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Home My WebLink AboutRyzoff, RonaldAlbert 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) 765-1852 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD February 24, 2000 Robert Herrmann En-Consultants Inc. 1329 North Sea Road Southampton NY 11968 RE: RONALD RYZOFF & BARBARA ANN MARCUS SCTM #31-14-6 Dear Rob, The following action was taken by the $outhold Town Board of Trustees at their Regular Meeting on February 24, 2000: RESOLVED, that the Southold Town. Board of Trustees grant a Waiver to construct a 10' X 19.5' wood deck landward of embankment and adjacent to existing stairs to beach with condition that 6" of turf be removed under the deck to allow for drainage and a copy of these deck plans submitted for file. Located: 12340 Main Road, East Marion. However, this permit does not constitute any other permits from other agencies. If you have any questions, please call our office at 765-1892. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK/djh cc. Bldg. Dept. EN- CONSULTANTS, INC. 1329 North Sea Road Southampton, New York 11968 516-283-6360 Fax: 516-283-6136 E-mail: encon @ peconic.net ENVIRONMENTAL SERVICES Lauren Standish Board of Trustees Town of Southold 53095 Main Road Southold, NY 11971 ~~¢TOWN Or: 5~;:~~:::', ;- February25,2000 Re: Ronald Ryzoff& Barbara Ann Marcus~ 12340 Main Road~ East Marion Dear Mrs. Standish: Enclosed please find a construction sketch of the proposed deck, including a note to remove the upper 6" of turf for drainage purposes, as requested by the Board during their regular meeting on 24 February 2000. I thank you for your assistance with this application and look forward to receipt of the Board's approval. Respectfully y,~rs, Robert E. He~mann Coastal Managemem Specialist Attachments EN- CONSULTANTS, INC. 1329 North Sea Road Southampton, New York 11968 516-283-6360 Fax: 516-283-6136 E-mail: encon @ peconic.net ENVIRONMENTAL SERVICES Board of Trustees Town of Southold 53095 Main Road Southold, NY 11971 TO..,.. CF '" Febmaryl6,2000 Re: Wetland Permit Application for Ronald Ryzoff & Barbara Ann Marcus Members of the Board: Your office recently requested that I research whether the proposed 10' x 20' deck would be located seaward of the Coastal Erosion Hazard Area (CEHA) boundary and thus whether it would be necessary to submit an application for a Coastal Erosion Management Permit. Based on an inspection of the CEHA Map, it appears that the deck would in fact be situated just seaward of the CEHA boundary line. However, because Section 37-6 of the Town Code appears to define as an "unregulated activity" a timber deck such as that proposed with "a top surface area of less than 200 square feet," the dimensions of the proposed deck have been reduced fi.om 10' x 20' to 10' x 19.5'. Because Section 3%11 in turn dictates that "no coastal erosion management permit is required for unregulated activities," we respectfully submit that no such permit is required for the subject deck. Thus, would you kindly proceed with your review of our Wetland Permit Waiver Request at your next regular meeting scheduled for 24 February 2000, and contact me at your earliest convenience if you require any further information at this time. Three copies of a revised site plan are attached for your review. Resp~/c fully urs, Coastal Management Specialist Attachments cc: Dr. Ronald Ryzoffand Barbara Ann Marcus Telephoue (516) 765-I~;~ Town Hall, 53095 Main Road P.O. Box 1179 8outhold, New York 11971 SOUTHOLD TOWN CONSERVATION ikl)VI$ORY COUNCIL At the meeting of the Southold Tow~ Conservation Advisory Council held Tuesday, February 15, 2000, the following recommendation was made: Moved by Jaclyn VanBourgondien, seconded by Ken Meskill, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL of the Waiver Request of RONALD RYZOFF & ~.ARBAIG~, ANN MAR. CUS 31-14-6 to construct a 10'X 20' wood deck landward of embankment and adjacent to existing stairs to beach. 