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HomeMy WebLinkAboutCutrone, Paul Glenn Goldsmith,President �®F S0 Town Hall Annex 54375 Route 25 A.Nicholas Krupski,Vice President �O� ®�® P.O. Box 1179 Eric Sepenoski l Southold,New York 11971 Liz Gillooly es' Telephone(631) 765-1892 Elizabeth Peeples Comm Fax(631) 765-6641 Coulm BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD March 19, 2025 John Cook Sublime Contracting LLC 20 Sandalwood Lane Riverhead, NY 11901 RE: PAUL CUTRONE 940 MARATOOKA LANE, MATTITUCK SCTM# 1000-115-3-17 Dear Mr. Cook: The Southold Town Board of Trustees reviewed the survey prepared by Condon Engineering, P.C., last dated February 14, 2025 and determined that the proposed work 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 / AVERAGE FRONT AR PUM�P(CW-PRESSER POWER aRCUIT M 2 SACK US �11 120105 Mp�tJR�° / TAX LOT 16 - 246.8' 7 a CB1 Ml \ TAX LOT = 3 9 153.0' � L7 81C �_ B11 I.. --®-f SPRAY TOTAL - 399.8 4ss 1/2 I �' euc � PACE 1 � / 399.8/2 = 199.9' FYS 11 48 1/2 Wf, .1r PUMP c > N N MOTOR PUMP RATINGS: m 3/HP ® 115V -` N ' \ ad ad u- - C82 M2 CSR 6 LOOPS 'I G 15.0 F.L.A. c W Co a �" �_ S"` �-- eLC RECIRC LIMP RATINGS: S I I \ a PUMP 3/4HP 0115V W W I MHr r " n MOTOR 15.0 F.L.A. y I CAP OLX SIX o l o< . '� CB3 M3 if G 0 0- W E o I • MIXER UMP RATINGS:o. VOX17DEEP g1rJ.00� p1��> ' I N z • • • • off r � � U PUMP 3/HP 0 115V m PROPOSED LEACHING POOL , Pl 1 I 1� B� 0 N MOTOR 15.0 F.L.A. MARRATOOKA POND � w � • 1 / DISTRIBUTION BOX - 1 4�p1 10� 1 ,�1"" 5w 1 i (n CB4 'I G PROJECT \ PROPOSED HYDRO-ACnON , i I Vol 1 11 1 1 I 1 W 5, t/2 - ar,r COMP COMP. RATINGS: LOCATION AN400 VA DINTS �K 1 I 13 vnR ( ) ) N • • 070 MHr 1/HP O 115V 0'4 "S- S \� °A5 I &STTE /$ / N MOTOR 5.4 F.L.A. LOCATION MAP \ / , r"12•6EEP� ) o REMOTE PLC CONTROL PANEL EXPANS N LEACHI�G I I ; N 11. W/ HP80 COMPRESSOR OTORS 1'�00 \ I s '. . '/�P 1bL I ' I I I �' O e MUST HAVE0 NOTE ALL nINTERNAL �/� SF RESIDENCE / _ I W23.06 O OVERLOAD PROTECTION. GENERAL NOTES \ CONNECTED TO PRIVATE WELL TW23.06\ I I I (WELL A SANITARY IN EXCESS OF 100'+) Z o /3"I/ ` c ONCE cP r % I ASw�A\ I I ew LRl-Ql \ I I I 1 � EXISTING CESSPOOLS Ml RMAIM M"i L ALL MATERIALS AND METHODS OF CONSTRUCTION SHALL EX SHED ' cE R`t p 1ro LR1-Q2 CONFORM TO THE STANDARDS AND SPECIFICATIONS OF THE B�tRE FEN I. -S� G 13 � 1 FLOC 0 P pOSt W I SLATE TO BE PUMPED DRY AND �"` M2 •"i LOCAL TOWN,OR VILLAGE AND THE SUFFOLK COUNTY 'DRY BUILDING• Y claGlko N , Roo I ® BE REMOVED M ' DEPARTMENT OF HEALTH SERVICES AS REQUIRED. �3014 WALL I I ACCORDANCE WITH THE tree 1 � Z^ / GF I ! I I W22.63 I I ) O SCDHS STANDARDS A EGRC RUNNING 2 BOUNDARY d TOPOGRAPHC INFORMATION FROM SURVEY BY - 4 + Tw24M