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HomeMy WebLinkAboutTR-4916 Board Of Southold Town Trustees SOUTH OLD, NEW YORK PERMIT NO. ISSUED TO '-I 91 " DATE: .May 29. 1998 JEANNE BARTOS AutqnriZ!utintt Pursuant to the provisions of Chapter b 15 of the Laws of the State of New York, 1893; and Chapter 404 of the Laws of the State of New York 1952; and the Southold Town Ordinance en- titled "REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;" and in accordance with the Resolution of The Board adopted at a meeting held on May 28.1998 19 98, and in consideration of the sum of $ 150.00 paid by Jeanne Bartos of . Peconk N. Y. and subject to the Terms and Conditions listed on the reverse side hereof, of South old Town Trustees authorizes and permits the following: Wetland Permit to construct a two story additiop on east side of.. existing structure with a small single story addition on south and!: .~' west side of structure. with condition that no other construction' . to be dpne sea¡vard aµ,d ;¡. rQw Q,f hayba,l\,s þe placed on th~ seaw I side all ,n accordance wltli the detaIled specIfIcatIons as presented In :' of the originating application. property during construct of the ;, addition thfNeAAL.sidf... ~ , WITNESS WHEREOF, The saId Board of Trustees here- II by causes its Corporate Seal to be affixed, and these presents to l' be subscribed by a majority of the said Board as of this date. ~ ,~ ~/.~~·z ~/'~ Æ~~h_ .ߣ-/:: j:;1?~~ Trustees . . Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-181J2 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD May 29, 1998 Jeanne Bartos 209 Park Ave Lyndhurst N.J. 07071 Re: SCTM #67-7-14 Dear Mr. Bartos, The following action was taken by the Board of Town Trustees during its Regular Meeting held on May 28, 1998, regarding the above matter: WHEREAS, JEANNE BARTOS, applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated May 7, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on May 28, 1998, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standard set forth in Chapter 97-18 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approves the application of . . . . ' JEANNE BARTOS to construct a two story addition on east side of existing structure with a small single story addition on south and west side of structure, with condition that no other construction to be done seward and a row of hay bales be placed on the seaward side of property during construction of the addition on the east side BE IT FURTHER RESOLVED that this determination should not be considered a determination made for any other Department or Agency which may also have an application pending for the same or similar project. Permit to construct and complete proiect will eXPire two years from the date it is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Two inspections are required and the Trustees are to be notified upon completion of said project. FEES: None Very truly yours, flLh..1 ~ /~' 9~ Albert J. Krupski, Jr. President, Board of Trustees AJK/djh cc. DEC ACE Dept. of State . ~ . Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-18ft2 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD ----------------------------------- In the Matter of the Application of ~~~JLlLVJ:___tt~~jC"~_________ COUNTY OF SUFFOLK) STATE OF NEW YORK) I, -::( ~ h YJ f..- &. I2l1J 5 ,residing L tvi)¡k Sr ew be ng duly swor , depose and y: That on the ';¿O"'day of fY!Ii1, 1997, I personally posted the property known as - i I \ l..d. V\ e...- t!-L-O rt I' 7 J ~ by placing the Board of Trustees official poster w er it can easily be seen, and that I have checked to be sure the poster has remained in place for seven days prior to the date of the public hearing. (date of hearing noted thereon to be held/f1Af ril-l: IfPr fJ,.) DIL A ð, u 7 7.' () () 1'_ ¡!of . ' AFFIDAVIT OF POSTING (1.¥ t /h'L at .JoC¡ 0701/ Dated: ~ 201 1197 Swo~n to before me this ~~ day Of~ J 1998 ~ð/~~ Notary Public r·~ (s', nature) MARION L PALSER Notary Public. State of New YorIc No_ 31-4600568 Qualified in New York County. _ Commission Expires March 30;~Oð . . Board Of Southold Town Trustees SOUTH OLD, NEW YORK PERMIT NO. ~<¡~ DATE: . Aug. 27,1998 ISSUED TO ... ....JEANNE..S.... BARTOS.. AutqnriZ!utintt Pursuant to the provisions of Chapter b 15 of the Laws of the State of New York, 1893; and Chapter 404 of the Laws of the State of New York 1952; and the Southold Town Ordinance en- titled "REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;". and in accordance with the Resolution of The Board adopted at a meeting held on J\llg. 26.,1998 19 98, and in consideration of the sum of $10.0....0.0. paid by Jeanne.. S. Bartos of .J'ec()l1iC N. Y. and subject to the Terms and Conditions listed on the reverse side hereof, of South old Town Trustees authorizes and permits the following: Grandfather Permit for an existing U8' bulkhead. all in accordance with the detailed specifications as presented in the originating application. IN WITNESS WHEREOF, The said Board of Trustees Mre- by causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. ~.IP~. ..)7.. ~... .......~,............./ ............P;¿/....C<....·; ....._~2::3LP '- . /' Trtlsl~ts . . Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD August 27, 1998 Jeanne S. Bartos 209 Park Ave. Lyndhurst, NJ 07071 RE: SCTM #67-7-14 Dear Mrs. Bartos, The following action was taken at the Southold Town Board of Trustees meeting on August 26, 1998: RESOLVED, that the Southold Town Board of Trustees approve the request for a Waiver for an existing 10' X 14' deck. However, this does not constitute approval from any other agencies. If you have any questions, please call our office at 765-1892. Sincerely, Sincerely, t2L~,.19 /~~ Albert J. Krupski, Jr. President, Board