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HomeMy WebLinkAboutRIND, ROYSTON & HELENAlbert 1. Krupski, President John Holzapfel, Vice President William G, Albertson Martin H. Garrell Peter Wenczel BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall · 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 TO: ROYSTON RIND Please be advised that your application, dated August 19, 1997 has bee reviewed by this Board, at the regular meeting of Sept. 24, 1997 and the following action was taken: ( XX ) Application Approved. (__) Application Denied. (__) Application Tabled. (see below) (see below) (See below) If you application is approved as noted above, a permit fee is now due. Make check or money order payable to the Southold Town Trustees. The fee is computed below according to the schedule of rates as set forth iht he sintruction sheet. The following fee must be paid within 90 days or reapplication including fees will be necessary. COMMENTS AND ~RNhA_RKS: coMPUTATION OF PERMIT FEES: 6' X 16' float = 96' X $3 = $288 4' X 16' Dock Ext. -=4 64' X.$3::~ $192 TOTAL FP.P.S DUE: $ 480.00 SIGNED: BY: 6/95 Albert J. Kmpski, President John Holzapfel, Vice President Jim King Martin H. Garrell Peter Wenczel September 25, 1997 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hail 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 J.M.0. Consulting Glenn E. Just P.O. Box 447 Qugoue NY 11958-0447 RE: ROYSTON RIND SCTM ~113-9-4, 47 & 50 Dear Mr. Just, The following action was taken at the Southald Town Board of Trustees Regular Meeting on May 28~ 1997: RESOLVED, that the Southold Town Board of Trustees approved the request for an Amendment to Permit ~3623 to construct a 4' X 16' extension onto the seaward end of existing catwalk, constructed a min. of 4' above grade of marsh, relocate existing 4' X 16' ramp and a 6' X 16' float and install an~ additional 6' X 16' float. Located: 1375 Meda¥ Ave., Mattituck. SCTM 9113-9-4 If you have any q~estions, please feel free to contact our office at 765-1892. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK/djh FROM : JmD CONSULTING PHONE NO. : 65~ 0607 Sep. 2~ 1997 10:04AM PO1 Environmental Consulting Services Phone (516) 653-0607 · Fax (516) 653-3348 121 Jessup Ave · 2nd Floor · P.O. Box 447 Quogue, NewYork 11959-0447 FAX COVER SHEET TO: ~,cxl~_hold Tn,sloes Date: .... C~/~_~'~_/~ Company Name_ Attention Fax Number Number of Pages Including Cover if you do not receive the correct number of pages, please call our o~ce as soon as possible PHONE NO. : 653 0607 S~p. 23 1997 10:05RM P02 FRO~ : JmO CONSULTING · Applicant proposes to construct a A'x 75' extension onto the landward end of existing catwalk, to construct a 4'x 16' extension onto' the seaward end of th~ existing catwalk, structures shall be constructed e minimum of 4' above !grade of marsh, relocate existing 4'x 16' ramp and 6'x 16' float and to install an additional 6'x I6' float. At Meday Avenue, Mattituek, Town of Southold, Suffolk County, New York. , Applicant: Royston P. & lielen T. Rind Purpo.e: Private r~creational docking Locus: ~2°36 40°48 S,G.T,M.NO. 1000-11 ~-9-4 NVI~q]39 ..~N 'Id , SCALE, ~- 60 3O · IMO ~ ,-,,T,~,,,,c,m... .~"b n~,~.L,'".