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Home My WebLink AboutTR-5552 . . Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTH OLD April 21,2004 Mr. Glenn E. Just J.M.O. Environmental Consulting Services, Inc. 121 Jessup Ave. 2nd Floor P.O. Box 447 Quogue, NY 11959-0447 RE: B.G. TREMAINE PRIVATE RD., FISHERS ISLAND SCTM#7 -1-2 Dear Mr. Just: The following action was taken at the Southold Town Board of Trustees regular meeting held on Wednesday, April 21, 2004: RESOLVED, that the Southold Town Board of Trustees APPROVE the request for Amendment to Permit #5552 to demolish the existing single-family dwelling and construct a new single-family dwelling, and as depicted on the site plan prepared by Richard H. Strouse last dated March 19, 2004. RESOLVED, that the Southold Town Board of Trustees APPROVE the request for a One-Year Extension to Permit #5552. If you have any questions, please contact our office at (631) 765-1892. Sincerely, P~-¥-?~(}- Albert J. Krupski, Jr. . President, Board of Trustees AJK:lms . . Telephone (631) 765-1892 Town HaIL 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD At the meeting of the Southold Town Conservation Advisory Council held Tuesday, April 13, 2004, the following recommendation was made: B.G. TREMAINE to Amend Permit #5552 to demolish the existing single-family dwelling and construct a new single-family dwelling. Located: Private Rd., Fishers Island. SCTM37-1-2 The CAC did not make an inspection, therefore no recommendation was made. Board Of Southold . Town Trustees PERMIT NO. B. G. TREMAINE ISSUED TO .............. ............. ....... SOUTH OLD, NEW YORK 5~5~ DATE: .. ..~ay 22, 2002 ...-........................... 1\ulQnri1!utinn Pursuant to the provisions of Chapter 615 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 "REGULA TING 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....22,....... . 20.~~..., and in consideration of the sum of $....25.0...00.. . paid by JMo¡;:n:vir()Il!1Ol~Il.tal...c:;()'.l.s1.lIti'.lg. "'P-. Þehª~.f ..Qt....6.....G......Tr.eroaine... of ..........9.Il".~.Il,,!...... ........ .. N. Y. and subject to the Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits thè follow;..'" Wetland Pennit to demolish the existing single family dwelling and constn'd a new single 1 family dwelling, garage, associated sanitary system, ramp. porch. pool terracing and new gravel drive. Prior to commencement a staked line ofhaybales and sili fencing shaH he instaHed and maintained until completion of project. Drywells and gutters instaHed to contoin roof run-off. aU in ac:cordance with the detailed specifications as presented in . the originating application. . IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporat«: S?III to be aff.ixed, and these p~esents to be subscribed by a maority of the said Board as of this daf,e. Trrul... . . TERMS and CONOmONS . .. ........~ \" .. . '~.' The Permittee R r:. "r....o........~;'R.g· resi~¡'1g at Private Road, Fisher:s Is1ann N. Y.. as put. of the consideration for the isSo........ of the PUmlt does uøc1eøtaDd and prescribe to the £01. lówiøg: 1. Tbat the said Board 01 Trustees and the Town 01 SouthoId ale released from r.ø.y and all damages, ex claims fat damages, of suits arlsing direcdy ot inditec:dy as a JaUk of r.ø.y ~. atioa performed p;nuant to chis pamIt. and the said F>. . ¡- will, at his ot her own ~ defend r.ø.y and aU such 1lÚ1S·1ait/.-d ..,. tbhd patda, and the said 1'-. I",., --- luIllåoblity wid> respect theLeto, to the C-O"'p1eœ a;dasion of the Board 01 Trasries 01 the Town 01 SoutMJd 2. That chis Peønit is' ...net f« a period of .;¡ 1 mos. wbi<h is (A1>S'-!..NJd to be the ~-ted åme' required CD coiTeœ the ""'"" in_hoed. but· shca1d ~....... warøør, request for on exœmion may be made to the Board at a later cIaIIe. 3. Tbat this permit should be rdaiued indef'uüte!y. or as loog as the said Permittee wishCs to ....¡_in the sttIJCQIte or project involved, to provide eridenœ to anyoac ~ that IIDb- orization was originally obtained. 