of Trustees AJK/djh cc. Bldg. Dept. . . Telephone (516) 765-1801 Town Hall. 53095 Main Road P.O. Box 1179 Southold. New York 11971 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL The following recommendation was made at the meeting of the Southold Town Conservation Advisory Council held August 2~, 1998: ." WR-113 and GF-69 JEANNE BARTOS 67-7-14 for an existing 10' Permit for an existing bulkhead measuring 112'. 1820 Mill Lane, Peconic I //' X 1~' deck and a Grandfather No comment, the CAC did not make an inspection. . . fuh d7¡Ití9Y '~áM ~yj .~ J¿;()JÌ1 ð( ~- /BW'vJ I~ . /ô I5Ò)(; 1/7e¡ ~/ ?Lf 11'171 0lj¿c ~/A~/ f/~~ ~ /YTl-R- 0.. ~ Jk, ~ ~S· ~ ~cA-~ 101)(/«' ú.JJv~ ~ !~ ~~~~ ~ ~ JM..'cIYtl-Jf, f.Þ ~ ~ s~v~ o/ì'I-A ~ ~ JY'--4. ~0 ~þ - fõ)Œ©ŒO\l7Œrñ) ual ~Uo &æ I~ TOWN OF SOUTHOlD / P(Lo. ðO dAuJ¿ ~~ ~:k-e-d ð~ ¿J fVð~: / f 80 mil L~ v (} p~, {ìlslll'iSY TIt'X fY?/'r-fJ ø /000 - ora I 07 If . . Telephone (516) 765-1801 Town Hall. 53095 Main Road P.O. Box 1179 Southold. New York 11971 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL The following recommendation was made at the meeting of the Southold Town Conservation Advisory Council held May 21, 1998: No. 1569 Moved by Melvyn Morris, seconded by Sharon Shine, it was RESOLVED to recommend to the Southold Town BoaI'd of Trustees APPROVAL of the Wetland Permit application of JEANNE BART~S 67-7-'" to construct a two story frame addition to east side of existing structure with small single story addition on south and west sides. 1820 Mill Lane, Peconic Vote of Council: Ayes: All Motion Carried l·u... I -=-71. I ~ +v , , é ( -, .+ . i\' t ~ ~ ~ " ò' ' " /,.-- (/ // / /' - 1 .~ F , \. F 0 \~ (J) G~'9~ O'g H. H"" ,9õ'-aEg,,,, ",. ~ . 0'V .caGo ~\i'~_. -- ",. . ,~/:;...--,-: - \ ,6__ 9'9\ =-- -.- . 'ó . .... .~ I~ .to. -II ~ H W fTl m C ni \ Z 10 \ fTl ~ \ \ ~ \ \ ... \~ . t F I \ S~ ~. . '! .,~____, /~r''f\ F \ r- .00 oH .oo,ca~060S \ F\\ ' .l.\~ISr:1"09" ~ -j.,'?!i'of/d .l.~"Ñ\ xt "µÑ(\O? t::\ " . -j.,.,O~~!i1S \ ' ~) ·~Ö,\. 'n'H'O .0'0\ '" .. 'IJ! ;r r-- ¡yr-- -tf ;::y- O - ,...,. ~~~a lS' ':~:~ ffi "'"':..(. ~ 'J cJ o o o ~ ~\1\\ --\J?:a 9.."6~~ '-'~ \:j 3 2- ~ ~;o o .Þ tJ ¡ ~ ~ ~ ~ 80 ,~ ~ @ = \ "'11>- ) ";- ::! fI¡ " fa ~a ~ :.;. 0 ï ,- .. ~ ~ .---- .,. .b ... ~. - ..... o o , o o o .... CJ) C SoUND V/~Yy A V~ --- F F F 1~;~I;·!f¡¡!~ SUi 1:1 ' ,.. .i..~J ·I¡· ~ j gi ii:~ : I~ ~.D! '¡hJ;'ÎI~ '.~¡ 'm !1"luj:.j" !;¡ hi: ,.. ¡. I .1. ;..1 ..._~ I PI-· 1~!;I!il! =~! i~i~ :iiïl··ð~~ Iii =!i= ;ï!~i~I~ši i~~ !~ii ....!,. If ....~ lai~.~~:t! 'i! ~I~· "oJ::!.; I.. ¿.! "'i~ ....... .......' :..... :!!~~~ al.. :~õ ,...... ~..~ D.~ .,~ !ge'3¡~i~= 'I'; ¡-; ¡i: .=:&i; !;5 ~:. .." . :1:= ¡~: ~: ~ f Ð ..~ ~ .J\ Z ÙI (\ ~ ~ ~ ~ i o ~ ~ ~ .. ¡Q r ~ i ~ ~ m l\ !JI"II ~ ~~ Z-t z- -"II i~ ! o C/I *' \ ,OJ'6£ M.OV.6£,£O \:j ~~ o."f.. .- c \~ ..-\ \~ - F F :UI -Iª 0- _0 o I I ..::¡:t ~bI -t 11 -» \]1-1 ....x - .