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HomeMy WebLinkAboutSinger, Samuel Glenn Goldsmith,President ®� S®(/��® Town Hall Annex 54375 Route 25 A.Nicholas Krupski,Vice President ® � ® P.O. Box 1179 Eric Sepenoski l Southold,New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples ® �� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD NOTICE OF DISAPPROVAL - ADMINISTRATIVE PERMIT Date of Receipt of Application:-March 1, 2024 Applicant: Samuel Singer SCTM#: 1000-75-6-6.1 Project Location: 44030 Route 25, Peconic Date of Resolution/Issuance: March 20, 2024 Reviewed by: Board of Trustees Project Description: Top eleven (11) trees (taped green), and take down ten (10) trees and grind stumps (taped pick) inside the 75' area/lawn area; outside the 75' area, cut down five (5) large and two (2) small trees (sprayed pink), and prune 15-18 smaller trees. Findings: The Board of Trustees DENIES the application as submitted. The proposed project would result in a loss of existing vegetation cover that will negatively impact the water quality and wildlife habitat, as well as have an adverse environmental impact_upon the wetlands. The project does not meet the requirements for issuance of an Administrative Permit as set forth in Southold Town Code Chapter 275-12A. —Adversely affects the wetlands of the Town. Any other activity within 100' of the wetland boundary requires a permit from this office. This is not a determination from any other agency. �t�)/4" Glenn Goldsmith, President Board of Trustees Glenn Goldsmith,President �, OGy� Town Hall Annex A.Nicholas Krupski,Vice President 54375 Route 25 Eric Sepenoski W w P.O.Box 1179 Liz Gillooly �y O� Southold,NY 11971 Elizabeth Peeples �0 �a' Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time:Ma" 10 Completed in field by: A Pee to v Mott's Tree Service on behalf of SAMUEL SINGER requests an Administrative Permit to top eleven (11) trees (taped green), and take down ten (10) trees and grind stumps (taped pick) inside the 75' area/lawn area; outside the 75' area, cut down five (5) large and two (2) small trees (sprayed pink), and prune 15-18 smaller trees. Located: 44030 Route 25, Peconic. SCTM# 1000-75-6-6.1 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.: rmvos-eaI x ` c hme, reAmov&IJre ov cc wcrc aa QQ of s i h�.�sorw►�. Present Were: G. Goldsmith N. Krypski E. Sepenoski L. Gillooly E. Peeples 1 SURVEY OF PROPERTY SITUATE PECONIC TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK 5� S.C. TAX No. 1000-75-06-6.1 SCALE 1"=100' FEBRUARY 1, 2015 l ' TOTAL AREA=1.032.7 6 aV•11. 2S.709— teaq@ _`QSl�� fT LA•FT1FlEE SNCER $K t` GOLD N g V M1 � aU0 0 1 STEWART TSIT'LE S UNK N—CECOMPANY SEE DET "yh AIL ADVOCATES AOSTR.ACT,I... �'c d $O•x /i � C OAR, '°,�\ 0� GATE DETAIL q;"A 'So ti4+55 SCALE 1'-40' 1 I y ✓ Z,\ i `yY 4 o 2 a. 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Oo 23.709 cc. t5 0 f �'0 _A 1 00, ,�• w CERTIFIED TO: SAMUEL SINGER po•R 5�b pf �`• GOLDMAN SACHS BANK USA i $, O STEWART TITLE INSURANCE COMPANY rT ADVOCATES ABSTRACT, Inc. �b�. ,�►, SEE DETAIL %d 4 0 \ QQ o } \ 0,0, f e •� J � o \ �,c \ .w GATE DETAIL V Y� O 'w. E y o N 7;;6% '" SCALE s c. o AL �� .C� o •e,,%, o ,� v N \ l51 q7- 4 N g ,J O ow 0.0A S AL. W AL � .S, no N 06\6+A3" g5. Z AL. N AL o, 0. t NJ � wJ \ ow£` AL y 9t 00•'`` O 1 ALA y l jj 0 Y' PQ V'E b a AL 0. y •�r; ALA $ $, £ i � AL i N 00*25*22" E 102.85' AL ` Y N. A7Nh i e�p 2 \ mz AL 0 q 11 Q tal .D Io t AY. V A N Ag•t2'30" W W ,$ A9.22 c o,f !n N^� q :o 2 £ o $ N ZAL 0 AA A, AL o In z IV 7 Ak T N Fa �1 All, O ALAIL� N a'0 sls8 fs. O•lo �f, .S) k•` AIk S51• O L—S wnNDE En.w,Nm � I fb Fim°XE.�"nan�na nc NC..aR❑.rt wo —67 i LIAR — 1 2024 . Nl=D ER Nathan Taft Corwin III ,RR.R,=e,M.P ND,6DRa1D Land Surveyor Southold — `°m""'DJ=E Tow n Suuxea To-6 J Iwk,.n,Ar 46, ZT TO 1411vfRfO rtl0n wiw�M LRM So.l A Y k—,LS a, B c a r e e ON MS 9OINf,O,AN TAN -S.Da.RMx„- SR.PRN S- Camhic4m t d of True+ s �����.ERNNN�.A� K _�... TD Q ND mwRsiRAaA. PHONE 1 31)727-2090 To.(631)727-1727 OFi10E3 LOCATED AT RANIM ADDRESS THE EXISTENCE OF RANT OR MAYS ISB611R.