4. That the work involved will be lUbject to the ïnspectioo and approval 01 the Board ot its agents, and ooa-œmp1iaoœ wid>. the provisions of the otIgi-fi.,g appliatioo, ø.y be caase fot revocation of this Permit ..,. resolution of the said Boa<d. 5. That there will be no UftnaSOC'.I-01e interfeuoœ wid> navigatioo as a JaUk 01 the wod< betdn authorized. 6. That there sba1l be DO iøterfeuoœ wiIh the right of the pJbIk to pass and repas .Ioag the beach between high and low water marks. . 7. That iffuaue openrloos 01 the Town of Southold reqaire the 1'eIDOftI and/at alccratioas . In the Jocatioa. 01 the work betein ...""..r-l. or if; in the opIøioc1 01 the Board 01 Trusœes, the. work sba1l cause unreasooab1e obsttudlOO to free oavigadoo. the said ¡>-i..... will be requiRd, upoo clue notiœ, to remove or alter this work or project betdn stated wicbout ....j>eDSCS to the Town 01 SoutholcL 8. That the said Board ..ill be notified ..,. the Permittee or the compIcdoa. of the work IIDb- orizecL 9. That the Pennitœe will obeain aU other permits and coøseatI chat ø.y be requited sup- plemental to this permit whkb ø.y be subject to revoke upon failure to obtain - " Albert J, Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson . . Town Hall 53095 Route 25 P.O, Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax \631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD COASTAL EROSION MANAGEMENT PERMIT Pennit Number: 5552 Date: May 22, 2002 Name of Applicant/Agent: JMO Environmental Consulting Name ofPennittee: B.G. Tremaine Address ofPennittee: Private Road Fisher's Island, NY Description of Activity: to demolish the existing single family dwelling and construct a new single family dwelling, garage, associated sanitary system, ramp, porch, pool terracing and new gravel drive, Prior to commencement a staked line of hay bales and silt fencing shall be installed and maintained until completion of project. Dl)'\vells and gutters installed to contain mofrun- off. Date of Penn it Issuance: May 22,2002 This pennit is valid for a period of two years fÌ"om the dates uf issuance, SPECL'\L CONDITIONS: ------Bluffrestoration through a re-vegetation agreement is a necessary special condition of this pennit. _A relocation agreement is attached hereto and is a necessary special condition to this pennit. _A maintenance agreement as attached with application and is a necessary special condition of this pennit. O~t~·1 ~ /4.ï~~& 1'> Albert J, Krupski, J r. President, Board of Trustees AJK:cjc Albert J, Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson . . Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD May 29, 2002 Mr, Glenn Just clo JMO Environmental Consulting PO Box 447 Quogue, NY 11959-0447 RE: SCTM#07-I-p/o lot 2 B.G. TREMAINE Private Road, Fisher's Island, NY Dear Mr. Just: The following action as taken by the Board of Town Trustees during a Regular Meeting, held on May 22, 2002, regarding the above matter. WHEREAS, JMO Environmental Consulting on behalf of B.G. Tremaine. applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated March 6, 2002 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 2~ ,2002 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. "" . 2 . 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 approved the application of B.G. Tremaine for a Wetland Permit to demolish the existing single family dwelling and construct a new single family dwelling, garage, associated sanitary system, ramp, porch, pool terracing and new gravel drive, Prior to commencement a staked line of haybales and silt fencing shall be installed and maintained until completion of project. Drywells ana gutters installed to contain roof run-off. 