~ ~ 11 IJ ì ~ r n - F ~~(J\-n iI~ë!Ji1 oZ»O roñl -~,... ~ S~riI, CC(\k) z Q~ z' - . . . , At't'Ltt!AN't TRANSACTIONAL DISCLOSURB FORM The Town of SouthOld's Code of E~hics þtohibi~s contlic~s ot in~eres~ on ~he par~ of town officers and employees. The ur ose of this form is to rovide information which can alert the town of poss ble conflicts of nterest and allow it to take whatever action is necessary to avoid same. tOUR NAHR. 0:) Last name, fi st name, you are applying in the other entity, such as a company. If so, the other person's or company's name.) , , , '," ,,"';..''''\,.¡.\ : :"-;':'\f,~fl;"- '~:f.lf·'''~:Þ¡'-· ... ',,;1:: ·;->'l".>..,,/.',-'.r'·,' . > NATURB ot ^rrLI~ATIONt (Check all tha~ apply.) .,:" Tax grievance Variance ,/ Change of zone Ap'p~~al of plat , Exe~ption from plat or official map other (If "other," name the acti~i~y.) .... Do you personally (or through your ~o.pany, Spouee, eibling, parent, or child) havR a relationship vith any officer or employee of the Town of Southold? -Relationship- includes by blood, marriage, or business interest. -business interest- means a business, including a partnership, in which the town officer or employee has even . partial ownership of (or employment by) a corp,oration in vhich the town officer or employee owns more than S% of the shares. YBS NO -L ~ ; ,',,1',· " If you answered -YBS,- complete the baiance öt ~his lorm and date and sign vhere indicated. Name of person employed by the Town of Sou~hold Title or position of that person Describe the relationship between yourself (the applicant) 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 owner of greater than 5% of the shares of the corporate stock of the applicånt (when the applicant is a corporation), B) the legal or béneficial owner Of any in~etes~ in a noncorpora~e'entity (when ~he applicant is no~ a corporation), C) an officer, direc~or, par~ner, or employee ot ~he appl1can~, or D) the actual applicant. . ,\' DESCRIPTION OF nELATIONSIIIP ,>, . '.. ,-,,".. ii, -', r>""" .i~,~J;);·:, . '.....', ~.. > .......j'."" - ,- ~,._...~ J.,~~ ....,,'.~,"'."'.~~..'...~, SUbm! hted'thi;'\~~'~?~:':;"~:~~ 1 :~,~~. siønature ~ .,~,.". ,,:., ·po-in" ham" 1:.::Ff·~I/\...:;'¡¡¡;"';~!~'~,i"{í,", .. ~ "0',." ..~""=:!:!:_;: . _~ ,¿-~-..,¡.t'fj'i :·:-~;;(~~~>~;,:'~>~\Æ:i~#M.r~7f(~4~'j,;,:~;:·:~j~'~!:"1 ";~{',~~!.. ; .i ) . I! '. 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IJ!; !~I~T~ ..c 11 c f ' t~: ~~~ ~,~5 ~~ ~_. m ::;~;i (~ .:Ñ ~~. 5..:_~ ~g= II II,." t:. -- ov_ ~II& .!. =:E'!. .:~. . ~ _.ø C~ ~ Q~.~& it~ ~.. ~;[_..i=:~ :::-~ _," II Ô DI5"'r ~:: H¡. =-!¡: !hm.~;i .e;. ~~3 'D~;~~~~_o ~v "' ...... ~ "'-.~-J" c!~~ ~õ! ~~~.¡~::¡!~ ~ ~! o_.u :: .~u..!... = .1 . !CII lieu '",O!L _.¡_ _A ~-:=~ 0="· ~!::ä ..~= !:¥:~ "'!õi .=~w ~k! -~t" &=~.~ 'D.II: _em If-¥.-!