-t ~-~.',r~ ~,~s~F-~- SHEET (_./ · (.,ON,. LJI TING QUOGUF_', NY FROM : JmO CONSULTING PHONE NO. : 653 0607 Sap. iT~ 1997 10:05AM P05 ~>. On: J MO CONSULTING QUOGUE, I'1"/ 6.)5-~):/ Environmental Consulting Servi August 19, 1997 Mr. Albert J. Krupski, President Board of Town Trustees Town of Southold $3095 Main Road, P.O. Box 1179 Southold, N.Y~ 11971-1179 Re: Application for Roystcn Rind 1375 Meday Avenue, Mattituck S.C.T.M. No. 1000-113-9-4- Lots 47-50 Inclusive Dear Mr. Krupski: As per the Board of Trustees request at their last meeting, we are modifying this application. The applicant is currently requesting to construct a 4~x 75' extension onto the landward end of an existing catwatk~ to construct a 4'x 16' extension onto the seaward end of existing catwalk, structures shall be constructed a minimum of 4' above grade of existing marsh and relocated existing 4'x t6' ramp and 16' float. For your review and files, we have enclosed copies of the revised plan and cross section. As always, should you have any comments or questions regarding this request, please feel free to contact our office. GEJ:arh Most sincerely, ~lenn E.UJust~ Phone (516) 653-0607 ~ Fax (516) 653-3348 121 Jessup Ave ~ 2nd Floor ~ P.O. Box 447 Quo§ue, NewYork 11959-0447 Applicant proposes to construct a 4'x 75' extension onto the landward end of an existing catwalk, to construct a 4'x 16' extension onto the seaward end of the existing catwalk, structures shall be constructed a minimum of 4' above grade of marsh and relocated existing 4'x 16' ramp and 6'x 16' float. At Meday Avenue, Mattituck, Town of Southotd, County of Suffolk, New York.  Applicant: Royston & Helen T. Rind Purpose: Private recreational docking Locus: ~2°36~ 40°48 S.xC.T.M.N0. 1000-113-9-4 ' ' ~~k CoUnty ltagstro~ Map 28 Scale 1 =3,000 SCALE I'~ 60' 0 3O 6O J MO ZZ \ '--00 Ct. IWSULTI NG ©UOGUE, SHEET I OF 2 5,.5-Q,50 Z 0 )> · J MO GONSULTING QLIOGI. Jt}:~ H'F' ....... ~ Albert J. Kmpski, President John Holzapfel, Vice President Jim King Martin H. Garrell Peter Wenczel July 31~ 1997 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 ,¥.,Telephdne (516) 765-1892 Fax (516) 765-1823 J~M.O. Consulting Mr. Glenn E. Just P.O. Box 447 Quogue, NY 11959-0447 RE: ROYSTON RIND SCTM ~113-9-4, 47 & 50 Dear Mr. Just, The following action was taken at the Southold Town Board of Trustees Regular Meeting on July 30, 1997: RESOLVED, that the Southold Town Board of Trustees approve the request for an Amendme~t to Pe£mit 93623 to construct a 4' X 75' extension to an existing catwalk landward a min. of 4' above grade of marsh, add 16' to fixed dock and 1- 6' X 16' float. This approval does not constitute approvals from any other agency. If you have any questions, please feel free to contact our office at 765-1892. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK/djh ALL MOORINGS/ ~D STAKES :,lUST DISPLAY VIS LE MOORING ALL DOCKS ANb BULKHEADS MUST DISPLAY VISibLE PEREIIT NUMBERS Bo d Of S 'h i d T ~ ~:~.~"~,:: ....................................................................... ~"~ e~ ....~. Ioo~=D TO Roy,s~on P. ~nd' e ...... ~ ,,:~,~, Pursuan~ ~o ~he provls;ons of Chapter 615 of ~he Laws o$ %he State of New York, 1893: and Chapter 404 of ~he Laws of the State of New York 1952; and the Soufhold Town Ordinance eh- fffled "RE~U~TIN~ AND THE PLACIN~ OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC ~NDS and +he RE~OVAL OF SAND, ~RAVEL OR OTHER ~ATERIA~ FRO~ ~NDS UNDER TOWN WATERS;" and b accordance with the ~ Resolufion of The Board adopted afa meeting held on ~.~R~.z....~.~... · 8T .~ 19 ............. and in cons[deratlon of the sum of $_..~.~.:.99 ....... paid by ' ' Royston P. Rind o{ ...... ~.~.