12340 Main Rd., East Marion YoteofCouncil: Ayes: All Motion Carried New York State Department of Environmental Conservation Building 40 - SUNY, Stony Brook, New York 11790-2356 Telephone (516) Facsimile (516) 444-0360 John P. Cahill Acting Commissioner TIDAL WETLAND LETTER OF NON-J-JRISDICTION Mr. Ronald Ryzoff 991 Singleton Avenue Woodmer6, N~/ 11598 May 19, 1997 Re: UPA# 1-4738-01463/00002 Property- 12340 Main Road SCTM# 1000-31-14-0( East Marion (Orient Harbor) Dear Mr. Ryzoff: Ci 2000 Based on the information you have submitted, the New York State Department of Environmental Conservation has determined thas: The property landward of the topographic cr~st of the bank greater than 10 feet in elevation, as shown on the survey by John T. Metzger last revised on 4/30/97, is beyond Article 25 (Tidal Wetland) jurisdiction. Therefore, in accordance with the current Tidal Wetlands Land Use Regulations (6AIYCRR Part 661) nc permit is required under ~he Tidal Wetlands Act Please be advised, however, chat no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal wetlands jurisdictional boundary, as indicated above, without a permit. 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 which may result from your project. Such precautions may include maintaining adequate work area between the tidal wetland jurisdictional boundary and your project (i.e. a 15' to 20' wide construction area) or erecting a temporary fence, barrier, or hay bale berm. Please be further advised that chis letter does not relieve you of the responsibility of obtaining any necessary permits or approvals from other agencies. c c: BMHP Ver,; truly yours, Pe-W~it Admznis~rator CONSULTANTS, INC. 1329 North Sea Road Southampton, New York 11968 516-283-6360 Fax: 516-283-6136 E-mail: encon @ peconic.net ENVIRONMENTAL SERVICES February 2, 2000 WAIVER REQUEST Town of Southold Board of Trustees Post Office Box 1179 Southold, New York 11971 Attn.: Diane Herbert Re: Ronald Ryzoff & Barbara Ann Marcus 12340 Main Road, East Marion SCTM #1000-31-14-6 FEB 3- 301 il T:Q~r¥ ".I ' : .... Dear Ms. Herbert: In regard to the above referenced property, enclosed are the following for the Board of Trustees review: 2. 3. 4. 5. 6. One (1) Waiver Application form, Authorization & disclosure forms. Two (2) copies of survey. Copy of NYS DEC Letter of Non-Jurisdiction. One (1) set of site photographs. Application fee of $40.00. I trust this information shall allow you to process our request for a Waiver. Should any additional information be required, please do not hesitate to contact our office. Coastal Management Specialist /khs Enc. Henry Smith l~n Pcliw~da To'w~ ~ 530~ Mn,in P.O. Box 5cuth~d. l~lew Y~rlt Tel~pb. cne t515) (516) BOA.RD OF TOWN TOW'~ OF 80UTHOLD ~I~TTER OF R~Q~T I~OR A WA[ DATE ~bruary~2, 2000 Ronald Ryzoff & O%I~NEI~ Barbara Ann Marcus .ADDI~ESS 991 Singleton Avenue, TOWN OF PHONE 631-569-7059 Woodmere, NY 11598 Ao~]cr En-Consultants, Inc.PHONI~ 631-283-6360 ADDRESS ~329 North Se~ Road, Southampton, NY 11968 PROPB~TYLOCAT'rON 12340 Main Road, East Marion TAX~f~.APNO.__.. 