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. Fee must be paid, if applicable and permit issued within six months of the date ofthis notification, Two inspections are required and the Trustees are to be notified when project is started and on completion of said project. FEES: NONE Very truly yours, {2':"lL'¡ /7. /./ ,,~ _ e/ ï' ,/C't-~ï"'-IZ." ~ Albert J, Krupski, Jr. President, Board of Trustees AJK/cjc cc DEC Building Department . . Telephone (631) 765-1892 Town Hall. 53095 Main Road P.Q, Box 1179 Southold. New Yock 11971 . SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Thursday, April 18, 2002, the following recommendation was made: B.G. TREMAINE to demolish the existing single-family dwelling and construct a new single-family dwelling, garage, associated sanitary system, ramp, porch, pool, terracing and new gravel drive, Prior to commencement a staked line of hay bales and silt fencing shall be installed and maintained until completion of project. Located: Private Rd" Fishers Island, SCTM#7-1-p/o 2 The CAC did not make an inspection, therefore no recommendation was made, ~ . . RPR-6-2ØØ4 13:57 FRDM:JMD CONSULTING 65333<1a ID:78EI7776 P.2 = , Albert J. KruJ>Mi, Preoiden. JatnCft Xing, V.iC:III-P:reaident Ariiø 1'os_ Ken Poli"M)dl!L Peggy A. Dickerson Town Hall 53095 &ute 25 P.O. B"" 1179 SDuthold, New York 111171-119¡j9 T~pbQne(631¡76õ-1892 Fu (6:!11) 765-13615 BOARD OF TOWN TRUSTEES TOWN OF SOU'l'HOLJ) BOARD OFTlW~'TEES: TOWN UF sOUnfOLD -------------~-----------------_.._---------~~-p-----~~~-~- In the Ml!ttcr oftbç Application of __ß.e.::læ~_____.____.__ COUN1Y OF SUFFOLK) STArn OF NEW 'lURK) L .CIItItJ NiauK/I AFFJDA vrr OF POSTING , residing at H. 511CKJ :IS L~ ., JJt..¡ belllg «1ll.1y sworn. depose and say: That on the 9 day of 11.200~IpersOn.a11 posted tb., p.-op"rty known "" ;r'¡'" by placing the Board of TIUStees official poster where it can easily be seen. and that I have checlced to be sure the poster has remained in place for eight days prior to the date ofllie public hearing, Date of hearing noted thereon to be held .. o Dated: z;,~J~hÅ- (" Me) ~. ';_..l\ - - " . -:: - - < .. VERONICA HAMILTON NOTARY PUBLIC $TATE OF NEW YORK NO. 01HA6067785 QUALIFIED IN SUFFOLl( COUN1Y TERM EXPIRIiL - .... .' ..... ..- . . APPLICANT/AGENTnREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics orohibits conflicts of interest on the Dart of town officers and emDlovees. The DUroose of this [onn is to DTOvide information which can alert the town ofoossible conflicts of interest and allow it to take whatever action is necessarv to avoid same. YOUR NAME: ~ I r J (;t-eV\l/ì t E, (Last name, first name, .Qliddle itiaJ. unless you are applying in the name of someone else or other entity, such as a company. Ifso, indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Variance Change of Zone Approval of plat Exemption from plat or ofticial map Other ([f··Other". name the activity.) Building Trustee Coastal Erosion Mooring Planning v---- Do you personally (or through your company, spouse. sibling, parent. or child) have a relationship with 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 a partial ownership of (or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. v"~ YES NO ---~ If you answered "YES", complete the balance of this fomt and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Y'\ \('t... , ý'\ \ r.... , Describe the relationship between yourself(the applicant/agent/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 owner of greater than 5% of the shares of the corporate stock ofthe applicant (when the applicant is a corporation); _B) the legal or beneficial owner of any interest in a non-corporate entity (when the applicant is not a corporation); _C) an officer, director, partner, or employee of the applicant; or _D) the actual applicant. DESCRIPTION OF RELA TlONSHIP Submitted this Signature Print Name 200 cd Fonn TS I · . .. - Albert J, Krupski, President JameL Kirrg, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Main Road P,O, Box 1179 Southold, New York 11971 Telephone (5H:) 765-18.'12 Fax (516) 7H5-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only ~oastal Erosion Permit Application Wetland Permit Application ---Grandfather Permit