EL�C_SiR�I �F/��-I, BLu LR1-Q3 » \ \ ` 7 E `_•- \ ___c, /` ` - - \ a PROP ACE WPR SLATE ' Ra■uE ! llr M3 AERIAL LAND SURVEYING,DPC DATED AM 13,2024. STEPS W22. r IXER RUNNING •1 g�3� ��\ \\ ��R� -�\ r ELECTRIC LINE TO BE ewz2st I ) ) ) G 3. ELEVATIONS ARE REFERENCED TO THE NAVD 88 DATUM. \`►� \ \ \ \\ \ \ ` \ / PLACED IN CONDUIT / 2 �� I \ // 6AS SLT VI �1 I LKWA I GA �---,GA� As / o Bln LRl MHT 4. THE CONTRACTOR SHALL FIELD VERIFY THE LOCATION AND LR1-Q4 ASPHALT v � _ _o BW l�D DEPTH OF ALL UTILITIES PRIOR TO THE COMMENCEMENT OF SLPQ�(70�00 DRIVEWAY O AQ 00300 b0 PAR Fps Of I \ w LL .U�e�. PC19, 16 PLC INPUT WORK THE CONTRACTOR IS ADVISED ALL SUBSURFACE a STE GAS N w rn n t/4 �, AS-1 Prec INFORMATION SHOWN ON THESE PLANS IS CONCEPTUAL AND \ \\ \\ \\I \ \ \ \\ \ \ \ \ tx C.S WATER SERVI /� ATE Bw 41 ' I I I z x MUST BE CONFORMED ACCORDINGLY IN THE FIELD. \ 1 1 \ \ \ \ \ \ 1 TOGARAG ' WAL ) (,� .L1, ,� RUN AUD. N `�' U7 o d Z 63 5 6 5. A MMIMIfiA SEPARATION OFTEN(10)FEET HORIZONTAL AND W(?L L Tq BE/ / / w of ALARM EIGHTEEN(18)INCHES VERTICAL IS TO BE MAINTAINED BETWEEN /ABI'NDONED LL w F HWA MUTE WATER LINES,STORM DRAINAGE AND/OR SANITARY LINES OR ASPH[T w Q Barr STRUCTURES. zN TEST pp{�� i ,,J 6. THE CONTRACTOR SHALL BE RESPONSIBLE FOR SECURING ALL DRIVEWAY 1;s �m OPROP " � 'yM �^F�POSED WATER LINF1 z.�7 �\ WMr \ \ \ \ \ \ \\ p�� N ` GAj W RE\` \ DRw Y \ \ O B / I c� o uGH M NECESSARY PERMITS BEFORE COMMENCING WORK r \\ \ \\\\\\\\\\\\ \ \ \ \ \� `2�t2 \ POOE POOLR S�GPS ` ikE E'OL\ FE 01N ` 1 1 o/L L \ 8 RED B1C •v \ Pc^\ \\\ \ \ \\ \ \ \ \ \ �o\�1 PAn0 PUMP -v HEA G �� / STORAGE ��0.3• ' J li .2•N , l ` I 7. ALL UNSUITABLE MATERIAL AND DEBRICOUNTY, SHALL N DISPOSED OF STTA_E e'�fSRL rEFcE \ PROPOSED WELL O3 M ACCORDANCE WITH TOWN,COl1NTY,STATE AND FEDERAL LAWS,CODES AND ORDINANCES.CONTRACTOR SHALL BE 1A 60 ENABLE RESPONSIBLE FOR DISPOSING OF ALL UNSUITABLE MATERIALS \\ \ \\ \\ \\ \ \ NEWB'9XTDEEP DEED) N �"' 1 2 '�` I1 PLC INPUT OFFSITE. DEBRIS SHALL NOT BE BURIED ON-SITE. \ \ \ \ \ \ \ a, DRYWELL 0O \ \ , ��) �51• BILL OF MATERIALS \ N 1 C o c+�r!� BWZ�91 � SF RESIDENCE 6.1 IJ� C \ \ \ >>,�r� Tw(2104 3� 8. ALL PRECAST STRUCTURES SHALL INCLUDE SUFFICIENT STEEL o 6 \ \ OPOSED HYDRO-ACTION CONNECTED TO PRIVATE WELL rrE,ul P RI QrY: OVERRIDE REINFORCEMENT FOR TEMPERATURE AND SHRINKAGE, CONTROL PANEL AND AIR PUMP \ (WELL ) / 3 4 TRANSPORT,AND TO ALLOW THE STRUCTURE TO WITHSTAND g,�RE EENCE- �FE p�5 N ql'N b SANITARY M EXCESS OF 100'+ HA-180053 AN400,245 NITROGEN REDUCTION COMPLETE 1 � IZ PLC INPUT CSR AASHTO H-20 LOADING AT THE COVER CONDITIONS SHOWN ON A 36'X 36'X(i P.C.SLAB A 180052 TANK PREIPUMP 400 1 THE PLANS. WITH 6X6 W1.4XW14 WWM \ �F I (�i' �" °M 