�Roof Pc9.e 16 AND/OR rE SEMENTSS OF RECORD,If AaDA,pal,Nxl Yak 11947 J wW,,t.MA Ya 11947 N01 OMARNITEED. SURVEY OF PROPERTY SITUATE PECONIC TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK �51 S.C. TAX No. 1000-75-06-6.1 SCALE 1"=100' FEBRUARY 1, 2015 �5. TOTAL AREA = 1,032.796 ,032. 9 c sq. (f. 00 p5p0 ' CERTIFIED T0: SAMUEL SINGER by bry. �`• GOLDMAN SACHS BANK USA 00, Q STEWART TITLE INSURANCE COMPANY N� SEE DETAIL ADVOCATES ABSTRACT, Inc. r. o / \ p00t p O GATE DETAIL o 0 2�j �e. 95'.4A a '" SCALE N 1 ga.; 'u '/ \ let, Ire GA- �9y o0. \ % Os \ y � W� \ i . o Z 0"1 . y.., Z AL r-i ALA b ' IL 'a AIL a .0 i n14 R °s v. s N 00'25'22" E 102.85' 0 1 AL h. AL •ryy. as = wz�nz Z � r 6. N 4g'12'30„ W W ; 49.22' b' ham` = ^I Z O O N, Ln o o 6 0 ,NL � �• �. AL s :/ •. -___= l ap'-'jam /' N 4L IA 5m� r m � A O O N g 7y3g' 'I '1 1� 9g.8q s"W i $ ry c z O ""v' 8 I AL N a ] 41 d M., Au. 3 ti O`� s8��• 4ar°as nnFs�wvErs�11XASMisr /J. �000 d�OIQ�M EF&e�W lox.m——wort wm 94.E b G• 'oe ® EC E N.Y.S.LIE.No.50467 MAP - 1 2024 TO�B55M Y 6�VaNgN� Nathan Taft Corwin III SEcn9N]OR Q ME,me mm,suit Land Surveyor TO BE ED SEAL RUE 0 N9T fANAOFA[D NID TRUE COPI. Southold Town mRYa� tt,L sR m„R TR:J.Zry J.Habee,Jr.l5. Board of Trustees P. NE RER9°N �Y NE s9 Jmeps A Sit,Inp R�9 iNIL°pour; Iy�TMµp Tiue Surreys—SuDdlivon — Lle Gana— Lam4uction La]oul TO IMC°,SiIMiON USiEO IV7fE0N,Ix0 Eo ENE AsvcNEEs a ra LODWO wsn- I PHONE(631)727-2090 Gca(671)727-1727 runaN.cEmsEuncra.RE x°r iR.xsEnAR�E. OFFICES1585LOGIm AT YAI11N0 ADDRESS THE OR EXISTENCE OF ROF EC WAYS ISB6 YRN—A P.O.Boa 16 ANDN EASEMENTS OF RECORD,I( JRmesp°rt,NeEr TRr4 11917 Jemnpsrt.New TerE 11917 A.Y.,NOT SNOWN ARE NOT GUARINT[[0. OFFICE LOCATION: ������ S�U�yOI MAILING ADDRESS: Town Hall Annex O P.O. Box 1179 54375 State,Route 25 J Southold,NY 11971 (cor.Main Rd. &Youngs Ave.) y Southold, NY 11971 �OQ Telephone: 631 765-1938 couffm 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: March 20, 2024 Re: LWRP Coastal Consistency Review for SAMUEL SINGER SCTM# 1000-75-6-6.1 Mott's Tree Service on behalf of SAMUEL SINGER requests an Administrative Permit to top eleven (11)trees (taped green), and take down ten (10)trees and grind stumps (taped pick) inside the 75' area/lawn area; outside the 75' area, cut down five (5) large and two(2)small trees(sprayed pink), and prune 15-18 smaller trees. Located: 44030 Route 25, Peconic. SCTM# 1000-75-6-6.1 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, as well as the records available to me, it is my recommendation that the as-builts are INCONSISTENT with LWRP Policy 6.3 and, therefore, INCONSISTENT with the LWRP. The removal of trees adjacent to the wetland that is serving as a vegetative buffer is inconsistent with policy 6. Richmond Creek is an important waterbody that has experienced red algal blooms in the past. All vegetation capable of removing nutrients should be retained. 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 . q 54375 Route 25 A.Nicholas Krupski,Vice President , ` .P.O.Box 1179'.. , Eric 5epenoski Southold,New York 11971 Liz Gillooly ., T-eleph a 631) 765-1892 Elizabeth Peeples F ( ) 5- �- - i • BOARD OF TOWN TRUSTEES MAR2024 TOWN OF SOUTHOLD Southold:T '...., ..• •. uar o rustees;.. This Section For Office Use Only Coastal Erosion Permit Application Wetland Permit Application p=Administrative Permit ` Amendnient(Transfer/Extensi n Received Application: Received Fee: $ a' Completed Application: Incomplete; SEQRA Classification: Type I Type II Unlisted Negative Dec. ' Positive Dec. Lead Agency.Determination Date:.. _ Coordination:(date sent): �TLWRP Consistency Assessment Form.Sent: 3 a _CAC Referral Sent: . . 