·" . _II .11_ LoBLC'!!.. NDC" lIell :a ~2aa.aØ _c "_... II,!.P _c ~¡!iI §.:. =¡uiti~i!" .......8 0.. .....r üI I. iI iai~ ~:i~ tt...!!!5G5! ~t;i ~.a ~ilh~:n::: N '" ... 0 0 N 0 0 , IC1 ... en 0 .. Z LU U U Z ~ LU .J a: LU U1 U. LU >- a: z ~ ~ ~\9~- . (~ \ 1" S\JI"I"O\..~ 1"." "O\J~1-~s \~\..e" f'¡"'~ "60\..DStoA\ \ "F- 110 00' . ~ S090~B'OO J~:')( -;} ~)\----!.~' -' . \ .. \l~. \ I' ~ ~S 8~':·" ~ \ .' I ~ \ I \ \ \ \ \ \ \ ~. ~ () 0. \l.l'- I:::' D ~ \ 10.0.... ~( ~. . \ 1~ ~ -1-:'g,:- _ _ r-'Z'~./ o'2.B'AO"'(4· \~ __ ~16 96' < 03 "39' 40·W 011; 50·~ 3'2.· 39.10' \ tu'\6.12' -;} J ~ ;¡/\ V aNn'6~//\ -;} -- - CD ...... o ...... C1.J ^_ A,-Jf C\ IS) ~~§'=6 Qkl-~ \~~ M\ I- 5\ ~ . o o o !'7 "- "- ~ .... Q -!::' Sf- -J~ -J ~ " -.:.. )-:\l.I\IJ ~~~~ v\i;u..:I: :\ o ...1\ L - - ..... ~ ~ <:> <:> ~ ! ... ......J o '7 ~ . I)a " U g¡!2 \C\ ."'O~~ Q <II ~ ,"" III -c ... --.... I =~~i~ o I;If) ~ e ~ ~ ~<a:ð Q 6 Q~ ~ J" o o l. 0 lD 0 C\J II , ..... 0 't lJJ ...J « U (/) U H I Q. « a: l!J o C\J o 08/07/98 09:24 FLEET .B8NK/HACKEN5ACK 112438 -+ 516 765 1823. ; .. .. NO. 114 1>02 Albert J. Krupski, President James King. Vice-President Henry Smit.h Artie Footer Ken poliwoda Town Hall 63096 Main Road P.O. Bas 1179 Soutbold. New York 11971 - ~.' Telephone (516) 765-18,.z F"", (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use On! ~ Coastal Erosion Permit Applicatio ---Wetland Permit Application ~Grandfather Permit Application ---Waiver/Amendment/Changes ReCëfved APplication:Y- 7- '1 t:: Received Fee:$ Completed APplijftion Incomplete~.o ~ SEQRA Classifica on: Type I_Type II_unlisted_ coordination: (date sent) CAC Referral Sent: ep: 7- y~ Date of Inspection: -1'1- po- Receipt of CAC Report: Lead Agency Determination: Technical Review: Public Hearing Held: ¡¡-~ ,21. - IP Resolution: TOWN OF SOUTHOLD Name of App1icant~~~ '?\IoJ-/,p_T ðl+te.TOS Address dO q PM ¡{ IJ~~ ~ fL Lyl".tl -hIAVSt- "I 07ð7/Phone Number: (U/) ¥3r- 37~1 Suffolk County Tax Map Number: 1000 - 0' 1 (J 7 1'1 Property Location: J r ~O IY/I if L fJ... , fJ~¿an¡'c .ñ If/(9~j' rJ'/T Po/of. ~tI<- . Nt.»' Sol¿ntL,,¡ðA/ J1-1Ji/... (provide tILCO Pole #, distanée to cross streets, and location) AGENT: (If appl1caÞle) Address. Phone: FAX.: 1 08/07/98 09:24 FLEET BANK/HACKENSACK ~2438 ~ 516 765 1823 BoA of Trustees Application . NO. 114 [;103 GENERAL DATA Land Area (in square feet): Area Zoning:J '10 q,357 Intended use of property: Re~¡,t!€nc.<- ~ Previous use of property: Prior permits/approvals for site improvements: Agency Date ~~~:#-1-'i7?/:¡- O(¡glooool ...2d- -sfT~ -f~~~ .3/gsfw' S'/acrllé.. . ./ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? ,/ No 'Ie:;; If yes, provide explanation: Project Description N~ Ð~.p hü()l!IttØ. :ßlfII/X AI~e¡/.s ~ rt. PJ~f{e. gra.YItI...~. þt- 15 tinl1 p J\o.\It / I ~ 61. 2 . . Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-18,'/2 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use 0 œœ~OWŒr~ MAY -1~~1 TOWN OF SOUTHOLPJ coastal Erosion Permit Applicat' ~Wetland Permit Application ___Grandfather Permit Application ___waiver/Amendment/Changes Received Application: 5- ? - " y Received Fee:$~ . Completed Application ~- :7 - r"'" Incomplete SEQRA Classification: Type I Type II Unlisted Coordination: (date sent) ---- CAC Referral Sent: ~ I~ Date of Inspection: . O· Receipt of CAC Report: Lead Agency Determination: Technical Review: Public Hearing Held: S--,~Jf'- '1"" Resolution: ~D MAY - 7 1996 Name of Applicant 5e..AV\V\'L bCl..'í-ToS Address cf2.0 q '?G\.¡-'K A\I'f?..... ~11.:t (L ~ V\ &. '¥\ u.,'í~\ ~ :s 01011 Phone Number: (.2.()/) lJ. 3 f - ? 11'-1 Suffolk County Tax Map Number: 1000 - O(¡¡ 1 0' /4 Property Location: J '6 ~O r(h U Lethe.... P€"'L.onlc N\{ lLC¡~t IIJ'fî?òle.#-'I(P (provide LILCO Pole #, distance to cross streets, and location) 1\ ~ I(" SolA VI&. V ',~ /ì-v-Q I't t.ú'- ' AGENT: (If applicable) Address: Phone: FAX#: 1 Boar~ Trustees Application . ./ GENERAL DATA Land Area (in square feet): Area Zoning: J 4- 0 '1,357 Intended use of property: 'Ref>i&ence C~d.-rtht). ~,r i J'"'A CA.(\..I R.:-t> S í&fl/\ c.e... , Previous use of property: Prior permits/approvals for site improvements: Agency Date ')) (C- F\'I'\ìt -!h /_li7~¡ -o/rn/ OD 00 I 31~5Iq~ ~ 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 '"P(bfD'¿,e~ L sto".~ *o..W\-e.. o{l e¥.is~nj ~<A-G"k"x'e u4/-h o ^ 5ðu.~1I 9- w~St- s\d..-e if necessary): QdJ.,(ho\t\ ~ Ýti6t- SIC£.e. SmfL// ~'~/e ::'W"1 .4d:/¡¡,'tN1 2 Board. Trustees Application . v' WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: þV\C ve Q se (¡'¡ //1 '5 5fCí C~ Percent coverage of lot: S- ex) t - square feet ~ % Area of wetlands on lot: Closest distance between nearest existing structure and upland edge of wetlands: 9<2 feet Closest distance between nearest proposed structure and upland edge of wetlands: i? 3 feet Does the project involve excavation or filling? /" Yes No If yes, how much material will be excavated? (nO cubic yards How much material will be filled? VI 01'1 e.- cubic yards Depth of which material will be removed or deposited: 'f'Xf'r{ 1/t{{-¡ÌJYIdebth ?, feet ..:f- >ld( lJt¡..u... f/Df 1-0 -e/'tCNec{ n(~ < r proposed slope throughout the area of operations: ic 0 ~,Yt s-%' Manner in which material will be removed or ddposited: _f )«(,CI VrJ.+(' £ we-it (LyJ 5 -411 1D I? e (.¡:>~~{cu1 'P/l Ovì :se;{þadC ý ~u.X-e{)-.~~ . sit€... b€Y°Y\..ðl NI+ '(J öV\cJ any, on the wetlands and tidal result by reason of such proposed if appropriate): -e"OS'hlt~ b.ulJchY'ad < Statement of the effect, if waters of the town that may operations (use attachments 3 1"·~6·4 (2{87) ìext 12 I PROJECT I.P. NUMBER 617.21 . Appendix C State Environmental Quality Review SHORTEN~RONMENTALASSESSMENTFORM For UNLISTED ACTIONS Only PART I-PROJECT INFORMATION (To be completed by Applicant or Project sponsor) . I . SEC 1. APPLICANT ¡SPONSOR ---f": ,. 