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Home My WebLink AboutTR-10539A r'� i ®� S®(/ Town Hall Annex Glenn Goldsmith, President ®�� ®� 54375 Route 25 A. Nicholas Krupski,Vice President o� ® P.O. Box 1179 Eric Sepenoski FJ�i Southold, New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples y® Fax(631) 765-6641 ®ly&UU BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITIES CHECKED OFF BELOW INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1 sc day of construction '/z constructed When project complete, call for compliance inspection; S.C.T.M. N0. DISTRICT: 1000 SECTION: 97 BLOCK: 7 LOT(S): 7 rAON._ APPROVED BY BOARD OF 1 TRUSTEES --��Q� ' '��RF k\ TOWN OF SOUTHOLD 'n's S'69o. �o�U„r DATE MozcJ\ :9-0 a LI 'r LOT 28 G EO&C Lf 9 0' :::.... foo861 J / {� Wit::•:::_:•:::•:::�::•::•idy�1.•�'FRA':::•: :!;;r:•;•. I �:i}''r��:is�::•i:{iii.:'/f•�KJNG_. 1.:::::... r' Blue Spruce LOT 27 W.M. Eastern red cedar Hollywood Beach Plum Juniper Q N 4 (0 °qT Eastern red Hollywood � ,, cedar Juniper o MON. Bayberry = GUYWhite Spruce. 340.00' U.P. y 6 FRM. FqO '• .3: SHED S 86030' '� W a 4.6'S Red Poin Bayfi�erry / Bayberry Maple �' Beach Plum Sea Green C4GE ot" pAVE►AeM' Beach Plum Juniper Sea Green Juniper - - - AN�� - 174E WATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL LOCATIONS SHOWN ARE FROM FIELD OBSERVATIONS Plant Schedule: AND OR DATA OBTAINED FROM OTHERS (1)4" Red Point Maple (7) Native Eastern Red Cedar AREA: 29,263.34 SQ.FT. or 0.67 ACRES ELEVAnON DATUM: (7) 6-8'Beach Plum *Berm not to �- UNAUTHORIZED ALTERATION OR ADD/710N TO 7HIS SURVEY IS A VIOLA77ON OF SECTION 7209 OF THE NEW YORK STATF EDUCAAON LAW. COPIES OF THIS SURVEY (8) 36" Bayberry exceed 18" In MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN (3) 5-6'White Spruce height* ONLY T THE',EANDNT FORTH E AOM THE EESSURVEY I PREINGED AND ON HIS BEHALF FES ARTHE E 777LE C SPANY GOVERNMENTAL AGENCY AND LENDING INS77TV77ON (3) 5-6'Blue Spruce 7HE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE 77JEREFORE THEY ARE (6) 8-10' Hollywood Juniper NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES, ADD177ONAL STRUCTURES OR AND OTHER IMPROVEMENTS EASEMENTS (6) 5-6' Sea Green Juniper AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON 7HE PREMISES AT THE TIME OF SURVEY SURVEY OF: LOT 27 CERTIFIED TO: JOHN L. GALGANO; ® MAP OF: MOOSE COVE LAURA M. GALGANO; FILED:AUGUST 30, 1960 No.3230 FIDELITY NATIONAL TITLE INSURANCE COMPANY; MAR - 1 2024 SITUATED AT: EAST CUTCHOGUE CITIBANK, N.A.; TOWN OF: SOUTHOLD KENNETH M WOYCHUI{ LAND SURVEYING, PLLC Southold Town Board of Trustees SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design � � P.O. Bog 153 Aquebogue, New York 11931 PHONE (831)298-1588 FAX (631) 296-1588 FILE # 18-23 SCALE: 1"=30' DATE: MARCH 5, 2018 N.Y.S. LISC. NO. 050882 morn talnlng the reoorde of Robert J. Heaneary /c Kenneth lI. 1loyahuk S.C.T.M. NO. DISTRICT: 1000 SECTION: 97 BLOCK: 7 LOT(S): 7 MON. S 6 0 ti 9 j :lees ti LOT 28 9.0. 86-1 OP ...... °' o c.... .. N �1 •:i::r:•::a•:-:i:Cati•}6,T':; :iirtii: ii::•r:t:•r::O �" •.�:::::::::::.. ::::::::::............ ::::::::r MON. LOT 27 W.M. 0� p ^1 p �O 0� oql a c �'Y J > 4 2 MON. �j>l/ ti 340.00' GUY FRM. ° U. SHED S 8603010011 W $ 4.6'S c" / EDGE OF PEW AS - - --- - -- - ER LA�1E - AN�'L THE WATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL LOCH77ONS SHOWN ARE FROM FIELD OBSERVA77ONS AND OR DATA OBTAINED FROM OTHERS. AREA: 29,268.34 SQ.FT. or 0.67 ACRES ELEVA77ON DATUM.- UNAUTHORIZED ALTERA77ON OR ADD17ION TO THIS SURVEY IS A WOLA77ON OF SEC77ON 7209 OF THE NEW YORK STATE EDUCA77ON LAW. COPIES OF THIS SURVEY MAP NOT BEARING 77-IE LAND SURVEYORS EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN ONLY TO 7HE PERSON FOR WHOM THE SURVEY 1S PREPARED AND ON HIS BEHALF TO 7HE 7177E COMPANY, GOVERNMENTAL AGENCY AND LENDING INS77TU77ON LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INS77TU770N, GUARANTEES ARE NOT TRANSFERABLE. 