5 -Date of Inspection: 3 /. a Receipt of CAC Report: . TR Technical Review: blic Hearing Held:esolution: Owner(s)Legal Name of Property (as shown on Deed): Samuel Singer Mailing Address: :44030 Main Road Peconic NY 11958 Phone Number: , 646-330-8658 Suffolk County Tax Map Number: 1000 - 473779 75-6-6.1 Property Location: (If necessary;provide LILCO Pole 4, distance to cross street,, and location) AGENT(If applicable): Mott's Tree Service _ Mailing Address: PO Box 484 Peconic NY 11958 Phone Number: 631-734-5569 _ Email, mottstree@gmaii.com P - I -a/hr\ ` - S i47L ILI -c-ca a - d 11 (C r��w►� i VAR SouOi� ldfi91� Board ofru�ts 'ard of Trustees Applicat� GENERAL DATA Land Area(in square feet):_ --1,032,796 Area Zoning: R40 Previous use of property: Residence Intended use of property: .Residence Covenants and Restrictions on property? Yes ✓ No If"Yes", please provide a copy. Will this project require.'a.Building Permit as per Town Code? E—Yes . No 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 _Z_No.. If"Yes';please provide copy of decision. his project re llany demolition as per Town Code or as determined by the'Building Dept.? Yes ✓ No Does the structure(s) on property have a valid Certificate of Occupancy? Yes=No: 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? (Nog Yes If yes, provide explanation:. . Project Description:(use attachments if necessary): Tree removal and pruning within 75'.ofwe#lands Trees are marked on property. 11 with green tape are to be topped. 10 with pink tape-are to be taken down and stump grinding. 'ard of Trustees Applicat� WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Enhance view of water, create additional sunlight for garden and pool area. Area of wetlands on lot: , square feet Percent coverage of lot:,. _. Closest distance between nearest existing structure and upland edge of wetlands: feet feet Closest distance between nearest proposed structure and upland edge of wetlands: _.., ..:-.-.;feet " Does the project involve excavation or filling? 0 No If yes, how much material will be excavated? g cubic yards . How much.material will be filled?" 0 _ cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: " Manner"in whickmaterial will be removed or deposited: Trees will brought back;to Mott's Tree Service location for firewood processing. 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): 617.20 Appendix B Short Environmental Assessment Form Instructions for Corn 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"l.based oninformation currently available. If additional research or investigation would be'rieeded to fully' . respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. 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. Part1-Project and'Sponsor"Information 'Name of Action or Project: , Singer Project Locat.ion(describe,and attach alocation map):" 44030:Main.14oad Peconic NY 11958 Brief Description,of Proposed Action: Tree removal (trees are marked) 11 green - topped, 10 pink - remove Tree pruning/topping Name of Applicant or Sponsor: Telephone: Mott' vice E-Mail: mottstree@gmail.Cot11' s Tree• er - Address: PO Box 484 'City7PO State: Zip"Code: 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? 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 front 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? acres 4. Che I]and us at occur'on,adjoining an ar the propq=4 action. Urban Rural(non-agriculture} Industrial Commercial ❑✓Residential'(suburbany. Forest Agriculture Aquatic Other(specify):::❑ ❑ Parkland Page" 1 of 4 5.-1s the proposed action, NO YES': N/A a. A permitted use under the zoning regulations? Fv 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: .. .., _o a 8. a.Will the proposed action result in'a substantial increase in traffic above present levels? :NO JNES 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? 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. Wilt-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 conned to existing wastewater utilities? NO ?':YES If No;.describe method for providing wastewater treatment:... _ 1...2. a.Does the site"contain a structure that is listed on either the State or National. Register of Historic , YES', Places?..:' b. Is the proposed action located in an archeological sensitive area? 13.a.Does'an ortion of the site of the proposed action,or lands adjoining the ro posed`action; y P P P J g P P contain .. "' NO;;.