14 PLC INPUT v B 130002 KIT,SNG 2 TANK CONNECTING STANDARD OPOSED VENT TO BE TERMINATED T� A / 1 TIME DOSE TM 17 PLC INPUT 9. ALL PRECAST STRUCTURES SHALL BE MANUFACTURED WITH ��" OLD C 100110 ASSEMBLY,RE-CIRCULATION 245 COMPLETE 1 S82•17 W THROUGH THE ROOF WITH A CARBON FILTER \ SAJ / 4000 PSI/28 DAY STRENGTH CONCRETE D AN400-P AN400 W/PLATFORM COMPLETE 1 DEMAND E EC50-30-L-80-PLC OPS,EC50-304480-PLC 1 10. SANITARY PIPE TO BE SDR-35 PVC OR AS SPECIFIED ON PLANS. "X_ Q I / SPRAY 0 TAN 18 PLC INPUT 11. DURING CONSTRUCTION EROSION AND SEDIMENT CONTROL I I NOTES: FLOAT SWITCH TO BE RATED 2 AMP AT 120V MINIMUM. MEASURES TO BE UTILIZED AS NECESSARY TO PREVENT THE MAIN PANEL DISCONNECT MUST BE PROVIDED BY INSTALLER. TRANSPORT LETS,OF ETC. TH METHODS OFF-WE AREAS,PONDS, NOTES. ' \ Bl DASHED LINES INDICATE ITEMS NOT CONTAIN IN THE PANEL W1 DRAMAGEINLEHE,NST THE METHODS / REQUIRED TORQUE FOR TERMINAL BLOCK SCREWS IS 16 in-Ibs. EMPLOYED IN THE INSTALLATION AND MAINTENANCE of 1. ELEVATIONS ARE REFERENCED TO N.A.V.D. 1988 DATf,1M / FIELD WIRING MUST BE A MINIMUM OF K S COPPER WIRE. EROSION OL MEASURES SHALL CONFORM TO'ME NEW EXISTING ELEVATIONS ARE SHOWN THUS: \ YORK GUIDELINES FOR EROSION AND SEDIMENT CONTROL•. SITE PLAN CHANGES TOLERANCES DRAWN BY DATE F DECIMALS C. BARRICK tt/.3r6 SCHEMATIC, ELECTRICAL 12. �BA��LLBE SELECT GRANULAR MATERIAL SCALE:1•=30.,0• / -*-M COMPACTED TO 95%MAXIMUM DENSITY AT THE OPTIMUM D FRACTIONAL MATERIAL SPECIFICATION: MOISTURE CONTENT,AS DETERMINED BY STANDARD PROCTOR \ / - �-+-,/" SCALE PART N0. [E� TEST HOLE DATA sErric�R®n®crsn�c c AS NOTED FULL •, AN400 245 NITROGEN REDUCTION SYSTEM COMPLETE �N'p+ p9r:�� B. ANGLES 120105 / • A x=f1/r 13. LOT AREA 40,717 S.F. • w�Rovm er: su HATS DATE REV. PART# EL.zi.o hydr ` ctiolri 05/31/17 a HA-1800 3 i BROWN LOAM(OL) 0.51 BROWN SILTY SAND ISM) 3.0' PALE BROWN FINE SAND(SP) Notes: 'AA wiring and equipment are to be be provided and installed by the Electricalcontractor(EC)in (� 16X(EL.4.6 HIGHEST DIP.GROUNDWATER) Electrical Codes. accordance with the National Electric Code(NEC)and Local �______� 17.7(EL 3.8 HIGHEST EXP.GROUNDWATER) 'The EC will file all necessaryforms and all fees far the eledriral work shown on � •�' '�`-� P�' WATER IN PALE BROWN FINE SAND(SPX these drawings.The contractor Mull arrange for all inspections and secure a Fire ELEC MAR 7 2025 ! Underwriters certificate which is to be turned over to the owner at the completion of the PANEL 4 18.0' work. TESTHOLE BY MCDONALD S5700ld Town GEOSCIENCE DATED 8114@Q24 'AN foundation perpetrations for entry of directly buried feeders are to be equipped with Board of Trustees GROUNDWATER ENCOUNTERED 17.7 galvanized steel sleeves. RMC