2. PROJECT NAME '-.If 10S 3. PROJECT LOCATION: (! n () _[ Municipality So County Ù Ll T~ 4. PRWS; L~~; (S,~ ~"\\ss aL:~~sections. ",ominent lin~~rKs, ~,~~~'ae;~ Rìt)Vc t O-~ IJe c..v 1'\ \ '- I '"Y\ 'i \ L q.s-", ~~\J ¡ {JJJ {'rv-4L. . 5. IS PROPOSED ACTION: o New ~ Expansion 6. DESCRIBE PROJECT BRIEFLY: 1topOSé£ ~ 7>iùr-y UJI'/-fo r;mdf. ót'n¿j\-e. o Modification/alteratIon fYa VY\ ~ sf:o r "1 If&.d(fú) Yt Q& &-ì f-¡"o '" to I?m ï SiDE of t!¡C/S{¡4.:I sfru¿.fuye. 0J'1 øu-~ /t¡N!') ~WST 'l,;¡èÙ . 7. AMOUNT OF LAND AFFECTED: Inilially 119' SQ. ¡:ì _ Ultimately t,S7J se¿ Ç",- ._ 3_ v~ PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? T"i Yes 0 No If No. descnbe briefly 9. VJHAT IS PRESENT LANO USE. IN VICINITY OF PAOJECT? ~ Residential O.!ndustrial [J Commercial Describe: U Agriculture L..1 Park/Forest/Ooen soace LJ Other 10. DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL. STATE 0;:1 LOCAL)? ~ Yes 0 No If yes. list agency(s) and permit/approvals ~ Nl{S bEe.. y- tz>uJV\ P{"ú¡ti1,'rLj O-.epr ':r- 11. OOES ANY ASPECT OF THE ACTIQI' HAVE A CURRENTLY VAUO PERMIT OR APPROVAL? I2I Yes· 0 No If y-.s. list agency name and permiUappro....al DC~ 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REOUIRE .VIOOIFICAïION? o Yes No I CERTIFY THAT THE INFORMATION PAOVIDED ABOVE IS TRUE "'0 THE aEST OF MY KNOWLEDGE 8ctvtos Dale: LfjJ~/9r SIgnature: " the action is in the Co"stal Area. and you are a state agency, complete Ihe Coastal Assessment Form belore proceeding with this a.~~essment name: OVER . . PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: fYk-S, '501",' \ ~ St-e-ì l\ (Ì « ¿or\j rt Jg e__ I<J. .. u PlaY\~OI'Yl e. I NY /I 0"30 IH (w~ ¡i/ohlie1 ~¥~ rJm/r Su-\4b1 k ~\t1~~t, o{l Qxk ¡1jf7//cIIT (oJ!) f9 rIfAJ ~ STATE OF N~~~aOJ~ COUNTY ~ =rTV~~f bwJ h/J.ro ,.J . U .sr j 0 01 I , being duly sworn, deposes and says t at on the JNd day of Vv,7~ ,19..2L., deponent mailed a true copy of the Notice set orth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold¡ that sai~tices were mailed at the United States Post Office at . ?u. I'd ìI;::)1170îO, that said Notices were mailed to each of said persohs by (certified) (registered) mail. . residing at JOí (brk.~ _, /Vel Sworn to before me this ~ ?i' 7n~ -1A-ldc: a~ Notary Public ~. UANIEL THOMAS CANNON NOTARY PUBLIC OF NEW JERSEY MV Commission Expires Feb. 14. 2001 6 Boa" of Trustees Application 4IÞ County of ~ State of Ué:.w Yu.dt~~ Je.o. '1\ ~ ~ S vJ f'e.T &rt< TO 5 DEPOSES AND AFFIRMS THAT >iH!!/SHE 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 TOWN 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 ( S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. BEING DULY SWORN SWORN TO BEFORE ME THIS Jt!!/ '7ftt xzl jw 1ßaifø.V SJ.gn ure DAY OF 7117 . 19.1.£.... OMd'~~~ ,JAI~IEL THOMAS CANNON ,OTARY PUBLIC OF NEW JERSEY Ay Commission Expires Feb 14, ?001 7