`':>, -YES ' . wetlands or other waterbodies regulated by a federal,state or local agency? Y 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'144bitat types that oc n,or are likelyto 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 anima(,or associated habitats, Iisted• by the State or Federal government as threatened or endangered? ✓ 16:Is the project site located in the 100 yeas'flood plain? N0�':. YES 17.Will the proposed'action create stone water discharge,either from point or'non=point'sources? ;: NO.:.` .. If Yes, a. Will storm water discharges flow to'-adjacent properties? O ES ❑.' El b. Will storm water discharges be directed to established conveyance systems ff an drains)? If Yes,briefly:describe: NO " Page 2,of 4 '18. Does the proposed action include construction-or other activities that'resuIt in the impoundment of - NO :'YES; water or other liquids(e.g.retention pond, waste lagoon,dam)? f 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 soled waste management facility? 71 If Yes,describe:; 20.Has`the,site of the proposed action or an adjoining.property been ihe'subject of rernediation(ongoing or N®" YES: , completed)for hazardous waste? IfYes,describe: ❑ .I Ala'FIRM,THATTH&INFORMATION PROVIDE6ABOVE IS TRUE AND ACCURATE TO THE 8EST,OF MY:'. 'KNOWLEDGE Applicant/sponso name:...Ian ZUh�oSkl Date:2/17/24 ' Si g.na.., ture:; G2...� 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 impart 1 and other materials submitted by the.project so onsor'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 propose&action create a material conflict with'an.adopted land use plan'or'zomng 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? ` - El 4. Will the proposed action have an impact on the environmental characteristics that caused the establishment of Critical Environmental'Area(CEA)? 5Y ' 5. Will the proposed action result in an adverse change in the existing level of traffic or affect existing infrastructure for mass transit, biking or walkway? a. .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.o portunities?. : . 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)? Page 3 of 4 No,or Moderate: small: to1arge impact ' ' impact may may occur :occur 10. Will the proposed action result in an increase in the potential for erosion,Flooding or drainage problems? '`.t l 1. Will the proposed action create a hazard to environmental resources or human health? jam{ 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 paifiicular 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,ideritify'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 se tting,,probability of occurring, duration,.irreversibility;.geographie scope and magnitude. Also consider the potential for sliori-term, long-term,and cumulative impacts:f - Che'cl� his:box if you have determined,•based'on the'informatian and,analysis above,"and any.-supporfing d&66irr ei�tation; that the proposed action.may result in one or more potentially'large or significant adverse impact's and an environmental impact statement is required. Check this box if.you have determined,based on the information and analysis'above,and any supportingdocunientation; that the,proposed action will not result in any significant adverse environmental impacts. Town of'Southold=Board:of-Trustees Naine ofLead Agency Date,'' President Print or Type Name of Re sponsible'Officer in Lead Agency Title:of Responsible Officer Signature of Responsible Officer in Lead Agency Signafure.of Preparer(if different from,Responsible'Officerj ; PRINT Page 4 of 4 -and of zrustees. App1icat7- i AFFIDAVIT b BEING DULY SWORN DEPOSES AND AFFIRM9ZHA FIE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)'AND'THA.T 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 TRUSTtEES:DURING THE TERM OF THE PERMIT.' Signature of Property Owner Signature of Property Owner SWORN TO,BEFORE ME THIS, DAY OF ,Q7 ,20;c At. N Public KRYSTAL14ASAN Notary Public-State of New York N0.01HA5073030 Qualified in Queens County 'ommission Expires Feb.10, _ ,card of Trustees Applicatl. AUTHORIZATION (Where.the.applicant is not the owner) owners of the property identified as SCTM# 1000- .....in the town-of New