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HomeMy WebLinkAboutIsle of Cedars, LLC Glenn Goldsmith,President ®F SO`/,� Town Hall Annex 54375 Route 25 A. Nicholas Krupski,Vice President �� ®� � ® P.O.-Box 1179 Eric Sepenoski J Southold, New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples • a® Fax(631) 765-6641 c®U01 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD March 17, 2025 Kate Rummel Cole Environmental Services 425 Montauk Highway East Quogue, NY 11942 RE: ISLE OF CEDARS, LLC 2450 PETERS NECK ROAD, ORIENT SCTM# 1000-32-1-8 Dear Ms. Rummel: The Southold Town Board of Trustees reviewed the site plan prepared by Mark Schwartz & Associates, last dated February 14, 2025, and determined that the proposed construction of a 2- story garage, installation of drywells and gutters, removal of existing impervious driveway and installation of a new asphalt driveway, and extension of existing walkway is out of the 100 foot Wetland jurisdictional area under Chapter 275 of the Town Wetland Code and Chapter 111 of the Town Code. Please be advised, however, that no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal and/or freshwater wetlands jurisdictional boundary, or within 100' landward from the edge of vegetated wetlands, without further authorization from the Southold Town Board of Trustees pursuant to Chapter 275 and/or Chapter 111 of the Town Code. It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation within Tidal Wetlands jurisdiction and Coastal Erosion Hazard Area, which may result from your project. Such precautions may include maintaining adequate work area between the tidal wetland jurisdictional boundary and the coastal erosion hazard area and your project or erecting a temporary fence, barrier, or hay bale berm. This determination is not a determination from any other agency. Sincerely, Glenn Goldsmith, President S�FFO(K Glenn Goldsmith,President 0�0 CMG Town Hall Annex A.Nicholas Krupski,Vice President 54375 Route 25 Eric Sepenoski y P.O.Box 1179 Liz Gillooly Southold,NY 11971 Elizabeth Peeples '� per, Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD NON-JURISDICTION INSPECTION DATE OF INSPECTION: INSPECTED BY: X Ch. 275 Ch. 111 COMMENTS: STORM WATER MANAGEMENT DETAILS SITE DATA PROPERTY: 61,399 SF 1.41 ac LOCATION: SF AREA: 100%RUNOFF AT DRYWELL DRYWELL 2"RAIN PER HOUR PROVIDE: CAPACITY: �{ GARAGE ROOF: 1572 SF 262.5 CF (2)8'dia.,4'deep 338 CF TOTAL WETLANDS: 53.3 - _ BUILDABLE: 61,345.7 SF ESTIMATED AREA OF •-10,000 SF TANDARD 5" GROUND DISTURBANCE: — OGEE GUTTER-S NOTES: 1)AIX DSO NOT BEGIN INSTALLATION UNTIL SUBSTRATES HAVE BEEN PROPERLY PREPARED. I �._-. R_200 FLOOD ZONES: !f/)] VE 8/AE6 2).PREPARATION' � }as` Y ..,,� � lJ A).CLEAN SURFACE THOROUGHLY PRIOR TO