is to be used at all other foundation and floor BELOW GRADE penetrations. .Furnish and install new service equipment and circuit breakers as shown in these drawings. AA panels and breakers are to be labeled. The electric panels are to be EXTERIOR RATED JUNCTION BOX 20 AMP BREAKER 022.45 installed and grounded in accordance with the NEC and Local Electric Codes. BELOW GARDE M A SPRINKLER BOX 1057." 021.65 `AN switch and outlet boxes,junction boxes,and pull boxes installed on the exterior are ]055.0crn] -- to be galvanized steel and rated for exterior use 12 AWG OF WIRE IN 3/4'PVC SCH 80 CONDUIT 131 'All exte outlets are to be housed in weaffw proof endosures. { P3-" rior i I • • CUT AWAY VIEW PLC CONTROL PANEL I I WI HP80 COMPRESSOR AIR PUMP 1s.6o MP [39.im] 2"VENT ELECTRIC RISER DIAGRAM - 020.65 THE VENT TO BE Tin I _ _ 052�1 12"MIN. THROUGH THE ROOF. NOT TO SCALE - BOTTOM VIEW TOP VIEW H R 131.74 ] POLYLOK 20"D-BOX FISIDE BOX MIN' PART NO.3017-20 UHTc COVERs PARTNO.-3WIC CARBON FILTER MATERIAL-HDPE HEAVY COVER PART NO.a017-Cn (MATE- PART NO.-30174320 DATE; 8112104 G'TAIL RISER PART NO.3W9 DEVICE WATERTIGHT PLASTIC FRAME&COVER 1TTALL RISER PART NO.3W9-R12 W/APPROVED LOCKING DEVICE TO WEIGH 60 LBS.MIN.OR SECONDARY CONCRETE COVER 22.45�57.Ocm] PROVIDE END CAP TYPE LEVELING SAFETY LIDS/DEVICES TO BE PROVIDED TRAFFIC Ff.EL 29.82 DEVICES AT OUTLETS BEARING SLAB EL 29.3 EL 29.2 EL 29.2 29.0 /EL 27.5 16.,0 200[5.08cm BUT HEALTH DEPARTMENT APPROVAL STAMP INSTALL DUMMY RINGS OR DOME AS 140 San CL To c1 TO A CUT ACCEPT CLEANOUT 1'MIN. 8'MM. Trn.4o PLcs.l To LYLOKS INVJ3.Z7.0 2 MAX NECESSARY TO BRING PROPOSED Panox sEa 2I14/25 SCDHS COMMENTS INV.EL,26.9 INVEL 26.7 STRUCTURE TO GRADE .n Par.No.30M 'EL 17.4 7 VENT TO VA UNIT - -- ALL LEACHING POOLS SHALL 13 91 �" "' Cm TYP. �`S. REVISIONS 4'SANITARY WASTE PIPE 4'PVC WASTE EL 26.4 4"PVC W 3 MM. .n ,., JCL.TO CL.I INV.EL 27.1 LINE PITCH 118 rt" LJNE PITCH 1/8 BE PLACED M ACCEPTABLE 13s. ] DRAINAGE CALCULATIONS: PfTCH1/41NCIiPERFooT N TOR 20 _ •a •6 couAR S VIED .n , INCH PER INCH PER 316 .n an FOOT FOOT a POOR LEACHING MATERIAL IS 6n Is ] THE PROPOSED ON-SITE DRAINAGE SYSTEM TO PROVIDE STORAGE I 25'(2 MIN.) ENCOUNTERED,EXCAVATION IS FROMISME VIEW FOR A T RAINFALL STORAGE TO BE PROVIDED IN PRECAST 12(IT MIN.) i E-21•7 LL TO BE CONTINUED TO DRYWELLS PROVIDING 42.24 CF/FT OF STORAGE THE DESIGN IS POLYLa(3017-2M 20• w SUITABLE MATERIAL AND PROPOSED HY 00I/AOWTS BOXORASEPTICRODISTRIBUTION 4• POLYLOK 3017-20H6 20" ROUND SEPTIC DISTRIBUTION BOX DETAIL BASED ON THE FOLLOWING RUNOFF COEFFICIENTS:ROOF 1.0. 