York, hereby authorizes .. .... ... .::..... o 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 operty. Property Owner's Signature Property Owner's Signature 0.SWORN TO BEFORE.ME:THIS S5 DAY OF �jj� .. $2 �� �. .. No Public KRYSTAL HASAN !Votary Public e State of New York No.01HA5073030 Qualified in Queens County �nmmission Expires Feb. 10,�� B Z s APPLICANT/AGENT/RE-PRESENT.TIVE TRANSACTIONAL DISCLOSURE FORM e Mown OUN Q ull.o 's de athics nrohibi bonflict of into re to .the art etowlio"fficers arid eat l ee9a ne of this form is to provide information which can alert the town of possible conflicts of interest and allow it to'iake.wtiateve_aefirs is necossary to avoid same, YOUR NAME: (East name,first name,.griddle initial,unless you are applying rn the name of someone else or other entity,such as a companyy If so,.indicate the.other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax,grievance Building Variance 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,sililing,parent,or child)have,a relationship with:any.officer or employee ofthe Town of Southold? "Relationship''includes by blond,,marriage,or business iateiest."Businrss iirterest'?trig?ns;ri lietsitres� inaluilirig;a paithgrslrip;.ist,which,the town officer or.-cmployce has.even a partial ovrnczslrip of(or employmcnf by} .corporation: Itt'?V.h..ic)sthc-town:itf'fi�rorgmplvyceovinsmor .tKait 'Po,oftheshares. YES —. NO LX—, 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,br position of that person Describe the relationship between yourself(the applicant/agcnt/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 that apply): A}.the than 5%of the shares of the corporate stock of the applii rti (Whin the applicant is a corporation), B}the legal-orbeneficiai owner ofany interest in.a non-corporate entity(whenthe applicant is not a corporatiori); C)an officer,director,partner,pr employee of the applicant;or D)the actual applicant. DESCRIPTION.OF RELATIONSHIP Subrnitted this Sgrtaiure .. Print N Form TS 1 /`� Town of Southold LWRP'CONSISTENCY ASSESSMENT FORM.";: A. INSTRUCTIONS L All applicants'for.,permits* including Town'of:Southold:.agencies,,`shall.complete=tfiis:CCAF for proposed actions that are subjectto the Town of Southold waterfront Consistency Review Law::.This assessment,is. intended.to supplement. other information:used. by',a Town ,of Southold-agency in making a;determination of consistency. .*Except minor,;exempt,action's.including>-Building,Permits: and other ministerialpermits not,loeated within the Coastdl,Erosion;Hazard Area: y '2. ,,Before;answering the ,questions in Section C, the preparer of this,form"should:,reviewahe;exempt_:. mor'actioii list,policies and explanations of each policy contained iri„the Town of'Southold.Local . ,•.. Waterfront'Revitalization �Program. A. 'ro' ed`aetion- All,":to,-evaluated as to its:_•si icant' beneficial art``d adverse effects upvri.tlie.coastal:area{which includes aU of Soutfioid' 3 If.any question.in Section C on this,form is,answered."yes"nor.,"no", then the%proposed action will affect,the 'achievement•of the LWRP policy standards and conditions con tained•i i-the:consistency review law. Thus;'each:answer midst°bi 'exD ain'ed in,'detail�listin�both-supQor °and non= „supportintttkcts: If an action cannot be certified as consistentwith the;LWRP"policy standards aiid" conditions,I shall not.be,undertakeii. A copy of the LWRP is available in the following places:'online,at.the Town of Southold's `,webs te`(southoldtown.northfork:net), the"Boardof-Trustees Office;:,the:PlAhningwDepartcrient;;all. : local,libraries'and the Town.Cler'k's office. B. :DESCRIPTION,,OF SITE AND PROPOSED ACTION SCTMN PROJECT NAME77 Ttie Application has,b een spbmitted to(check appropriate response): `_ x' Town Boad ❑c ''Plafi hi Board Bnildin' Dep L Board' f Trustees 1. `Category of Town'of Southold.agency action(check appropriater-response):,,`.. r' jii (a) Actioniuid-ertaken-directly by Town'agoncy(e.g.capital' ; ❑ ; co _ nstrudtioii;`,planniiig activity, agency regulation land`trarisactiori) f" ,a (b); Y)' Fuiancial":assistance(e:g..grarit,loan;subsid ;r ( ); femiit,`a royal;license,certification: Nature and extent of action:" • Y f V{ llr ari . Location of action: vf G ktsi Ck 0,�- Site acreage: 23. �. l.