Application ---Waiver/Amendment/£~~~2~~ ~ceived APPlicat.t~n:~~I~ ~cei ved Fee: $ a~.... ___ ~ompleted Application Incomplete SEQRA Classification: Type I Type II Unlisted oordination: (date~n )~ J~- CAC Referral Sent: ~ ~__ ~te of Inspection: 0 L. Receipt of CAC Report: Lead Agency Determination: Technical Review: ,public Hearing He~ Resolution: I-,¡--\;"\ - b Name of Applicant B.G. Tremaine Address 290 Pratt Street, Meridan. CT 06414 Phone Number: (203 ) 639-5234 Suffolk County Tax Map Number: 1000 - 007-l-p/olot 2 Property Location: private road, no# Fishers Island (provide LILCO Pole J, distance to cross streets, and location) AGENT: Glenn E. Just/ J.M.O. Environmental Consultin~ (If applicable) Address: P.O. Box 447, Quogue, NY 11959-0447 ,.$ Phone: 6 5 3-06~è FAXJ: b)j Jj 1 ~ of Trustees APPlicati~ GENERAL DATA Land Area (in square feet): 142,100 sf Area Zoning: R-120 Previous use of property: vacant Intended use of property: single family dwelling and associated structures Prior permits/approvals for site improvements: Agency Date V<o 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 if necessary): Applicant proposes to remove (demolish) existing single family dwelling construct a new single family dwelling, garage, associated sanitary system, ramp, porch, 0001, terracing and new gravel drive. Prior to commencement a staked line of hay bales and silt fencing shall be installed and maintained until completion of project. 2 ~ of Trustees APPlicati9lllt COASTAL EROSION APPLICATION DATA Purposes of proposed activity: Single family dwelling Are wetlands present within 75 feet of the proposed activity? No X Yes Does the project involve excavation or filling? No X Yes Regrading If Yes, how much material will be excavated? o o (cubic yards) (cubic yards) How much material will be filled? Manner in which material will be removed or deposited: Payloader and Bulldozer shall perform the regrading Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) Through the use of setbacks. minimal c]earin~. new sanitary system, silt fencing and staked hay bales there should be no ne~ative impacts. 4 B~f Trustees APPlication4IIIÞ WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Single family dwelling Area of wetlands on lot: +1,000 square feet Percent coverage of lot: 7 % Closest distance between nearest existing structure and uplanj edge of wetlands: +80 feet Closest distance between nearest proposed structure and upland edge of wetlands: +81 feet Does the project involve excavation or filling? No x Yes Regrading If yes, how much material will be excavated? o cubic yards How much material will be filled? o cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: 1:1 Manner in which material will be removed or deposited: Area to be regraded with pavloader and bulldozer 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): As proposed project shall have no negative impacts upon the waters or wetlands of the Town of Southold 3 l'N' ,.-,t .- .. J.M.O. Environment.al Consulting Services To whom it may concern: T )~, Î '~I: Please be advised that we have authorized the linn of ],M,O. Environmental Consulting Services to aet as our agent on our behalf in applying for certain approvals through your agency and others involved with this project. .I.M,O. Consulting Services has heen retained to coordinate all approvals necessary through your and other involved agencies, as well as our architect, engineer and contractors. We request tlmt all communications, correspondences, notices, arprovals and calls be addressed direclly to. the offices of .I,M.O, Environmental Consulting Services, _. '. n. . ~ -ß. C ~ Signature ~~ ......, ...\..O.h'l.l.....::t:.~~.~ '< Dated ---C3:L~ 1 / OZ ~ i , t Phone (631) 653-0ó07 . r fIX (631) 653-33118 121 Jessup Ave. /nd flc)()[ . P,O, Box 4L11 Quogue. New York 11959-0447 . r" of 'l'rll"tCf'S I\PPlicatio~ .' County of Suffolk State of New York ,1: . ~¡ ~ l :' ;i "·f·{ -1'3lXZ.,.-c ,.J ~" '..,.