L(i u\ C 114YY tt KM 4,t.FhTRCD Vi IT CI;PRT T TI CCOOCOr i'Kr'TO [ $ IY A p FP lY/TNr ,a. ,- - ... .. h NYC-F.STATF.ASSOGIATfONO PRO'F.514YAi `liF°.TI i'.,P' Gl CFRT CA 0 I TTFITn'\R40NSFOR:IM+Oi1-HP FfO 0.NRYLI�M Pp RhFTI LA,ttiFT l,-pe1PAM'YO � C SURVYh G PLLC n N6bb T 60`/CNI N1 RLM:F]'KY aJ'O x11E161 L.Ln IU hl 111 11 NUAk fiURVEY a� 1.,,. - i rJTTRgMwTRhfiF S, I3' "iA L_!L71 6 C::OG.TIC}O UN.FNCaR U D VFIK34T4C YC RJ flTtpTA \^',c"OWN LAND SUR' �Xl�[ BPLANNI§IIG. N tta�u L TRF n„ r�vbN�RGP�h :Y `j . \ I D b'�HO.YM fHE FRGYF."MFNl50R GYChT1F[C M+SNIS Ip,t101 tAtElit lT NA55S It Ef '.1{ < `�-?�,�Zmay.- '. - 3..� _,; Yr rorr�rTe onr uri;c:�wal;elomtriTirn r+om u'rT rcu r6. rrkhr x. rs kC i 77{S �o...� n�t.�►ry � �'CENTE �C 'ep� ,yO W A i'LCt i•UAN US fiNb i"GIiEF L hUt fi I }3l ul�k lHkt3tEC NbF O 11�i.7 �I b •A �4n;1, CEt a PE A tX NA M)O S.P TI')SIRNI Gv MA tI X TUt IM1CI UN+Y,OTI fl3 - I `, .i Ut`ROPE1iT.'KURIR'RMi:I M t+C'pT —IT.1 a5u ci.EF.� iEfl\YI.=UtiJlrn. oS .&ly.A;1.C24"6@OP fONLINE.NET Nu n,E>s EMc rc ER l.+(iRY1CY FOOT- Yours truly, Ao Robert W. Anderson (enc.) C.C. J.Vavas E�Sfbip , . Town Hall Annex Michael .,)mino,President 4 f 54375 Route 25 John M.Bredemeyer III,Vice-President !`0` l4 P.O.Box 1179 Glenn Goldsmith ;' Southold,New York 11971 A.Nicholas Krupski Telephone(631)765-1892 Greg Williams Q a0 ' ' Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Chapter 275-8 A. •"Presubmission conference. Applicants are encouraged to schedule a voluntary presubmission site visit to discuss the proposed operations with the Board. Discussions in the,field are purely advisory and nonbinding, but this meeting is intended to facilitate communication between the applicant and the Board. There will be a $50. for this conference,which may be applied,to an application fee for a wetlands permit made within six months of the site visit and which application involves structures that were the subject of the site visit!' I HAVE READ THE FOREGOING AND AM AWARE OF ITS CONTENT: Board of Trustees Application County of Suffolk State of New York James A Vavas and Vicky Vavas 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 TOWN 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) HEIRAGENTS)OR REPRESENTATIVES(S),TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIE OF THIS APPLICATION. . 1/ S� ratre Signature L SWORN TO BEFORE ME THIS � 3 DAY OF / C cl ,20 a,a- ELAINE STAMAS NOTARY PUBLIC STATE OF NEWYORK Toa-- 'ptila KINGS-COUNTY LIC.#01ST4880 31 COMM.EXP. /y r s' a- Board of Trustees Application i i AUTHORIZATION (where the applicant is not the owner) i We, James D. Vavas and Vicky Vavas residing at 152 83`d Street. • Brooklyn,NY 11209 do hereby authorize Suffolk Environmental Consulting, Inc. To apply for peimit(s)from the Southold Board of Town Trustees on our behalf. mes D. Vavas Vicky Vavas I i i I �f I i 1 1 i i APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of the town officers and employees. The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: James D. Vavas (Last name,first name,middle initial,unless you are applying in the name of someone else of other entity,such as a company.If so,indicate the other person's or company's name.) NATURE 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 applicant/agent/representative)and the town officer or employee.Either check 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 then 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 1 day of 202D Sgatr Print name fJames D.Vavas APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of the town officers and employees. The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: Vicky Vavas (Last name,first name,middle initial,unless you are applying in the name of someone else of other entity,such as a company.If so,indicate the other person's or company's name.) NATURE 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 partnersliip,.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 applicant(agent(representative)and the town officer or employee.Either check 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 then 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 day of �q�1 20? y Sigriatue f� a-- Print name Vi ckilVavas t APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM. The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of the town officers and employees The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: Robert W.Anderson (Last name,first name,middle initial,unless you are applying in the name of someone else of other entity, such as a company.If so, indicate the other person's or company's name.) NATURE 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 applicant/agent/representative)and the town officer or employee.Either check 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 then 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 zday of ick. _20 ZZ Print name Robert Anderson R111 HATCH SMSEO.NO.ws nam J, -----Z— �o —SEC.NQ 015 16x2L1 3 NATCx -- IINE i —�--- --Z--- FOR PLL NO. ym,�1 1.7A(c) SEE 2 TOWII OF OISLS00i O"] Q''`/ lOM-03 04tIe05 ///,b 1] wO\ DD F r✓P\' FOR PARLELNO.: OS2600 / ]A `SO\ a2 3S T,eplc) B , SEE SEC.N0. / ola m , couxry aF suFF°uc e2 1 ( 0/ tel`) / 0]i-00 TO��SOUIHOLO R 1A• TOWN OFOSgRHOI➢ p� � .i a e% �2SOB caTmnR ` woe � '°/pF •� s x,4.12 < -, 3 h 13/•e I ,T " .�ai�,i ;o-tx-t2 R FC/T e.9 TfTO of a 9' 0.2612 / '��0 3 t3� S ISOIIRIOIO /�/ 11-0612 / a3-� 4 / LOUMY OFF SUFFOLK 01.2&3 rrF ' ,1 10 raw ol.zo-u O' rq2^ 4° _ _ � m KF a ei' `°,' e1` �a• To,,NoFF8W,tx�o,.o 3 r _ Rk'Iry 3 yeE $ N T Nr 10.1 _ T=OFSOUfHOIfr CREEK o p '9 Q s • '4iB P � 16 a r A' "b 4v 4 y"SN POS�y, dL g L F 4 �eWcl O !•ro 8,r8 4a )'Q 4�L ,A LY � y]� �"' d �.sA° - �. ,.4A(c)p .� ' xvi lm Z F r ♦ _-/\.... FOR PCL NO. 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