7HE OFFSETS OR DIMENSIONS SHOWN HEREON FROM 77-IE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE NOT INTENDED TO MONUMENT 7HE PROPERTY LINES OR TO GUIDE THE EREC71ON OF FENCES, ADD177ONAL STRUCTURES OR AND 07HER IMPROVEMENTS: EASEMENTS AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE TIME OF SURVEY SURVEY OR LOT 27 CERTIFIED T0: JOHN L. GALGANO; MAP OR MOOSE COVE LAURA M. GALGANO; FILED:AUGUST 30, 1960 No.3230 FIDELITY NATIONAL TITLE INSURANCE COMPANY; SITUATED AT: EAST CUTCHOGUE CITIBANK, N.A.; TOWN OF: SOUTHOLD KENNETH M WOYCHUK LAND SURVEYING, PLLC SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design �j* P.O. Box 153 Aquebogue, New York 11931 FILE # 18-23 SCALE: 1„-30' DATE: MARCH 5, 2018 PHONE (831)298-1588 FAX (631) 298-1588 N.Y.S. LISC. NO. 050882 molntHning the records of Robert J. Kemeny All Kenneth M. Woychuk 1 Glenn Goldsmith,President ®� S®(/ 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 C®U V BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10539A Date of Receipt of Application: January 26, 2024 Applicant: John & Laura Galgano SCTM#: 1000-97-7-7 Project Location: 780 Beebe Drive, Cutchogue Date of Resolution/Issuance: February 14, 2024 Date of Expiration: February 14, 2027 Reviewed by: Board of Trustees Project Description: For planting along Antler Road consisting of: (1) 4" Red Point Maple; (7) 7-8' Native Eastern Red Cedar; (7) 6-8' Beach Plum; (8) 36" Bayberry; (3) 5-6' White Spruce; (3) 5-6' Blue 'Spruce; (6) 8-10' Hollywood Juniper; and (6) 5-6' Sea Green Juniper; with the condition that the proposed berm not exceed 18" in height. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the site plan prepared by Coastal Plantings, Inc., received on March 1, 2024, and stamped approved on March 6, 2024. Special Conditions: None. Inspections: Final Inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. 4�-O- 4" Glenn Goldsmith, President Board of Trustees RUST� EES Nma_, 1.10 �39� IssuedT �o sor, �' G�.c .,,, .date"Al�y a Addl"CSS ZM2 Bezj�A �r�vc C"Ti&M%ft s_ THIS NOTICE A�IUST BE DISPLAYED' DURING- CONSTRUCTION TOWN'TRUSTEES OFFICEa7'O1AiRl OF SOU,TFIOCD SOUTHOLD, N.Y. 11971 TEL.: 765.1892' Gletu'i Goldsmith,President Town Hall Annex A.Nicholas Krupski,Vice President < 54375 Route 25 Eric Sepenoski y ,? P.O. Box 1179 Liz Gillooly �y • o�� Southold,NY 11971 Elizabeth Peeples � �a' Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: Z17 Z`I Completed in field by: M K'All Coastal Plantings Inc., on behalf of JOHN & LAURA GALGANO requests an Administrative Permit for a planting along Antler Road of: (1) 4" Red Point Maple; (7) 7- 8' Native Eastern Red Cedar; (7) 6-8' Beach Plum; (8) 36" Bayberry; (3) 5-6' White Spruce; (3) 5-6' Blue Spruce; (6) 8-10' Hollywood Juniper; and (6) 5-6' Sea Green Juniper. Located: 780 Beebe Drive, Cutchogue. SCTM#: 1000-97-7-7 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 Pre-Submission Violation Notice of Hearing card posted on property: Yes No ✓Not Applicable Info needed/Modifications/Conditions/Etc.: Present Were: G. 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NXl born G•rc.N,M:s{.5T/lilN W E A'GF%ImFO M ar 117=; ,w NF sounnl0 097 c,ffdn COam TwrN i0 p ____.__ nw-e.nrn_ __..—_ ,.. •�••+w l21) ,r. r> vmloRT�rtTiit rts'as901t n'1� p p�.M —____ S PH1 f1NilTf TW YrJrv,£nIBLY ac.R2 1'W+�ar I OFFICE LOCATION: ��f S0(/ryQl MAILING ADDRESS: Town Hall Annex O P.O.Box 1179 54375 State Route 25 Southold,NY 11971 (cor.Main Rd. &Youngs Ave.) y Southold,NY 11971 a� Telephone: 631 765-1938 olycom LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Glenn Goldsmith, President Town of Southold Board of Trustees From: Mark Terry, AICP LWRP Coordinator Date: February 12, 2024 Re: LWRP Coastal Consistency Review for Galgano Residence SCTM# 1000-97-7-7 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department and the records available to me, I recommend that the proposal is CONSISTENT with LWRP Policies and with the LWRP. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Honorable Lori Hulse, Attorney Glenn Goldsmith,President $ �,� � � �.. Town Hall Annex Vice President 54375 Route 25 .. A.Nicholas Krupski, P.O.Box 1179; Eric Sepenoski Southold,New York 11971. Liz Gillooly Elizabeth Peeples - Telephone(631) 765-1892 Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application Wetland Permit Application EG E t V Administrative Permit D re Amendment/Transfer/Extension —d eceived Application: �•�v• JAN 2640 Received Fee: $�, Completed Application: •u.•? `� Incomplete: Southold Town SEQRA Classification: Type I__ Type II Unlisted Nega tv otT steel Lead Agency Determination Date: _ oordination:(date sent):. LWRP Consistency Assessment Form Sent: CAC Referral Sent: Date of Inspection: Receipt of CAC Report:._ _ Technical Review: Public Hearing Held: Resolution: . Owner(s)Legal Name of Property (as shown on Deed): John and Laura Galgano Mailing Address: 130 Antler Lane Cutchogue NY 11935 Phone Number: 914-837-9866 Suffolk County Tax Map Number: 1000- 97-7-7 Property Location: 130 Antler Lane Cutchogue NY 11935 (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): Coastal Plantings Inc Mailing Address: PO Box 484 Peconic NY 11958 Phone Number: 631-734-7443 Email-.info @ coastal pl anti ngs.com Galgano Residence— 130 Antler Lane Cutchogue NY 11935 Plant schedule: •Supply and plant along 12' off Antler Road,: (1) 4" Red Point Maple (7) 7-8' Native Eastern Red Cedar (7) 6-8' Beach Plum (8) 36 Bayberry (3) 5-6' White Spruce (3) 5-6' Blue Spruce (6) 8-10' Hollywood Juniper (6) 5-6' Sea Green Juniper Board of Trustee_: Application GENERAL DATA Land Area(in square feet): 0.67 Area Zoning: R40 Previous use of property: Primary residential Intended use of property: Primary Residential Covenants and Restrictions on property? =Yes _E_No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? E—Yes _allo If"Yes",be advised this application will be reviewed by the Building Dept.prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? =Yes _✓ _No . If"Yes", please provide copy.of decision. 11 "is project renpre. any demolition as per Town Code or as determined by the Building.Dept.? Yes' ✓DO Does the structure(s) on property have a valid Certificate of Occupancy? Yes 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): Board of Truste__ Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Create bed with topsoil. Plant native plants/trees to 12' off Antler Lane to help with privacy and keep people from walking through property to get . to Town dock. Area of wetlands on lot:. square feet Percent,coverage of lot:. Closest distance between nearest existing structure and upland edge of wetlands: .. feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the.project involve excavation,or filling? 0 No Yes If yes, how much material will be excavated? cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: N/A feet Proposed slope throughout the area of operations: N/A Manner in which material will be removed or deposited: 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): 61 Z20 Appendix B Short Environmental Assessment Form Instructions f6r Com letin Part 1 -Project Information. The applicant or project.sponsor is responsible for the completion of Part 1. Responses , become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part I based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part I. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1 -Project and Sponsor Information Coastal Plantings Inc Name of Action or Project: Galgano Residence Project Location(describe,and attach a location map): 130 Antler Lane Cutchogue NY 11935 Brief Description of Proposed Action: Create bed with topsoil. Plant native plants/trees to 12'off Antler Lane to help with privacy and keep people from walking through property to get to the Town dock. Name of Applicant or Sponsor: Telephone:631-734-7443 Coastal Plantings Inc. E-Mail:info@coastalplantings:com •Address' 27400 C R 48 City/PO: State: Zip Code: PO Box 484, Peconic NY 11958 1.Does the'proposed action only involve the legislative adoption of a plan,local law,ordinance; No YES. administrative rule,or regulation? t If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES.: If Yes,list agency(s)name and permit or approval: 3.a.Total acreage of the site of the proposed action? acres b.Total acreage to be physically disturbed? acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? cres 4." Che 1 land us�` at occur on,adjoining an ar the prop action. Urban' tftral(non-agriculture) Industrial Commercial R Residential(suburban) Forest E]AAgriculture Aquatic QOther(specify): Parkland Page I of 4 r 5. Is the proposed action, NO 'YES' .N/A a. A permitted use under the zoning regulations? ✓ b.Consistent with the adopted comprehensive plan? ✓ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO j YES b.Are public transportation service(s)available at or near the site of the proposed action? ✓ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? v"; 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies:. 10. Will the proposed action connect to an existing public/private water supply? NO: YES, If No,describe method for providing potable water: 11.Will the proposed action connect to existing wastewater utilities? 'NO YES. If No,describe method for providing wastewater treatment: . 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic "NO YES, Places? ✓ b. Is the proposed action located in an archeological sensitive area? Ll 13.A.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO.: YES wetlands or other waterbodies regulated by a federal,state or local agency? ✓ b.Would the proposed action physically alter,or encroach into, any existing wetland or waterbody? If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres:, . 14. ntify the typic bitat types that oc n,or are likely to be found on t roject site. Check all that apply:. Shoreline Forest Agricultural/grasslands Early mid-successional Wetland Urban Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats, listed' NO- YES by the State or Federal government as threatened or endangered? ✓ 16.Is the project site located in the 100 year flood"plain? NO "YES.. 17.Will the proposed',action create storm water discharge,'either from point or non-point sources? NO . YES if Yes, a. Will storm water discharges flow to adjacent properties? DO' DES b. Will storm water discharges be directed to established conveyance systems f an drains)? If Yes,briefly describe: r5o YES Page 2 of 4 18. Does the proposed action include construction or other activities that result in the impoundment of NO YES' water or other liquids(e.g.retention pond,waste lagoon, dam)? If Yes,explain purpose and size: 19.'Has the site of the proposed action or an adjoining property been the location of an active or closed' NO YES' solid waste management facility? If Yes,describe: ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES' completed)for hazardous waste? If Yes,describe: I AFFIRM THAT THE INFORMATION PROVIDED.ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY , KNOWLEDGE Applicant/spons name: Ian ZuhOSki Date1/24/2024 Signature: G��^' Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part I and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate. small to large impact impact, may may occur occur 1. Will the proposed action create a material conflict with an'adopted land use plan or zoning regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? 3. Will the proposed action impair the character or quality of the existing community? 4. Will the proposed action have an impact on the environmental characteristics that caused the establishment of a Critical Environmental Area(CEA)? 