INSTALLATION. M ^ B).PREPARE SURFACES USING METHODS RECOMMENDED BY THE MANUFACTURE FOR H ACHIEVING THE BEST RESULTS FOR THE SUBSTRATE UNDER THE PROJECT CONDITIONS. C).PAINT CONCEALED METAL SURFACES AND SURFACES IN CONTACT WITH DISSIMILAR METALS WITH PROTECTIVE RACKING PAINT. FEB 2 2025 EXISTING: AREA: LOT COVERAGE: 3.INSTALLATION: it I A).PERFORM WORK IN ACCORDANCE WITH CDA HANDBOOK AND THE DRAWINGS. O 1).GUTTER TO BE PITCHED TOWARDS LEADER V TO 2"FOR EVERY 40'OF RUN. HOUSE: 2,385.8 SF 2).SHEET METAL JOIN LENGTHS WITH WATERTIGHT JOINTS. a).COPPER/LEAD:FLASH AND SOLDER GUTTERS TO DOWNSPOUTS AND "'� oOYV I NORTH PORCH: 68.4 SF A••I AccEssoRlEs. , B).ALUMINUM:RIVET AND CAULK WITH A BUTYL SEALANT SLIP JOINT - coNNECTORs. �--- -- rf'' tCeS SOUTH DECK: 290.6 SF 3).CONNECT DOWNSPOUTS TO STORM SEWER SYSTEM AS INDICATED.SEAL CONNECTION WATERTIGHT. _J DRY WELLS TO BE 10'MIN. 4).PROTECTION: WOOD SHED: 146.0 SF r/^/ AWAY FROM HOUSE A).PROTECT INSTALLED PRODUCTS UNTIL COMPLETION OF PROJECT. B).TOUCH-UP,REPAIR OR REPLACE DAMAGED PRODUCTS BEFORE SUBSTANTIAL O.D.SHOWERw DECK COMPLETION. � o AND SHED: .1 S 0 ° ' COVERED WOOD DECK: 159.6 SF TOTAL: 3,238.5 SF 5.3% RAI 4 COASTAL EROSION HAZARD UNE AS 1 r SCALED FROM C : PROPOSED: AREA: LOT COVERAGE: e4 � COASTAL EROSION tiA7.ARD AREA MAP r PHOTO No.43-6211-83 iHEET 26-0 OF 49 s DETATCHED GARAGE: 1560.0 SF 2.5 F ti PROPOSED IMPERVIOUS 4380 SF 7 1 /°o a - F 3 DRIVEWAY: COMBINED TOTAL: 5,940 SF 9.7% C) O� ;G h�4 METES AND BOUNDS: SURVEYOR: NATHAN TAFT CORWIN III U W SCTM: 1000-32-1-8 Z DATE SURVEYED: APRIL 30,2009 Z 2 ELEVATIONS REFRENCE: NAVD 1988 W a o N 18'-0"MAX. C.to C. 269.341 GRADE m IR OCA'TE%C pS SHO`;UN CovERED 'CATE�ES��NG WN GENERATOR PS ` ` " - ( l7 Lu Z613011 C'J W / O S 16 ^{f 0 aC 4 y 6"MIN _ I j w d 1 ----,- `6 RELOCATE EXISTING OUTSIDE '�- n�, ,d �1 x N W , SHOWER WITH DECK AND N N U r SHED AS SHOWN ","_ O m i G tT CNI° �. ss�° PERSPECTIVE VIEW GO/ ` / N RELOCATE EXISTING WOOD SHED $' I• a, 4 O \ `.l to /—� i TOP �I /—� �� ♦ Qn m& V < ON WOOD TIES AS SHOWN 1 22 t~' ' IDWI SOIL IDWI + 28, Iki �. 36" MINIMUM 2 x 2 Lo U r-152.0' »i 2 fir,.. m c1] ao FENCE POST a a� N � w3 7 PROPOSED 2 STY ? O I� GARAGE WOVEN WIRE FENCE CONCRETE `- (6x6 - 10/10 WWF) WASHOU 52.0' � 2 M APRON 0 SEP7CSYSTEM .I FILTER CLOTH W n EXISTING O E"1 m O 1-1/2 STY `' (N z n -F PROPOSED NEW HOUSE SLOpc EXTEND WALKWAY ' ♦f U z n ASHALT DRIVEWAY } m^ gq r EMBED FILTER CLOTH DF MIN. 6" INTO GROUND Z m r _ l A } O - O r v WA AR o - - - b )N NOTE: rn IV, MAXIMUM DRAINAGE AREA ry 1/2 ACRE / 100 LINEAR FEET x REMOVE EXISTING Z • ' IMPERVIOUS DRIVEWAY SECTION DETAIL mod' 294.611 SILT FENCE DETAILS I OII '^.. .. DRAWN: I °3110 .... / 17 A4 ; ,2 SCALE: x, ,Y` lti. JOB#: 1 2/14/2025 SHEET NUMBER: PROPOSED SITE PLAN S- 1 11 1 " 77 it n Lc r�ss Ck " MAR 9 2020 I 3 � 3 --BDa�d n 11872 S 71-2. 