5'MIN. Box OR APPROVED EQUAL BACKFILLED AS DETAILED. AN�100 VA OWTS GUTTING RINGS MAY BE DRAINAGE AREA "A• EL 13.8 REQUIRED. NOT TO SCALESTORAGE REQUIRED:REQUIRED: DISTRIBUTION ti'DIAMETER ROOF AREA: 3,380 SF X 1.00 X 7/12=563.3 CF HYDRO-ACTION AN-400 DETAIL BOX DETAIL a D PENETRATION INTO S.C.T.M.:DIST. 1000 SEC. 115 BLK.3 LOT.17 LEACHING ____----SAND AND GRAVEL STRATA HIGHEST EXPECTED GROUNDWATER `•' 563.3 CF/42.24 CFIFT=13.3 FEET REQUIRED POOL DETAIL EL4.6PERUSGSWELLS39269.1 Scale:AS SHOWN Condon Engineering, P.C. CUTRONE RESIDENCE STORAGE PROVIDED: SANITARY SEPTIC SYSTEM PROFILE 940 MARRATOOKA LANE USE 2-8'0 DRYVVELLS T DEEP EACH 14 FT.>13.3 FT= Plats are prepared by Condon Engineering,P.C. It is a vitiation of the New York State NOT TO SCALE Education Law,Article 145,Section 7209,for any person unless acting under the direction of a DraWn by.JJC Ma17 1755 55k,SlgSbee Road New York 11952 MATTITU CK NY O IFlicensed Professional Engineer,Architect,or Land Surveyor,to after an item in if an r Rem bearing the seal of an Enginem Architect,or land surveyor is altered,the altering (631)298-1986 (631)298-2651 fax Architect m%-e b his Surveyor shall affix e at item his/her seal and t notation Date:9/4/2024 SANITARY PLAN 'Altered by followed by hislher signature and the date of satin alterations,and a specific WWW.COndonengineering.Cl,m description oft alteration. r- ,A _ Glenn Goldsmith,President o�QS�fFUC�'.00 Town Hall Annex A.Nicholas Krupski,Vice President may` y� 54375 Route 25 Eric Sepenoski co z P.O.Box 1179 Liz Gillooly Southold,NY 11971 Elizabeth Peeples '1' p! Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD NON-JURISDICTION INSPECTION DATE OF INSPECTION: rs-/zS INSPECTED BY: Cam. Go CdSM�'�' Ch. 275 Ch. 111 COMMENTS: PTc�oaSe� i7C�c�G� i5 r�a�� �ht�� 100Pc°� .,R 6EE 6EGNP.188•. �., Y\l,\ �\ \\\. � \\`` '\�\ \\'\ � y \.^' (Ydl _r:-•��•'�_.�...•. ' S\ �R .._... .zr .. .... ..7 _ `.+t _oa _ �,�€t '.,s \1,.x,.� ,ek' d wuarm\ 4\, \\\ , \ .\\ .:`a..d ... 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Iwo secriwro o R __ -_ -10iY'0-_ __ O - �,n,,,• ,'v Eaf >Np ny Taz S°nicc Age..y Y Narnw•++s rJvunw suEm R •1� u a U/IC.ru<rMrc.Po„rinnx.,Y/ILUI W gSxRiBRIOILT0.WPIXl,IONOFiHE M�� +,� vm°, 90UTNOlD 115 N wr,_g2x,——— —_ —— —_ "1" ••` • ] LFfOOt CtlMv TP%5NP 6 W t01,E8 A p .cwc___.—_ (21) o-.e, ra YnnWfN1°tiW f,lA'6YW O'n0 V -i �rY J�s �oa� R, ECEIVE MAR 7 2025 Southold Town Board of Trustees _ird of Trustees Applicatioi'4,- AUTHOMATION (Where the applicant is not the owner) owners of the property identified as SCTM# 1000- in the town of :N ew York,hereby authorizes to act as my agent and handle all necessary workinvolved with the application process for permit(s)from the Southold Town Board of Trustees for this property. Property Owner's gignature