-n. A I,,)~ 'Iir BEI!JG DUr,y è\o10RN DEPOSES /\ND IIFFIRMS THII HE SHE IS TilE IIPPLICANT Fan THE 7IBOVE DESCRIBED PERmT(S) IIND T IILL ST1\TEMENTS CONT1\HIr.D HEREIN liRE TRUE TO THE BEST OF illS/HER KNOWLEDGE /\ND BELIEF, MID THT,T ALL WORK \HLL BE DOllE IN THE MIINNER SET FORTH IN THIS 7IPPLIC1\TION 1\!lD liS MlIY BE lIPPROVED BY THE SOUTHOr.,D TOWN BOl\RDor' TRUSTE2~. TilE IIPFTJICM1T 1\GREES TO HOLD TilE Toml OF SOUTIIOLD 1111[1 THE TOWN TRUSTEES HIIRMLESS I\NT> FREE FROM lINY MID ALL DAMAGES IIIID crJAtf.ts ARISING UNDER OR BY VIRTUE OF SIIID PERMIT(S), IF GRl\trTED. IN COI-IPLETING THIS I\PPLICATION, I HEREBY AUTHORIZE THE 'lTmSTEE~. TIIEIR IIGENT( S) OR REPRESENTATIVES (S). TO ENTER 011'1'0 fly PROPERTY TO INSPECT THE PREMISES IN CONJutlcTIml WITH REVIEW rw THIS 1\PPLIC1\TION. ~~ ~~1~'_ ~~~ Signature SWORN TO BEFORE ME THIS <27 of '1 , r. ¡ D1\'{ OF Ie brl.-' 9..cV_,.;2 d-.. t DQ~ Notary lìh~j, Public My Gnrnmission Exp, Aug, 31, 2002 7 , j "!.: _ of Trustees I\J1Plicati~ I, J\tn110RIZJ\TJONl 'whe« 'he .pplieo", 1. DO' 'he ~D.r) ~ f at ótry¿J [':f'liif ð ..~ (mailinq 1\ddn:!S8' ~~ !., , fdt1-€.J À F,,-', c~ 06 L-/,sÒ do hereby authorize_ ~.s.-. HI , t,';. . ( lIgent ) l' . I'.' for permit(s) from the !J'j ~~~ ." ~\)'è.îOI) (~.7k:'IttJA-f/Vt.¡¡¡- resi,Un<1 (print owner of property) ... '2..-:> l' (.£.L~ WI I:\--itlt \ _ g\:"'tvc~'j (, D".J3 VL I~ to arply. Southold Board of Town Trustees on my behalf. ~I n q « ' J¿ß~ ~t~y~ (Owner S signature i , ¡ . 8 . , . . SEaR '14.16.2 (9/95)-7c 617,20 Appendix A Slnte Envlronmenlnl Qunllly RnvléW FULL ENVIRON.MENTAL ASSESSMgNT FORM Purpose: The full EAF Is designed to help applicants and agencies determine, In an orderly manner. wheth.r a proJect· or action may be significant. The question of whether an action may be significant Is not 'Iways easy to answer, Frequent- ly, there are aspects of a project that are subjective or unmeasureable. Ills also understood that those who determine significance may have little or no formal knowledge of the environment or may not be technically expert In envIronmental analysis, In addition, many who have knowledge In one particular area may not be aware of the broader concern~ affecting the question of significance, The full EAF Is Intended to provide a method whereby applicants and agencies can be assured that the determination process has been orderly. comprehensIve In nature. yet flexible enough to allow Introduction of Information to fit a prolect or action. Full EAF Components: The full EAF Is comprised of three parts: Patt 1: Provides ob/ectlve data and Information about a given project and Its site, By Identifying basic proiect data. It assist.! a reviewer In the analysis that takes place In Parts 2 and 3. Part 2: Focuses on Identifying the range of possible Impacls that may occur from a project or action, It provIdes guidance as to whether an Impact Is likely to be considered small to moderate nr whether It Is a potentially. large Impact The form also I~entlfles whether an Impact can be mitigated or reduced. Part 3: If any Impact In Part 2 Is Identified as potentially-large, then Part 3 Is used to evaluate whether or not the Impact Is actually Important, DETERMINATION OF SIGNIFICANCE- Type 1 and Unlisted Actions Identify the Portions of EAF completed for this pro/eel: 0 Part 1 0 Part 2 OPart 3 Upon review of the Information recorded on this EAF (Parts 1 and 2 and 3 If appropriate), and any other supportIng Information. and consIderIng both the magnitude and Importance of each Impact, It Is reasonably determined by the lead agency that: o A, The project will not result In any large and Important Impact(sl and, therefore, Is one whIch will not have a sIgnificant Impact on the environment, therefore a ne.atlve declaration will be prepared. o 8. Although the project could have a significant effect on the environment, there will not be I .I.nlllclnt effect for this Unlisted Action because the mItigation measures described In PART 3 have been required, therefore