3.40, 4 e „ 9.69', n 46 o� SURVEY OF PROPERTY ® E C E 0 Y }� �w i i °o' SITUATE 02 - ORIENT FEB 21 ' 2025 SG� +Po �* TOWN OF SOUTHOLD ay ' z4 •/ 1 SUFFOLK COUNTY, NEW YORK Q ' a Southold Town ,��W, CVS.C. TAX No. 1000-32-01 -08 Board of Trustees $ gg g ' SCALE 1"=50' o w l AUGUST 4, 2019 -- - - CO 24*44 A. . a S�av 4 ; rep �j —�B• UNAUTHORIZED ALTERATION OR ADDITION A0T0 NO' 40 VNf p°�S�/'� '•1 `` �� , TO THIS SURVEY IS A VIOLATION OF 6 45 SECTION 7209 OF THE NEW YORK STATE ��e3 sH+ � � £ � AREA = 61,399 sq. ft. EDUCATION LAW. SHE? O�Y 1.410 ac. COPIES OF THIS SURVEY MAP NOT BEARING I ' THE LAND SURVEYOR'S INKED SEAL OR SS�� EMBOSSED SEAL SHALL NOT BE CONSIDERED �.OF 4g\ fq�yk2 / B TO BE A VAUD TRUE COPY. CERTIFICATIONS INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED,AND ON HIS BEHALF TO THE TILE COMPANY.GOVERNMENTAL AGENCY AND go LENDING INSTITUTION LISTED HEREON,AND TO THE ASSIGNEES OF THE LENDING INSI- \ °j �t ,yOVS TUTON.CERTIFICATIONS ARE NOT TRANSFERABLE. f THE EXISTENCE OF RIGHTS OF WAY AND/OR EASEMENTS OF RECORD, IF ANY, NOT SHOWN ARE NOT GUARANTEED. Z 1I PREPARED IN ACCORDANCE WITH THE MINIMUM - STANDARDS FOR TILE SURVEYS AS ESTABLISHED BY THE LULLS.AND APPROVED AND ADOPTED a) FOR SUCH USE LTY THE_NEW YORK STATE LAND �`� R4 ,j1 O TITLE ASSGC% 041 OF �P+ , Co ® O I 2 l� �\ _ ' 1_ NOTES: � {` Jo�� �� $ 1. ELEVATIONS ARE REFERENCED TO N.A.V.D. 1988 DATUM 'f ;`r '�/' 7b o t 1 v�- — �I \��y'^'�w� ` X �� �x __*�Q_y e EXISTING ELEVATIONS-ARE SHOWN THUS:" +� 1h� gs5 I EXISTING CONTOUR LINES ARE SHOWN THUS: — --x------- �q I%W µAS F.n. - FIRST FLOOR ;� ( n..*�•--� S` yB M uNfc G.FL- GARAGE FLOOR -1.5 O',ys S W4?0 c,p, TB - TOP OF BULKHEAD g,P BB - BOTTOM OF BULKHEAD Aa .Y.S. Uc. No. 50467 0 S N oe, TW — TOP OF WALL 'PA-1-\"o.,i -4- ��+ _` ��,` R) d' S9, aei,. BIN - BOTTOM OF WALL AG Nathan -Wt Corwin III Land Surveyor 011? s y� ��� LAw LLw wAm MAAK GN oe/os/2o,e - Title Surveys =Su6ctvisions — Site Plans — Construction Layout A� PHONE (631)727-2090 Fox (631)727-1727 fx �Q OFFICES LOCATED AT M41UNG ADDRESS 1586 Main Road P.O. Box 16 Jamesport, New York 11947 Jamesport, New York 11947 39-141-4 SURVEY OF PROPERTY SITUATE ORIENT TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-32-01 —08 SCALE 1 "=30' 73°4 APRIL 30, 2009 s73402 0�30'' �� 1 OCTOBER 18, 2011 ADDED TOPOGRAPHICAL SURVEY 18.72' 42 4'JON, f 4.2 E r2s%` ,s' MARCH 1, 2012 ADD COASTAL EROSION HAZARD LINE S1•36'10 E 2 22 g fd� JUNE 27, 2012 ADD SPOT ELEVATION o N O� Cr—Cpy � g•�9' pR� c SEPTEMBER 29, 2018 UPDATE SURVEY �J�o2 _ ax; 3 `9T�' RD NOVEMBER 8, 2018 ADD WATER LINE 4 g 4.8 ,gy OCTOBER 19, 2019 FINAL SURVEY X �� IT `�d1Y 62 4 JANUARY 9, 2025 UPDATE SURVEY N 13 D AREA = 61,407 sq. ft. 4- . � FpU 0'' n (TO TIE LINE) 1.410 ac. MpN CERTIFIED TO: \'�40 .4:X % /� \\ �4.6 4 ISLE OF CEDARS LLC FIDELITY NATIONAL TITLE INSURANCE COMPANY X-3-8 /\\ �1k x Q 37 I v� / �// \ \` V�4R 4.4 ��g4OF�pq SEPTIC SYSTEM TIE MEASUREMENTS \ X z x J0 2'8^'EHOUSE HOUSE r.sE CORNER ❑A CORNER SEPTIC TANK d X/ X-jj o vj COVER 32 58, X� / DISTRIBUTION t ,�,.