1000-31-14-6 I/W~ En-Consultants, Inc.r~qu~aW~v~ construct a 10' x 20' wood deck landward of embankment and adjacent tq. existip$ stairs to beach. Project is out of NYS DEC jurisdiction pursuant to Tidal Wetland Letter of Non- Jurisdiction No. 1-4738-01463/00002,.dated 19 May 199.7 (copy enclosed). Si~n~ By: ~ ~-... Robert E. Herrmann Coastal Management Specialist B~rd of Trustees Applica~i,$ AUTHORIZATION pr~n~ b~ner of D'ropercy) (mailing address) );~ ~{-o~ do hereby authorize (Agent) to apply for permit(s) from the Board of Town Trus=ees on my behalf. ~ard of Trustees Applicat~ County of Suffolk State of New York /~ Z /~o~ BEING DULY SWORN DEPOSES AND AFFIRMS T~IAT HE/SHE IS TH~ APPLICANT FOR THE ABOVE DESCRIBF. D PERMIT(S) AND THAT ALL STATEMENTS CONTAINED a~d~IN ARE TRUE TO ~ BEST OF HIS/HF~R Ki~OWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DON~ IN THE MAR/~ER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY T~u~ SOUTHOLDTOWNBOARD OF TRUSTEES. THE APPLICAI~T AGREES TO HOLD TH~ TOWN OF SOLF~OLD A~D THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDF. R OR BY VIRTUE OF SAID PERMIT(S), IF GRA~D. IN COMPLETING THIS APPLICATION, I HER~Y AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ~ ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH llEVI~W OF THI~ ~ . SWORN TO BEFORE ME THIS DAY OF ~;o~,~-~'K ,19 q9 'Not arC. Public g7 BRENDA J. DELAHAY Qualified in Naeeeu Coune/ Commission Expires Auguet 1~...~ APPLICANT TRANSACTIONAL DISCLOSURE POHH The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees, The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. '(~as~ n~e,- ~i~ name,-middie tni~lai; you are applying in the name ce someone else or other entity, such aea ~ompany. IE eo~ indicate the other person's or company's name.) NATURE OF APPLICATION~ (Check all that apply.) or official map Tax grievance Variance Change of zone A~p~oval of plat Exemption from plat Other (If "Other," name the activity.) Do you personally (or through your company, npouee, elbling, parent, or child) have a relationship with any officer or employee of the Town of Southold7 'Relationship' includes by blood, marriage, or business interest. interest* means a bueine~e, including a partnership, in ~hich the town officer or employee has even a partial o~nershtp of (or employment by) a corporation in ehtcl! the to~n officer or employee owns more than §~ og the shares. If you ansvered "YES,". complete the balance of this form and date and sign ~here indicated. Name of person employed by the Town of Southold Title or position of that person Describe tho 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 applicant (when the applicant is a corporation)~ B) the legal or beneficial owner of any interest in a noncorporate'entity (when the applicant is not a corporation)~ applicant; or __D) the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted Signature Print 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 t516) 765-18~ Fax (516) 765-1823 BOARD OF TOWN TRLTSTEES TOV~NOFSOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD Zn the MaTter of the Application of ,..3UL~. OF SUFFOLK) ~.A~E OF NEW YORK) AFFIDAVIT OF POSTZN.3 , rc-~iding ~t duly sworn, depose 'and say; ~ day That on the [7 of ~. , ~, I personally posted the property.. . known as l~$4~) Jq~.~ ~2~*~-)=,~T_~ .. by placing the Board of Trustees of,:'~.~a~ poster wher.