�•C� ::. Present land use: AZQ L G�?,r1`fl G�(� Present zoning classification: 2. If an application'for the,proposed.'action has been filed with the Town of Southold,agency;:the;following informationshall be provided: : r J5ri a �W Name of applreant: 2U 0 Y ' S (Gr, , .e Mailing address: ro). (c):Telephone number: `Will.the action be directly undertaken,require,funding,or approyal by a state.or,federal,agency?`; Yes .Nol:� If yes,which state:or,federal agency? C., Evaluate the project-:to the following:policies'by analyzing how the project will further support_or:,: not support the policies. Provide all proposed"13est Management Practices that will-.further each,policy. Incomplete answers will require that.the form be returned for completion:. : DEVELOPElJ COAST POLICY ; Tol*' 1':-Foster a pattern�of dev:elopment in the Town of Southold ihat enhances`community'character,, :`preserves:open space,,makes efficient use.of infrastructure,'makes Fbeueficial:'use of a.,coastal location,;and: minimizes adverse effects of development.. See LWRP Section III Policies; age e 2.for.eval I ion';.': criteria. .❑.Yes, .No Not Applicable . ... _.;:. { Attach additionalaheets'if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See VA RP.Section`III Policies Pages 3 throug, h 6 for,.evaluation criteria Yes,0• Yo. No A pp livable N Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout. the Town of Southold. See LWRP Section III--Policies Pages 6 through 7 for evaluation criteria ❑ Yes ❑ No gNot Applicable Attach additional sheets if necessary NATURAL.COAST POLICIES Policy 4. Minimize loss of life,,structures, and.natural resources from flooding,and vrosion:.See.LWRP- Section III—Policies Pa es 8 through 16 for evaluation criteria ❑, Yes E -N® Not Applicable . Attach additional sheets if necessary Policy 5,. Protect and improve water,quality and supply in the Town of Southold. See LWRP Section In —Policies Pages 16 through 21 for evaluation criteria ❑, Yes ❑ No of Applicable ..... . . .. .. Kt—tach a itiona bets i necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. _See LWRP Section III Policies; Pages 22 through 32 for evaluation.criteria. ; Not Applicable Attach additional"sheeis'ifnecessary Policy 7. . Protect and'improve 'air quality in the Town of.Southold: See LWItP.Section-Iff-,Policies Pages 32 through 34 for evaluation criteria. Yes No Not Applicable ; 7.7 Attach additional sheets:if necessary Policy 8. , Minimize,environmental degradation,in Town•of South old,from.'solid',.waste:%and'haz'ardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for'evaluation"criteria. Yes: . :. . No Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public,access to, and recreational use of,.coastal waters; public lands;and.public resources of the Town Town of Southold., See,I WRP Section III-Polkiesi Pages 3&through 46 for;evaluation criteria. �. Ye" .•No Ndt Applicable Atta&additional'sheets if necessary WORDING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and,promote siting of new_:water®dependent uses in suitable locations: -.See LWRP'Section III--Policies; Pages 471hrough 56.for'evaluath)h-,criteria: ❑Yes ❑ No Not'Applicabile Attach additional sheets if necessary " Policy,11. Promote;sustainable use of living.marine resources in Long Island SoUnit."the Peconic Estuary and.Town waters: See LWRP Section III-Policies', Pages 57 through 62 for-evaluation-criteria. ❑Yes. E] No[Z"Not Applicable Attach additional sheets if necessary . Policy 12. .Protect; agricultural lands in the Town`of Southold. See.=LWRP"Section-IIl, Policies;-Pages 62 through 65 for evaluation criteria. ❑Yes ❑ No" Not Applicable Attach additional sheets if necessary Policy..13. Promote'appropriat.e use and development, of energy and mineral resources.",See LWRP Section III—.Policies;,Pages.65 througk68 for evaluation criteria. ❑Yes ❑ No Not,Applicable . :. DATE PREPARED BY �'� � .. TITLE � � `(