�_ POOL #1 COVER 36' 69' X2's4,:...; � ";:' X N DISTRIBUTION 40.5' 63' POOL #2 COVER d':; \\�...•• x $ �\\\X� X3.4 // N TES: 4S X �'` ' 2.5 1. ELEVATIONS ARE REFERENCED TO N.A.V.D. 1988 DATUM / x� 2• ! ��` \ ` / U 2. FLOOD ZONE INFORMATION TAKEN FROM: FLOOD INSURANCE RATE MAP No. 36103CO068H C �'� ZONE AE: BASE FLOOD ELEVATIONS DETERMINED X 3.6/ / Ov£R Op �„ ZONE VE: COASTAL FLOOD WITH VELOCITY HAZARD (WAVE ACTION); 'o \ woo E 4 BASE FLOUT: ELEVATIONS DETERMINED / /7�c0 `` • • \ \\ (STOR CS A�E� 2 ��4.'Q k \ �x 3.0 x ?Cy r O� \jgNknO N �R i .� 4-��� \\ ,'n� 'F w/ / �4,p. ^/ 3ro x Si` 62 ` O ,` X91� 5.1 X 461 �3 ~ �61 \ ry ���J'X I "sccf1k "Wo"o (e / OR V l 33 6.5 N 5.6 oN I $j 4- CRFR p \\ FLAG 9 w \4. I %7h 8 A _ 4.3 /� "':�,.i: qMF H _ LS x \\ FLAG 7 IC/ 5! - - - /` W�oOw?�?, w' ?4 s. OU.S�P5-9 �J~�C \ \ r _..... _._ 5.s F<C E r� �r roR �� sHEo F<AG ��Am� O6� � _ - /l \� lYpppFp (iNR� I J=�' ne. `\` �_$ j� __��_ 4v\ lf.0 I ' FEB 2 1 2025 OFo�`'R wo0� NO ��-ks � ��1 ao t M ?�y ` k Sz1 rs3 Wj '9Rp040 WOO, 3 FLAG 5 /-,CjX . \ \ 57cXsW /ll .� �6\ EDc 3 ��\� a ro ZQ9RJ' ` \``5,0 FLAG c LoA \ E OF'L4Wt4 � \` ` O S F ' O�rOE SH _. ._- pk f' GqQ m^ 4 �s\ \ ?3 I „�4 / �p' � R 3 c `�ry m �e W 3 Xi\ / —s�ED R �O a oF\ °0pep — _ \ ��g74q� �q�o ���C -4J �' _ ZONE —.EL. 6L 5.2\ \ N \ \ ; \ \ I ZONE VE (EL. 8) FLAG 3 i ' EDG�OF IA J \\ I? \ ` CQAS FLAG 2 PREPARED IN ACCORDANCE WITH THE MINIMUM 4" 3 TAL STANDARDS FOR TITLE SURVEYS AS ESTABLISHED v 111 EROSION FLAG 1 BY THE LI A LS. AND APPROVED AND ADOPTED ?t \ \ \ \Ss 6.7 \� (� \ z PHOTO HAZARD FOR SUCH USE BY THE NEW YORK STATE LAND \ \ \ X �e'it o . NO. 49- �tNE ,4S TITLE ASSOCIATION. s e FLAG 1 8 \ \\ \\ 6 ���\\ y � -7.2 x s.5 i?o —-6 O 628'83 SHE A SCALED pR 1 x s., X s\ - ti wn0 ET 26_0 OF OM �a O 49 �� 5.6 EDGE OF VEGETATION 11 \ \ \ _— _— - -X B.5 .N \3 \ \ 2.6 _ _— =x 7- 6 4 3' \ 1 8 0 \ ROCK FLAG 11 \ \ \ \ FLAG 1 FLAG 12 �IAG 5 � FLAG 9 91 � FLAG 13 2'�jQ• � N.Y.S. Lic. No. 50467 G� •? FLAG 6 ++ + 5 7 6 4yjapaj 6- 5.72 °off 0 n.Q� SECTION0RZED ALTERATION OR ADDITION 72SURVEY OF THE NEWnYORKO STATE Nathan Taft Corwin III ��C1 �° , . ?�� �l OS I FLAG 14 EDUCATION LAW. v ► GPQ G� COPIES OF THIS SURVEY MAP NOT BEARING Land Surveyor pN��H4q THE LAND SURVEYOR'S INKED SEAL OR OO� TO BE EMBOSSA VALIDED LTRUE COPY.NOT BE CONSIDERED •�� ?