1-7 5. Will the proposed action result in an adverse change in the existing level of traffic or 1171, AJ affect existing infrastructure for mass transit, biking or walkway? T; 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate reasonably.available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: a.public/private water supplies? b.public/private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic,archaeological, architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands; waterbodies,groundwater,air quality,flora and fauna)? .° D Page 3 of 4 No,or Moderate small to large impact impact may may occur. occur 1,0. Will the proposed action result in an increase in the potential for erosion,flooding or drainage problems? ' 11. Will the proposed action create a hazard to environmental resources or human health? Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",'or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3`. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included'by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term, long-term and cumulative impacts. Check this"box if have determined,based'on the information and analysis above,and any supporting documentation; that the proposed action may result in one or more potentially large or significant adverse impacts and.an environmental impact statement is required. Check this box if you have determined,based on the,information and analysis above,and any supporting documentation,, that the,proposed action will not result in any significant adverse environmental impacts. Town of Southold-Board of Trustees TJ)tn of Lead Agency Date President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) (' PRINT Page 4 of 4 Board of Trustrz;o- Application AFFIDAVIT � r �)0 rJ L- C,-A AN'0.. AMA-C-2Lq L CqN a BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE'IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS)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. S' afar P perty Owner eiggnpLk�ureof Property O r SWORN TO BEFORE ME THIS DAY OF. J()nuo ry , 20 24 Notary Public DEANDREA BUNBURY Notary Public-State of New York No.DIBU6364608 Qualified in Suffolk County My Commission Expires o9/lam25 Board of Trusts.., Application AUTHORIZATION (Where the applicant is not the owner) owners of the property identified as SCTM# 1000- qI 7 " O a : m the town of New York, hereby authorizes 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. party caner' Signature operty Owner's Signature SWORN TO BEFORE ME THIS DAY OF r DEANDREA BUNBURY Notary Public Notary Public.State of New York No.-01 BU6364608 Qualified in Suffolk County Nty Commission Expires 09/18/2025 APPLICANTIAGENPREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM he Town offto—old's Coft RfElhiobrobibits #'c .ofinte tin the 1ME1 6Etgwn officers and em to ' s.The of t f rtrt' r Bide' t' n whiche o f ib cts ci al w e w ' ver a ' n i ecessary to avoid same_ YOURNAME: Coastal Plantings Inc .(Last"name,first name,diddle 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.) p Tax grievance Building Yariance 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,marriagc,or businessi nnterest."Bossiness inteiesf'means a business, including a partnership,in which the town officer or emplayce has even a partial ownership of(or employment by)a corporation in which the lown officer or employee owns more than.5%a of the shares. i YES n:._ NO _ t 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 applicantlagent/representative)andthe 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,o'r child is(check all that apply): JJA)the owner of greater than SO%of the shares of the corpomtc stock of the applicant Ja "(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); ;. :R C)an officer,director,partner,or employee of the applicant;or D)the actual applicant DESCRIPTION OF RELATIONSHIP Submitted this _day fJanuary 20Z4 Signature "`. Form TS I "" Print Name Ian Zuhoski