~.qS~ ............. ] ........................................... N. Y. and subject to-fhe ~' T6>ms and Condffions lisfed on the reverse s[de hereof,' o{ Soufhold Town Trustees aufhorkes and permih the following: ' Appro~ to construct ~ 80' x 4' catwalk~ 16' x 4' r~mp, ':: ~nd 16t x 6~ ~oat in ~ttituck G~eek,.to be constructed 4' ~b0v6 ~rade. ' .... all in accordance with the detailed .speciflcaHcns as presented ]n ' the or;glnating appllcaHon. IN WITNESS WHEREOF, The said Board of Trustees h,ere- By causes its CorpOrate Seal to be affixed, and these presents to be subscribed by a majority of the as of %his dat. e. Telephone ( 516~ 765-i801 Town HM1, 53{]95 Main Road P.O. Box 1179 Southold. New York 11971 SOUTt~OLD TOWN COI~SERV.iTION .iDVISORY COUNCIL The following recommendation was passed by the Southold Town Conservation Advisory Council at its July 28. 1997 meeting: A-IOU~ Moved by Kenneth Meskill, seconded by Melvyn Morris, it was RESOLVED to recommend to the Southold Town Board of Trustees DISAPPROVAL of the Amendment to Permit request of ROYSTON and HELEN RIND 113-9-[[ to construct a L~' x 75' extension onto the landward end of an existing catwalk, 4' above grade of marsh. Meday Avenue, Mattltuck The CAC recommends disapproval because the application should be a regular Wetland Permit Application, The permit being amended is ten ,/ears old. The CAC would recommend approval of the project if it were submitted as a Wetland Permit Application. Vote of Council: Motion Carried Ayes: Nays: Kenneth Meskill, Melvyn Morris, Mary Griffin, Scott Hilary, Bret Hedges, and Betty Wells Bruce Loucka CONSULTING PHON~ NO, : GDD 0G07 ~ul. ~D 1DD? 11:DGA~ PO~ j. 1.o. nv ronmental Consulting Services July 29, ~.997 Board of Town Trustees Town of Southold 53095 Main Road, P.O. Box 1179 Southold, N.Y. 11971-1179 Attn: Diane RE: Application for Rind, Mattituek Dear Diane: At th~ present time, we kindly request to modify the original grandfather appliontion to inolude two (2) additional 6~x 16' floats to form an "L" formation. Please find enclosed the revised plans depioting this change. Should you have any questions or comments, pleas~ feel free to oontaet our offtae. Mo~t sinoer~l~, ,~ arb Phone (516) 653-0607 · Fax (516) 653-3348 121 Jessup Ave · 2nd Floor · RO, Box 44.7 Quogue, NewYork 11959-0447' FECM ; JmO CONSULTING PHONE NO. : 6S3 0607 3ul. 29 1997 11:36AM P84 JUL 2 [~ ]997 )2icant proposes to construct- a extension onto the landward end o£ an existing catwalk , structure shal! be constructed a minimum o£ 4., above grsde of marsh. And to install ('2) ~*o 6"x 16' floats. At Meday Avenue, Mattituck, -Town of ~ou~hold ,County'of Suffolk, Ngw York. ' Applicant: Royston P. & Helen T. Rind Purpose: Private recreational docking LOCUS/ ~2°136' 40e48 ~S.C.T.M.NO. 1000-113-9-4 I -->.,. SCALE I~ 60' CONoUIZI lNG' QLJOGU['!:' TUCK Suffolk County Hagstrom Map 28 Scale 1"=3,000 FR~M : JmO CONSULTIN~ PHONE NO. Z J MO CONSULTING r- QUO6UE', Jul. 29 1997 11:36AM P03 I--~,~C~NC RETE MQN, NY Environmental Consulting Services ~:w 21, 1997 [TOWN OFSOUTHOL_~D Mr. Albert J. Krupski Board of Town Trustees Town of Southold 53095 Main Road P.O. Box 1179 Southoid, N.Y. 11971-1179 RE: Property of Rind, Mattituck Dear Mr~ Krupski: Enclosed please find the recent approval from the N.Y.S.D,O.