Property Owner's Signature SWORN TO BEFORE:ME THIS... DAY OF. 20 Notary Puthic P,* "N AYAL.A "OtarYPubli, State of Florida Ctl 91 Corn M#HH306087 6xplres 812912026 : e s APPLICANT/AGENT/REPRESENT ATIVE TRANSACTIONAL DISCLOSURE FORM the Tow afSauthotd's Code of Et ucs grohtbats can(�(p(s of mt "t on ihe'na aftaun 8fficerS and Crrt�lovees`The pu� s�of; 'this fo is t'- `tic inf "aw • + i` 1 ct . f n icLg of,Trite g t ti r: i „ YOUR NAME.,. (Last name,first name, ►fiddle initial,unless: ou ace a ni' thme of Y PPlY� g�tie na someone else or other entity,such as a,company.If so,indicate the,oiher person's or company's name.) NAME OF APPLICATION: (Check ail that apply.) Tax grievance _ Building Variance Trustee Change ofZone Coastal Erosion Approval of plat k .; Mooring ; Exemption from plat or official map, Planning Other (If"Other'',name.the activity.): Art y,.nu peiaonatly(ortroun your aattpatny,cause,�ibhng,pamnt,ar clniil)have a xeiahonship wtf}i-tiny officer ar employee of tlic`"i'a�nao-f Seuthol: "Itel>�tio>rtshnp'�ihcludes by blood,igalrtage�or business it}t Business utezest means a busiuess,, YES incltufrng a partnefshi13,in which the tort af?t'icxr or cinploy�bas'cGen apartnal owirrship�f'(or erttployment by);a pvrporRttoir in�kcb�hettw�i`ot�3r'at'em)iayee;o�ns mo `tkusn�°,�su�tha shams.; . , NO If you answeredz"YES",complete the balance of this foam and date and sign where indicated. Name of peopwomployed by the Town of Southold Title or position of that person,. - I)esc the the tetationship betWsen�oursolf(the sippy4Pf/pVe ,epresentative)and the town officer or employee.Either check the.appropriato:line A)thraUgt%I))pncllait describe inthespaxx provided. The town officer or employee or his•or her spouse,sibling,parent;or child is(check alfthat apply): A)tliq_owner dgmatcrihant .. ok wshares of the corporate stock of the applicant (taken the appJieant is n co"rat Ric); B)`the Iegnl ar6i iretictnl awner of any interest in a non-corporate entity(when the _. appincuttit'is not acarpptdion); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP . . :Submitted this da f 2 c�� egg;�i U 2 Stgttatara; ZY- Print Narne Form TS 1 "-,__,-Lrd of Trustees Applicati6i,___'11 .AFFIDAVIT_ UL C(1)_0,,0JVC'0' 'BEING DULY-SWORN _T DEPOSES AND AFFIRMS THAT AEISHE 1910kAPPLICANT 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 BEAPPROVED BY THE.SOUTHOJLD 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'ARISINGIUNDER 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. Signature of Property 0Wner: Signature;ofProperty.Owner SWORN 7.0 BEFORE ME THIS q DAY OF 00jr(k. �2029 No Public KEVIN AYALA Notary Public State of Florida Comm#HH306087 Expires 0/29/2026