HomeMy WebLinkAboutJackson, Warren 2017 Revocable Trust rza
Glenn'Goldsmith,President ����SUFFU(�COGy Town Hall Annex
A.Nicholas Krupski,Vice President 54375 Route 25
0
Eric Sepenoski ,? P.O.Box 1179
Liz Gillooly 4,-
• o�� Southold,NY 11971
Elizabeth Peeples ol *r �a l Telephone(631)765-1892
Fax(631)765-6641
Southold Town Board of Trustees
Field, Inspection Report
Date/Time: .5 /q /
2 Completed in field by: (3, 0." I�.�,,
En-Consultants on behalf of WARREN W. JACKSON 2017 REVOCABLE TRUST
requests a Pre-Submission Inspection to discuss undertaking a shoreline
restoration/erosion control project, possibly consisting of a low-sill bulkhead and/or
stone rip-rap. Located: 300 Deep Hole Drive, Mattituck. SCTM# 1000-115-12-4
TTof area to be impacted:
Saltwater Wetland Freshwater Wetland Sound Bay
Part of Town Code proposed work falls under: VChapt.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.:
D;s�ts��� pcoc��s�d 10..✓ s;11 6v �� �n.�.�+
Present Were: G. G Idsmith \/ N. Krupski i/ E. Sepenoski
�L. Gillooly ,/E. Peeples
EN-CONSULTANTS
_ � n
April 19, 2023
Glenn Goldsmith, Chairman APS 19 2023
Board of Trustees ._
Town of Southold
P.O Box 1179
Southold,NY 11971
Re: Warren W.Jackson 2017 Revocable Trust,300 Deep Hole Drive,Mattituck, 1000-115-12-4
Dear Mr. Goldsmith:
We have been retained by Todd Jackson, as Trustee of the Warren W. Jackson 2017 Revocable
Trust, for the purpose of exploring the feasibility of obtaining permits to undertake a shoreline
restoration/erosion control project,possibly consisting of a low-sill bulkhead and/or stone rip-rap.
As we would like to discuss potentially approvable solutions with the Board, please accept this
letter and enclosed checks as a request for a pre-application site meeting during the Board's next
available field inspections. Also enclosed is an old survey copied from a prior Trustees permit;
"Board of Trustees Application"affidavit forms authorizing the Trustees to enter the property;and
"Board of Trustees Application" agent authorization forms authorizing En-Consultants to act on
the owners' behalf.
Should you require any additional information prior to meeting me at the site,please let me know,
and I thank you for your attention to our request.
Res ctfully yours,
Robert Herrmann
Coastal Management Specialist
Enclosures
1319 North Sea Road Southampton,New York 11968 p 631.283.6360 1 f 631.283.6136 www.enconsultants.com
environmental consulting
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Southh()I Town
Board of Trustees i
Board of Trustees Application
AFFIDAVIT
Todd W.Jackson,Trustee,Warren W.Jackson 2017 Revocable Trust BEING.DULY SWORN
DEPOSES AND AFFIRMS THAT HE/SHE IS THE.:APPLICANT YORTHE ABOVE
DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN
ARE TRUE TO THE BEST OF 111WHER,KNOWLEDGE AND RELIEF,.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.SOUTH.0,LD 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, T
.INCLUDING HE
CONSERVATION ADVISORY Y COUN CIL.-TO ENTER ONTO MY PROPERTY TO
INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION,
INCLUDING A.FINAL INSPECTION. IFURTHER AUTHORIZE THE.BOARD OF
TRUSTEES TO ENTER ONTO.MY PROPERTY AND AS REQUIRED TO INSURE
COMPLIANCE WITH ANY CONDITION OVANY WETLAND OR COASTAL
EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM
OF THETERMIT.
N/A . .....
Signature*o P Property, Owner ...... Sig m46'6f.P..rop.erty Owner
Todd W.Jackson,Trustee,Warren W.Jackson 2017 Revocable Trust
SWORN TO BEFORE ME THIS DAY OF' 5 20
Notary Public
BARBARA H.TANDY
Notary Public,State Of New York
No. OITA6086001
Qualified In Suffolk County jj ,3. ';k77
Commission Expires e'erI
APPLICANT/AG.ENT/R.EPRESENTATIVE
TRANS:A.CTIONAAL DISCLOSURE FORM
The T a f hold' of Etl ics ibis c nfiicts of t on the w r.e e 1 0
,
" fornt t rov nfb ` atio w to can: e e t tend II w•rt to t atevci acts n i
nese—Mry to avid wine.
Todd W.Jackson,Trustee
Warren W.Jackson 2017 Revocable Trust
YOUR NAME:
(Last name,.first name;>?iiddle:initial,finless you are applying in fhe name of
someone else or otliec.entity;.such as a company.Ifso,indicate the other:
person's or company's name.)
NAME OF APPLICATION: (Check ail that apply.):
Tact grievance Building
Variance Trustee x
Change of Zone Coastal Erosion
Approyal of plat Mooring
Exemption from,piat ovofficial map Planning:
Other
(If"Other':,name the activity.)
Do you personally"(orthrough yoar coinpany,spousse,sibling parent,or-child)have a relationship;vitli uny.+afficcr or.etnployee
of the Town of Southold?"Relationship",includes by blood;tiiarriage;or busi4css..Jgi kgesL"BUSlKSS interest"4neansa.businoss,
including a.partnership,inwhichthetosiwnrftTcerbrcrtiployes tial even a`P;oi lowncrsltipoC(orenMploymohtby)acorporation
in which the t6wn•officer or employee owns snore than 5%Dftj1e shares.
YES
NO
ifyou answered"YES",complete the baianceofthis 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(theapplicantlagent/representative)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:fhat apply):
A)ttte ownos ofgrettter;thati 5"/aofthc shares:oftlte_corporate:stoc of...e applicant
.� (±�4hen,tlt�sippticarit is:aedrparatioq);.
$}tlie'.legafor benefictM 6vner pf:any iateresein a non.=corporate entity(when the
hpplicaai isnot i'corpomtion) .
G)ati 0. Icer,'tiiNctor, .pai"Mor;or employee,02 tl*Apptibant,'or
Dl the actual applicant.
DESCRIPTION OF.RELATIONSHIP
Submitted this a- d of� 20
SigptitM - .
Print Name. Todd w
KWarren W:Jackson 2017 Revocable Trust
Form TS I
Board. of Trustees Application
AUTHORIZATION
(Where the:applicant is'not the owner).
T/ViWe Todd W.Jackson,Trustee,Warren W.Jackson 2017 Revocable Trust
owners of the property identified as SCTM# 1000, 7572 4.... in the town o
Southold . .New York;hereby authorizes
En-Consubnts
to act as my agent and:handle all
necessary work involved with the application process for p!-,Mi_t(s) from xhe Southold Town
5oard'of Trustees:for this property:
WA
Property Owner's Signature Property Owner's Signature
Todd W.Jackson,Trustee,Warren W.Jackson 2017 Revacable Trust
SWORN TO BEFORE ME THIS (�- 1..:. . .:,DAY OF _;20. 3
Notary Public
II
BARBARA H.TANDY
Notary Public,State Of New York
No. 01TA6086001
Qualified in Suffolk County S 20a.1
Commission Expires COMM