HomeMy WebLinkAboutTR-4513 Board Of Southold Town Trustees
SOUTHOLD, NEW YORK
PERMIT NO. f'~'./' ~ DATE: ...9./.28/95
ISSUED TO _..ADELE..IA~GE
Pursuan+ fo +he provisions o{ Chaplet 615 of fhe Laws o~
+he Sfafe o~ New Yo&, 1893; and ~apfe~ 404 of fhe Laws of fhe
Sfafe o~ New York 1952; and +he Sou+hold Town Ordinance en-
filled "~E~U~TIN~ AND THE PLACIN~ OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS and fhe
RE~OVAL OF SAND, ~RAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN WATERS;' and ~n accordance wi+h fhe
ResoJufion of The Board adopfed a+ a mee+ing held on
199~ ...... and in cons~derafion of fhe sum o~ $ ~O0~00 paid by
o~ .~0~ ~.. N. Y. and sub~ecf fo fhe
Terms and Conditions Ils+ed on +he reverse side hereo{,
of Southold Town Trus+ees aufhorlzes and perm~+s fhe following:
C~s~&E~he~ ~e~ Eo~ ~ 50~ ~Z~e~ (30~ oE
~e~Zsce~ ~=&/~Zsce) w~ 4[~ ~e~=. 20a ~e~= ~=~ ~ ~0~
~e~7 o= ~e so~ s~e, s 30~ ~e~=y o= ~he ~o~
~e~Yall in accordance wi+h +he derailed specifications as preen+ed in
Ze~ orlg~na~ing ap~Jlcaf~on~° ho~se,' s=~ ~ ~5 b~EEe~
5~Z~e~d. ~?es 'Cove, ~;~o=~c
IN WITNESS WHEREOF, The said Board of Trusfees here-
by causes ifs Corpora+e Seal ~o be a~fixed, and +hese presenfs
be subscribed by a maiori+Y o~ +he said Board as of
.....
T~tees
Albert J. Klupski, President Town Itall
Johfi Holzapfel, Vice President 53095 Main Road
William G. Albertson P.O. Box 1179
Martin H. Garrell Southold. New York t 1971
Peter Wenczel Telephone (516) 765-1892
Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Coastal Erosion Permit Application ln~{~ ....
__~tland Permit Application UUt ~ ' 3 '~5 ii~5
~ Grandfather Permit Application
Trustee Lands Permit Application ~--~
-- . . TOWN
~ved Applicati~: ~/[~/?~
7Completed Application ~/IX/~
Incomplete
SEQ~ Classification:
~e I ~e.II Unlist~
~o~dination. (~ate seDt). ~
~CAC Referral Sent: ~//~/g~
~ate of Inspection: ~_~
~eceipt of CAC Report: (da%e)
Lead Agency Determination:
Technical Review: (date) .
~P~ic Hearing: (dat~
Dec~sion: ApDrov~d~(Y~) (aate) ~/~
~pplication~ee: $~ d-- . ~ /
Name of Applicant ~k~ ~
Phone N~er:(~/~) 7?~-
Suffolk County Tax Map N~ber: 1000 -~.~- ~- ~
Location:~A~6~ FOAb ~ ~L~ b
Property
{provide LILCO Pole ~, di nce to cross streets, and location)
( If applicable)
~oard of Trustees Applicat~ n
GENERAL DATA
Land Area (in square feet):
Area Zoning: ~ ~-qt b~?/~ ~
Previous use of property: ~(ST,~
Intended use of property:
Prior permits/approvals for site improvements:
Agency Date
No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspended by a
governmental agency?
/ No__ Yes
If yes, provide explanation:
Project Description (use attachments if necessary):
County of Suffolk )
Stake of New York )
~~ ~ C0ST~A~0~ S~o BEING DULY SWORN DEPOSES AND
AFFIRMS THAT HE/SHE IS Tim APPLICANT FOH THE ABOVE DESCRIHED
PERMIT[S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO
THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT 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 CoMPLETINd THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES,
THEIR AGENT[s) OR REPRESENTATIVE(s), TO ENTER ONTO MY PROPERTY
TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS
APPLICATION.
SWORN TO BEFORE ME THIS DAY OF ~,~.~ ,19 ~
SUSAN F_ LONG
U~LIC~ Notary Pub;it, State of New ~
~ ~Qu~lifi_e4 in $~k ~ __
P
Suggested space for location Map
TIIIS IS NOT A PERMIT
IPROJECT I O. NUMe~e I 6tr..21 SEQR
Appendix C
Stale Envhonmeetel (]frailty Review
SttORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS O~y
~ART I--~OJECT IH~o~MATIoH (To b~ completed by Applicant of ProJecl ~ponsor)
Costello Marine Contracting Corp.~ ~ ~, '~ ~t~
U..Iclp~ty ~Q ( ~ ~_~ ~ cou,,,~ Suf folk
See Attached area map.
WILL PROPOSEO ACTION COMPLY WIItl EXIS11I'IG ZONING OR OTHER EXISTING LAtlD USE rlE~lnlCtION~;?
{~ Yee [] No I! Ho. d.~cHbe bTlelly
WHAt IS PReSeNT LANO USE IN VICINITY OF PF~O.IFCT?
WATERFRONT
COSTELLO M~RINE CONTRACTING Unle:_ _
It lifo mellon Is In the Comslal Ar.~. and you are a slate agency, complete the
Coaslal Assessm~nl Form belore proceeding with.this as~gmenl
I
OVER