¢ O CERTIFICATIONS INDICATED HEREON SHALL RUN Successor To: Stanley J. Isoksen, Jr. L.S. ONLY TO THE PERSON FOR WHOM THE SURVEY Joseph A. Ingegno L.S. IS PREPARED, AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND Title Surveys - Subdivisions - Site Pfans - Construction Layout LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTI- PHONE (631)727-2090 Fax (631)727-1727 TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE. THE EXISTENCE OF RIGHT OF WAYS OFFICES LOCATED AT MAILING ADDRESS AND/OR EASEMENTS OF RECORD, IF 1586 Main Road P.O. Box 16 ANY, NOT SHOWN ARE NOT GUARANTEED. Jamesport, New York 11947 Jamesport, New York 11947 29-073E 425 Montauk Highway East Quogue, NY 11942 Environmental Consulting (631)369-9445 Wetland Project Management February 10, 2025 Board of�Trustees ® EC E � V E 54375 Main Road P.O. Box 1179 FEB 2 1 2025 Southold, NY 11971 Southold Town Re: 2450 Peters Neck-Detached Garage Board of Trustees Sarah Anglum on behalf of Isle of Cedars LLC 2450 Peters Neck Road - Orient, NY 11957 SCTM: 1000-032.00-01.00-008.000 To Whom It May Concern, We kindly request a Letter of No Jurisdiction for the proposed work at 2450 Peters Neck Road in Orient. Please find the$50.00 fee attached to this letter. We have enclosed one set of originals and one set of copies of the Affidavit and Authorization forms. The scope of the proposed work includes building a new 2-story garage, installing drywells and gutters, removing the existing impervious driveway and installing a new asphalt driveway,and extending the walkway,all of which is more than 100'from a wetland line. Additionally,the following existing structures will be relocated to be more than 100'from a wetland as shown on the plans:covered wood deck,generator,woodshed and outside shower with deck and shed. Should you have any questions, please do not hesitate to contact us. Thank you. Sincerely, Kate Rummel Principal Cole Environmental Services kate@ColeEnv!ronmentalServices.com www.ColeEnvironmentaIServices.com Board of Trustees Application AFFIDAVIT SA�R.1A w1 aN 8 t'`F' oG ISLE ors c.�AQ5 LAC .. BEING DULY SWORN' DEPOSES AND AFFIRMS THAT HE/ HE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)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 AN. Y AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAI.D PERMIT(S),IF i 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 S OF THE PERMIT. E { i•-- lgnature of Property Owner �ml, ,/ Signature of Property Owner SWORN TO BEFORE ME THIS., �_ . DAY OF._-NY-"-►ll\A 1"") s C E V No Public TIMOTHY LEITCH NOTARY PUBLIC STATE OF NEW YORK FEB 2 1 2025 SUFFOLK COUNTY LIC.#01LE0024350 COMM. EXP.05/03/202$ Southold Town Board of Trustees Board 'of Trustees Application E AUTHORIZATION (Where the applicant is not the owner) C E E D f EB 21 2025 Southold Town Board of Trustees E > L-�-C- _ IIWe, _ µ owners of the property identified as SCTM# 1.000 032.00-01.00-008.000 in the town of Orient .