~ ~c can easily be seen, and that I have checked to be sure the poster ices remained in place for seven days prlcr to ~'~_n~:- dat~c of -the p'~=..l,, b. eDrlng. ( of hearinq ( sl~na~hre ) ~ Sworn to befRre~ m~ this ~ V'D-- day of AREA = 4.5992 Acres fo fie line CERTIFIED TO, RONALD L RYZOFF BARBARA ANN MARCUS TICOR TITLE GUARANTEE CO. SURVEY OF ~'~ PROPER T Y A T EAST MARION o~ ' 7~WN OF SOUTHOLD -~ ' SUFFOLK COUNTY, N K ~ ?'' , '" 1000 - 31- 14 - O~ Scale, 1"= 60' Dec. 10,1996 , Mo~' e~, m~7 {pr*p o~'t'°"') ~ / ' / Mar. 21, 1997 m/evotions added) , Apr// 30~ 1997 (con/ours added) CONTOUR LINES · EL£V~ TIONS ARE REFERENCED TO N.G.V.D. [S. LIC. NO. 49618 P.C. (6312765 - 1797 Albert I. Kmpski, Presideat John Hohapfel, Vice President 3'ira King ._ Martin H. Garrell Peter Wenczel Town F~II 53095 Main Road P.O. Box 1179 Sour~old, New York 1197! Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD MARCH 26, 1997 EN-CONSULTANTS INC. 1329 NORTH SEA ROAD SOUTHAMI~TON, NY 11968 RE: RONALD RYZO~ff SCTM%31-14-6 DEAR EN-CONSULTANTS: The follow£ng actionwas taken by the Southol~Tuwn Trustees on Wednesday Mazch26,1997, at the3_~ regular RESOLVED ~hntthe Sou~hol~lTownTrum~ee~grnnt~reque~t for a waiv~ for Ro-n%~zo~i to r~e c~e~'~-hv%s ~ This approgal doe-~ not constitute a~=u~l~ fro~ a~ o~her agency. If you hav~ an~ q%~estion~, plem~e f_ee], f~'c.= ~1o ~on~-~,~ ~ office at 765-1892. - ' ':" 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 March 2u,, 1997 meeting of the Southold Town Conservation Advisory Council: No. lU,2 u, Moved by Scott Hilary, seconded by Betty Wells, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL of the Wetland Application of RONALD RYZOFF 31-11[-6 to remove existing concrete debris along edge of AHW by manually breaking it up with a pneumatic jack-hammer and removing off site and ex(sting pilings to be cut to grade level and remnants manually removed and disposed of off site. 123L~0 Main Road, East Marion Vote of Council: Ayes: All Motion Carried George E. Pataki Alexander F. Treadwell Secretary of State Roy L. Haj¢, President En-Consultants, Inc. 1329 North Sea Road Southampton, NY 11968 March 12, 1997 Re: F-97-147 U.S. Army Corps of Engineers/New York District Permit Application tO7-02490-L2 Ronald Ryzoff, Orient Harbor Town of Southold, Suffolk County Dear Mr. Haje: The Department of State has received the information you provided on March 4, 1997 describing the above proposed project. We have been informed by the U.S. Army Corps of Engineers that a Department of the Army permit will not be required. Therefore, no further review is required by this Department. We appreciate your referring this information to the Department of State for review. Sincerely, William F. Barton Chief, Project Review and Analysis Bureau WFB:VAB:dlb cc: COE/New York District - Denise Butts DEC/Region I - Regional Permit Administrator Town of Southold - Albert J. Knlpski George E. I'at aki AlexandeC ~ I¥c,tdwell Albert J. Krupski, ;r. Trustee, Town of Southold 53095 Main Street P.O. Box 1179 Southold, NY 119'/l March 6, 1997 U.S. Army Corps of Engineers/New York District Permit Application - Ronald P, yzoff, Orient Harbor Dear Mr. Krupski: Department of State for review of the above-referenced a copy of the information submitted to the Management Program for your information and Enclosed is Coastal ' wet assigned to this project, at (518) · ,--,'e ~' Burr, the DOS revle ........ ~,~ nc.-essatw to assmt you tn project with respect to its consistency with the . . ':-w lease contact .~,m,. '~.... _.~ ;.~,~r ation WlllCn Ill;Ay ts* LL~g -- tO nreliminary rex, t= · P -ns and any aamUotto~ ...... m reaching a decision as ~74.