$, for this project (Letter of No Review Necessary) Should you have any questions regarding this project~ please feel free to contact our office. arh Phone (516) 653-0607 - Fax (516) 653-3348 121 ]essup Ave · 2nd Floor · P,O, Box 447 Quogue, NewYork 11959-0447 TOWN George E. Pataki Alexander E Treadwell Secretary of State Glenn E4 Just J.M~O Consulting P.O~ Box 447 Quogue, NY 11959-0447 Dear Mr. Just: Re'. July 15, 1997 F-97-473 U.S. Army Corps of Engineers/New York District Permit Application #97-08040-L2 Rayston P. and Helen T. Rind - catwalk extension Mattituck Creek Town of Southold, Suffolk County No Review Necessary_ The Department of State received a U.S. Army Corps of Engineers letter on July 9, 1997 indicating that a Corps permit is not required for the above-referenced activities. Therefore, no review of this project by the Department of State is necessary. If you have any questions regarding this matter, please call Steven C. Resler at (518) 474-6000. WFB/SCR C' Since~ly; ~hilie;;~cFo~sa[etffcny/~Re~iew and Analysis COE/New York District - James W. Haggerty NYSDEC Region 1 - Regional Permit Administrator NYS DEPARTMENT OF STATE Division of Coastal Resources and Waterfront Revitalization Albany, NY 12231-0001 Voice: (518) 474-6000 Fax: (518) 475~2464 George E. Patak{ Alexander E Treadwell Secretary of State Albert J. KrupskL Jr. Trustee, Town of Southold 53095 Main Street P.O~ Box 1179 Southold, NY 11971 Re: July 7, 1997 F-97-473 U.So Army Corps of Engineers/New York District Permit Application - Royston P. Rind & Helen T. Rind, Mattituck Creek Dear Mr. Krupski: Enclosed is a copy of the information submitted to the Department of State for review of the above-referenced project with respect to its consistency with the Coastal Management Program for your information and preliminary review. Please contact Steven C. Resler, the DOS reviewer assigned to this project, at (518) 474-6000 to discuss your concerns, and any additional itifomation which may be necessary to assist you in reviewing this project. Any comments you may have wili assist the Department in reaching a decision as to the consistency of the proposed action with the approved NYS Coastal Management Program. Please note, however, that if we do not hear from you within 45 days of the date of this letter, we will presume that you have no objections to the proposed project. \~ ~ Si_ncerely, ,t ~ William F. Barton Chief, Consistency Review and Analysis Enclosures WFB: dlb ]¥3~'S DEPARTM~q*T ~ STATE Division of Coastal Resources and Waterfront Revitalization Albany, ~ 12~1-0001 Voice: (518) 474-6000 F~: (518) 473-2464 LOLA]'~ON" Meday Avenue, Mattituck PHOIO6RAPHF_D['12 June '97 au 1200 Hrs. NY 655.G.~7 APPLILAN'I' PropeKty of Rind · LO£A].iON~ Meday Avenue, Mattituck pHOIO6RAPHED/12 June '97 at 1200 Hrs. · .1 MO OOIq~: '~1. !1.ii QUOGUE~ 655~®7 APPLILAM'I~ Property of Rind · LO.CAItON" Meday Avenue, Mattituck pHOHO~RAP~iED[-12 June '97 at 1200 Hrs. QUOGUE, :' Ny , I MO COI~II: :l, II '['lNG 655~7 APPLICAN] ~ Property of Rind . LO£AIION" Meday Avenue, Mattituck ~HO]O6RAPHLD[~12 June '97 at 1200 Hrs. I MO COl/, ,I..11 rING O. UOGUE~ Albert J. Krupski, President ' John H'olzapfel, Vice President Jim King Martin H. Garrell Peter Wenczel BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892. Fax (516) 765-1823 Office Use Only Coastal Erosion Permit Applicati( Wetland Permit Application Grandfa~it Application ,~.Waive~__~ndmen-~C~a~ge~ · ( Received App--: Received Fee:$ Completed Application ~ Incomplete~%~O SEQRA C las~£~-i~ation: Type I Type I! Unlisted Coor~ination:(d~e ~se~t) ~_CAC Referral Sent: ~ Date of Inspection7 Receipt of CAC Report] Lead Agency Determination: Technical Review: ~-pUblic Hearing Held: ~---Resolution: N~ne of Applicant Address TOWN_____OF $OUTHOLD Royston p. & H'elen T. Rind P.O. Box 74 Mattituck N Phone Number:(516 ) 2DR-Sq~S Suffolk County Tax Map Number: 1000 - 113-9-4 Lots 47-50' inclusive Property Location: Meday~Avenue, Mattituck cross street Howard Ave (provide LILCO Pole ~, distance to cross streets, and location) AGENT: Glenn E. Just/ J.M.0. Consulting (If applicable) Address: P.O. Box 447, Qlloff]~: ?f,.y. 11qq9-~447 Phone: 653-0607 FAX~: 653-3548 Beard of Trustees Application GENEtlAL DATA Land Area (in square feet): Area zoning: Previous use of property: Intended use of property: single famil¥~dwell~n~ single family dwelling Prior permits/approvals for site improvements: Agency Date NYSDEC Oct 26, 1987 No prior permits/approvals for site improvements. Has any permit/apProval ever been revoked or suspended by a governmental agency? xx No Yes If yes, provide explanation: Project Description (use attachments if necessary): ~ Applicant proposes t~ ~np~tr~ot 8 4'~ 75~ ~¥tension onto the landward end of an existing catwalk~ structur~ ~b~]] h= constructed a minimum of 4' above grade of marsh. Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: privai_e__~ecreationa] dockinE Area of wetlands on lot: n/a square feet n/a % Percent coverage of lot: Closest distance between nearest existing structure and upland edge of wetlands: n/a feet Closest distance between nearest proposed structure and upland edge of wetlands: n/a feet Does the project involve excavation or filling? No Yes If 'yes, how much material' will be excavated? How much material will be filled? 0 Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations:_ n/a Manner in which material will be removed or deposited:_ n/a 0 cubic yards cubic yards n/a Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason, of such proposed operations (use attachments if appropriate): As proposed, pr_p_~ct shall ha ' ' upon the waters or wetlands of the Town of Southold 14-1~-4 i~87)--Text 12 I"~:"ROJECTI.D. NUMBER 817.21 Appendix C State Environmental Quall~y Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only ~ART I--PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT/SPONSOR I 2, PROJECT NAME Royston P. Rind & Helen T. Rind I ' Proposed dock extension 3. PROJECT LOCATION: ~U f f O 1 k MumclpaHty H a t t i t u c k county .. SEQR ' 4. PRECISE LOCATION (Street address and road Interseotl~s, prominent landmass, etc., or provide m~) Northeast corner of Howard & Meday Avenues No # ; S.C.T.M,No. 1000-113-9-4 Lots 47-50 inclusive Location Map enclosed , 5. IS PRqPOSED AC.T~N: ~.~lew , ~,,L~xpanslon [] Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: Applicant proposes to construct a 4'× 75' of an existing catwalk,s~ructure shall be above grade of marsh. extension onto the landward end conskructed a minimum of 4' 7. AMOUNT OF LAN~/AFFECTED: Initially · acres Ultimately ,.,i~''~ . acres 8. WlL~. PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE Rt:~ir~iCTIONS? [] No If No, describe briefly . 9. ~/rH~T IS PRESENT LAND USE IN VICINITY OF PROJECT? kJ/~.J~Resldentlal [] Industrial [] Commercial Describe: [] Agriculture [] pork/Forest/Open apace [] Other 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? [] No If yes, list agency(s) and permit/apprOvals $outhold Town Trustees, N.¥.$.D.F..C.,N.¥.$.D.0.$. & U.,S.D, O.A. 11. DOES ANY AS,~ECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [] Yes ~.No If yes, list agency name end permit/approval 12. AS A RESULT .~PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? []Yes ,t~--J No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST {~F MY KNOWLEDGE Applicant/sponsor name: Gi~. J~st~r~ age;t Date: 1 Signature: II the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 Applicant proposes to construct a 4'x ~5' extension onto the landward end of an existing catwalk , stru&tu, re shall be constructed a minimum of 4~, above grade of marsh. At Heday Avenue, Mattituck, Town of Southold, County'of Suffolk, New York. Applicant: Royston P. & Helen T. Rind cPurpose: Private recreational docking ~Locus: ~2°36* 40°48 ~S.C.T.M.NO. 1000-113-9-4 NYAFT139 ~N "id SCALE 1'~60' Suffolk County Hagstrom Map 28 Scale 1"=3,000' 3O o T JMO O01',I,_~UE lNG QUOGUE~ NY S G55-~7 C Z J MO CONSULTING o. CONCRETE MON, QUOGUE~ 'NY G55-~7 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: Martin & Florence Gellman Meday~Avenue~ Mattitdck ~661. I!]dv 'O0~S LUJO_d Sd STATE OF NEW YORK COUNTY OF SUFFOLK a. ~/~_/~¢~_~ , ~e~idi~g~at ~0 ~ ~, ~ ~ I~ ~?~?~dayo~9({&f ' being ~u±y sworn~ deposes and says ~-~-e~ ,19 f'~ , deponent mailed a true copy of the Hotice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roil of the Town of Southold; that sai~ Notices were mailed at ~he United ~_~ , that said Notices States Post office at ~ ~ersons b~ (cer ' ' d~ (re 'st mail.were mailed to each of ~~~' Sworn to~b~ore me this ~ ~ / day of ~%Q~c_ ,19 %~ ~ Notary PQblic ' cHERYL S. TAUNTON No~ Public, State of New¥Ork No. 52-4911852 Qualified in SuffOlk count~ C~mmiSsion Expli'es Nov. 30, PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: ~ Archie & Marlene Israel Address: 690 Howard Avenue, Mattituck STATE OF NEW yON COUN~ OF SUFFOLK ~ [~[ ~0Y g~9~ ~ , being duly swor~ depots and says ~_~ ,19 f'~ , deponent mailed %~a~ on the~ ~ day o~ ..... a true copy.~f the Notice set forth in the Board of Trustees Application, directed to each of the above name~ persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the sa~ Notices were mailed at'the United Town of Southold~ that ~3-~ , that Said Notices States Post Office at s~-~ersonJ DZ (c~r ' ' d)' (re ~st ~ d) mail.were mailed to each of Sworn to before me this ~ Notary Public CHERYL S TAUNTON Notary Public, State of NewYork No. 52-4911852 Qualified in Suffolk County Commission Expires Nov. 30, 19..L. Bc .d of Trustees Application AUTHORIZATION (where the applicant is not the owner) I, ~ ~-~ ~ ~ ~A3~ residing at ~0.~.f /~j~ ~ ~ (p~int owner of property) (mailing address) J.M.0. Consulting do hereby authorize -Glenn.E. Just/ (Agent) 'to apply for permit(s) from the ~"~ :~ ~ru=~-~= on my behalf. Suu=~o~= Board of Town ~ -~==- ('Owngr s si~hature) / Ba _~d of Trustees Application County of Suffolk State of New York DEPOSES AND AFFI~4S THAT HE/SHE IS '£~m ~PLICAR~T FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS COSVfAINED 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 A~ND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN ~ ~ ~ ~ ~.~.~ ~V~E THE u'RUSTEES COMPLETING THiS ~PrL±C~Tx~, I HEREBY THEIR AGENT(S) OR REPRESENTATIVES(S), TO F~TER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION- Si~natur~ ! ??. DA OF SWORN TO BEFORE ME THIS ALICE C. MecDONkLD Notary Public l%totary Public, State of New York No. 4879351 Quelified in Suffolk Coun~ ~mmi~ion E~kes Dec. 7 34 L O N G 35 Id A i T U CK / I' I .I I / / /'Q T 0 THE OFFSET5 IOR OIMENIlOtI~} ~Ow~ tIEREO~t F R.O M I It f ~TDUflTtI.E$ TO THE ~ROPE.TY GUARMITE[$ INDICATED HEREON CO~l~ OF T~I~ SURVEY U~P 'HOT OEA~IrIG THE LANO SUflVEYOR'~ A VALID TRUE COPY. · SCALE: I "= GO' DATE: "FILED I'~AP Nb: 7"f-~ bATE: S-Io-P-I .BOOK Nor F'AC, E: HAROLD F. TRAHCHoH $~. P.C LAHD &URYE¥OR HOKTH CBUIITRy RoAP-~/ADIN~ EtV[~ N.y.