-.New York, hereby authorizes COLE ENVIRONMENTAL SERVICES 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.,. Property Owner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS I DAY OF. ''�%-A 'Y ;.202S tart'Public TIMOTHY LEITCH NOTARY PUBLIC STATE OF NEW YORK SUFFOLK COUNTY LIC.#01 LE0024350 COMM. EXP.05/03/202! E3,- outhold APPLICANUAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM To o o rbb lmrtg f into vt' onni n i` c o i "#1 ;' allo "t o ake ver$cnon�s 1Z "am�r#o avota same S , � I.IACT 1�iM ktN L LW IVA 6 N SCROLL*: YOUR NAME. (Last S —C— (Last name,first name,.giiddle initial,unless you are applying Ut;the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) # E NAME OF APPLICATION: (Check all that apply.) , Tax grievance Building Variance Trustee X E Change of Zone Coastal Erosion Approval of.pla! Mooring Exemption from plat or:official map Planning _--- Other (if"Other';name.:the activity.) Do you personalty(tit through your campany,..spouse,.sibling,parent;or ch tdj havers relahonstup wrth>any oi€Iicer or emptgyep of the'CoeVi of Southold? "Relat�ossstip"includes byblood,rgarr�age,or:busancss[Merest "Business intereSt'�means a business; including a parMersliip,in which the ti +n officer or ctnplAyee h as'eVen ti:partial"gLvnershtp of Cqr employment ts )a cotporaUon` in which the town:officeror;-:employeeowns mb're than S° of the shares. YES _. - . NO i 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 t?esetibe Eltedelationsh�p beti+teen yourself(the apphcatttlapWrepresentative)and the town officer or employee.Either check the apptoi3riate'.line A)through D)andlar descr Ire n Zhe space provided. The town officer or employee or his or her spouse,sibling,parent,of child is(check all that apply): owlier oi'greater tlkttt 5°Jgof the stuurs ofYhe cot(foiate stock of the applicant —"when tie:appi�cant�s a corporation); BJ ilte legal irbenelicial owner of any 31 t*n p norr-corporate entity(when the f E B 2 ppl�eani3sriq acc+rportton}, 2026 +C};art officer,d�metQr,partner;or"enfployee of:thc applicant;or D} a actual applicant. Southold Town DESCRIPTION OF RELATIONSHIP Board of Trustees Submitted this day of J�kNi 20 25 Signature 1N►M� _�' Print Name:7,1 jl Form TS 1 Toga �-1, \\ SEESEC.NO. -1/f/ \6\ M CN ( � NN - ----�-�--, E /} N ,— 5',.\ FOR PCLNO. W - S3,I0 SEE SEC..N NO. /suaE A us sno o osi sM�avi4v \✓✓✓ 143 __ .�\\\Q" °mvt�c \ /• / @ 325A(c10'I ��'./�. i 21 N II 5aA(cl 111 HARBOR _._\ NI ' S v_ e a NOTICE acu- COUNTYOFSUFFOLK © E �cs SECTIONNO SOUTROLD Real Property Tax Service Agency r 3q OvmIY GnRr NvvTmC.NY11B01 M °�m EOF 032 Y�� •' L vi ti w fmca"°tisw't A p 1000 PROPERTY MAP