-6000 to discuss your concet , have will assist the Department in project. Any comments you may reviewing this of the proposed action with the approved NYS Coastal Management Program. the consistency Please note, however, that if we do not hear from you ~ of the date of this letter, we will presume that you have no objections to the propOSed project. Sincerely. t/ William F. Barton Chief, Project Review and Analysis Bureau Enclosures WFB:dlb EN-CONSULTANT8, INC. 1329 NORTH 8EA ROAD SOUTHAMPTON, NEW YORK 11968 Photograph #1: Looking east along beach Photograph #2: Looking west along beach _ soumO~ .H too -.--_., EN-CONSULI'^N'f $ 1329 NORTH SEA RD, SOUTHAMPTON N.Y. I19~ ~I~-253'6360 Albert I. Kmpski, President John HolzapfeL Vice President Jim King Martin H. Garrell Peter Wenczel 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 Office Use Only ~eaStal Erosion Permit Applicat tland Permit Application Grandfather Permit Application Waiver/Amendment/Changes j__~Received Applicat~0n: ~.-~'/ b/Received Fee:$ /~o - ~Completed Application ~-? Incomplete SEQRA Classification: Type I Type II Unlisted__ Coordination:(date sent) CAC Referral Sent: ~-7-q~ Date of Inspection: ~--IF~ Receipt of CAC Report: Lead Agency Determination:__ Technical Review: Public Hearing Held: Resolution: ,OWN OF SOUTHOLDI Name of Applicant Ronald R~zoff Address 991 Singleton Avenue Woodmere¢ NY 11598 Phone Number:Ol6 )569-7059 Suffolk County Tax Map Number: 1000 -31-14-6 Property Location: 12340 Main Road, East Marion, NY 11939 (provide LILCO Pole %, distance to cross streets, and location) AGENT: En-Consultants, Inc. (If applicable) Address: 1329 North Sea Road, Southampton, NY 11968 Phone: (516) 283-6360 FAX%: B~d of Trustees Applicatio~ ~ENERALDATA Land Area (in square feet):200,332.44 Area Zoning: R-120 Previous use of property: Single Family residence Intended use of property: No change in use. Prior permits/approvals for site improvements: Agency -Date X No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? X No Yes If yes, provide explanation: Project Description (use attachments if necessary): SEE ATTACHED Bo~d of Trustees Application WE~T~%ND/T~US~E LANDS A~PLICATION DATA Purpose of the proposed operations: Purpose is to clean beach for safe access. Area of wetlands on lot: 0 square feet Percent coverage of lot: 0 % Closest distance between nearest existing structure and upland edge of wetlands: N/A feet Closest distance between nearest proposed structure and upland edge of wetlands: N/A feet Does the project involve excavation or filling? x No Yes If yes, how much material will be excavated? How much material will be filled? 0 Depth of which material will be removed or deposited: N/A feet Proposed slope throughout the area of operations: No change Manner in which material will be removed or deposited: Material will be manually removed by breaking up existing concrete 0 cubic yards cubic yards with pneumatic jack-han%mer and manually sawing ie. pilings to level of grade. 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): No effect. Board of Trustees Applicatio~ AU~ORIZA~ON (where the applicant is not the owner) I, Ronald Ryzoff (print owner of property) residing at 991 Singleton Ave., (mailing address) Woodmere, NY ~1598 do hereby authorize En-Consultants, Inc. to apply for permit(s) Southold Board of Town Trustees on my behalf. (Owne~Vs signature) ~ J/ // (Agent) from the Bo~d of Trustees Application County of Suffolk State of New York Ronald Ryzoff BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/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 GR/~T~ED. IN COMPLETING THIS APPLICATION, I HE~F, BY AUTHORIZE THE TRUSTEES, THEIR AGENT( S,~ OR P_EPRES..FNTA~IVRS(~, TO Eb~f-ER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THiS APPLI CATION. ~"gnature ' ~ / ~! SWORN TO BEFORE ME THIS ~ DAY OF ~ Notary Public Project Description Remove existing concrete debris along edge of AHW by manually breaking it up with a pneumatic jack-hammer and trucking debris to an upland disposal site. existing pilings will be cut to grade level and remnants manually removed and disposed of at an upland disposal site. Adtacent Owners To east: 1000-31-14-7 Emanuel Xefos & Wife P.O. Box 413 East Marion, N.Y. 11939 To west: 1000-31-14-5 William Edgar Park Pine Neck Rd. Southold, N.Y. 11971 1000-31-14-4.1 Lucille Mosback P.O.Box 117 Rose Hill, N.C. 28458 1000-31-14-4.2 Robert Mosback Box 474 Rose Hill, N.C. 28458 1000-31-14-4.4 Lucille Mosback P.O. Box 117 Rose Hill, N.C. 28458 1000-31-14-4.5 Ruth Ann Bramson 54 Cedar Lane Way Boston, MA 02108-1214 PROJECT I.O. NUMSER I 61 7.21 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I--PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1 . APPLICA~T/SPONSOR I 2. PROJECT NAME RONALD RYZOFF BY EN-CONSULTANTS,INC SEQR 3. PROJECT LOCATION: Municipality EAST MARION Counly SUFFOLK 4. PRECISE LOCATION (Street addresa and road letter, actions, prominent landrrmrka, etc., or provide map) 12340 MA~ RD., EAST MARION, N.Y. 11939 SC']'~ #1000-31-14-6 $. IS PROPOSED ACTION: ~]New r'-] Exp.n.ion [~ ModiScatio nlalte r.tion 6. DESCRIBE PROJECT eRIEFLY: EE All'ACHED 7. AMOUNT OF LAND AFFECTED: Initlslly 4.59~) acres Ullimately 4.599 acres WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? [] No If No, d®Bcrib® bH®fly g. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? [] Reeidentl~l [] Induetrlal [] Commercial [~Agricu~ure J'--] ParkJForeet/Open apa(~a [] Other 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? tX] yes L~ No ff yea, list agency(e) and permit/approvals DOS, COE, TOWN OF SOUTHOLD 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [] No If yea, list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MOOIFICATION? [].o I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOVVLEDGE AppliGanl/sponlor name: ROY L. [-[AJE - P~ES[DENT C~ta: 2/28/97 Signature: If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: SEE ATTACHED STATE OF NEW ~ORK COUNTY OF SUFFOLK Roy L. Haje , ~r~t aha 1q79 ~r~h 9~ p~a Southampton , being duly sworn, deposes and says that on the 4 day of March ,1997 , deponent mailed a true copy of the No~ioe set forth in ~he Board of Trustees Application, directed to each of the above named persons at the addresses se= opposite there respective names; that the addresses se~ opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Sour_hold; that said Notices were mailed at the United States Post Office at Southampton , that said Notices were mailed to each of said persons by mail. Sworn to before me this_ ~ f Notary Public (registered) Pub;it, State of New Yo~ No. 4772055 ~,__ Q.ua!if~ed in.Suffolk County ,--remission EXpires July 3~, 6 ~JA_~WNERS RONALD RYZOFF SCTM~1000-31-14-6 TO EAST: ~1000-31-14-7 EMANUEL XEFOS & WIFE P.O. BOX 413 E MARION, NY 11939 TO WEST: #1000-31-14-4.1 LUCILLE MOSBACK P.O. BOX 117 ROSE BILL, NC 28458 #1000-31-14-4.2 ROBERT MOSBACK BOX 474 ROSE HILL, NC 28458 ~1000-31-14-4.4 LUCILLE MOSBACK P.O. BOX 117 ROSE BILL, NC 28458 ~1000-31-14-4.5 RUTH A/qN BP, AMSON 54 CEDAR LANE WAY BOSTON, MASS 02108-1214 ~1000-31-14-5 WILLIAM EDGAR PARK PIN~E NECK ROAD SOUTHOLD, NY 11971