a CONDITIONED ne.atlve dedaratlon will be prepared.' o C, The prolect may result In one or more large arid Important Impacts that may have a SignIficant Impact on the environment, therelore a positive declaration will be prepared. . A Conditioned Negative Declaration Is only valid for Unlisted ActlohS Name of Action Name 01 Lead Agency Print or Type Name of ResponslblA>ffce('~ ". Sf . -, Title of Responsible Officer Signature of Responsible Officer In lead Agency '.7 , Signature 01 Preparer (II different from responsible ofijcer) I Date 1 ":~ . . dO.10%JOO % 01015% 015% or greater % .ite. or district. listed on the State or the National % S. ^ppr~oximatc percentage of proposed project ~ite with slopes: 6. Is project substantially contiguous 10. or contain a building, Regi.ters of Hi.toric Place.1 DYe. Øiío 7. Is project .ub.tantially contiguous to a site lI.ted on the Register of National Natural Landn;arksl What i. the depth of the water tablel )0 It..{ (In feet) DYe. ~ 8. 9, Is site located over a primary, principal, or .ole source aquiferl A,(es DNo 10. Do hunting, fi.hing or .hell fi.hing opportunitle. pre.ently exist in the prole'èt .real 11, Doe. project .ite contain any specie. of plant or animal life that Is Identified as threatened DYe. ~ According to ~\ l- Identify each specie. . 12. Are there any unique or unu.ual land form. on the prolect sltel (i.e.. cliffs. dunes, other geologica' formations) DYe. ~o Describe . ~ DI~o or endangered I B. Is the proJect sit:....'lresently used by the community or neighborhood a. an open space or recreation areal DYe. UjIIIt. If yes, explain 14, Does the present site Include scenic view, known to be Important to the communltyl DYes ~ 15. Streams within or contiguous to project area: ~(~- a. Name of Stream and name of River to which It Is tributary 16, lakes. ponds. wetland ~r~s ~v,lthln, or contiguous to project area: a, Name W./?,~ 1M \r.),!\ 17, Is the site served by existing public utilities! Gt¥es oNo a) If Yes, does sufficient capacity exIst to allow çonnectionl ~ DNo b) If Yes, wllllmproveménts be necessary to allow connection I ¡;ayes DNo 18. Is the site located In an agricultural district certified pursuant to Agriculture and Markets law, Article 2s-M Section 303 and 304! DYes ~ . 19. It the site located In or substantlall~sontiguous to a Critical EnvIronmental Area designated pursuan't to Article 8 of the ECl, and 6 NYCRR 6171 ~ DNo' . 20, Has the site ever been used for the disposal of solid or hazardous wastes! DYes Øo b, SIze (In acresl ì llJé) B. Project Descrlpllon 1, Physical dimensions and scale of project (fill In dimensIons as opproprlate) 0, Totol contiguous acreage owned or c;'ntrolled by project sponsor 'o.{1- Inn b. Project acreage to be developed: ~ acrès InItially; o· \ c, ProJect acreage to remain undeveloped ~ ')..0 acres, d, length of proJect, In miles: ~ (If appropriate) e, 'f the project Is an expansion, Indicate percent of expansion proposed v'\ Ie f, Number of off·street parking spaces existing ,9"": proposed _.er-- g, Maximum vehicular trips generated per hour '1"- I", . (upon' completion of pro/ect)1 h. f residential: Number and type of housing units: One family Two family Initially 0\1) Ultimately {)IIJI I, Dimensions (In feet) of largest proposed structure :J -'\ .,- hellht; :5,)'-- width; , linear feet of frontage along a public thoroughfare project will occupy Isf ,:}. 3 r;..p.-- -~, acres ultimately. %; Multiple family Condominium t I \ 'tV' ft. length. . . 2-5. Approvals Required: Type Submiltol Dole City, T~ill~ge Board C¡tv. Town, Village Planning Board City. Town Zoning Board City, County Health Department Other local Agencle. Other Regional Agencie.. State Agencies Federal Agencies ~ UNo DYe. -Q!:I 0 DYe. ~o c;I.Ye · UNo DYe. ~o DYe. 3Wo E;I5' e . DNo DYe. .}JNo }~ '~, 00' ~I\i .", if. 'J . ~/D~ -~ ~"''-\,.\.t\\çJ _ 'J:i ~J .11 ~ 1 ~. C. Zoning and Planning Information 1. Does proposed action In~olve a planning or zoning decision? DYes ~ :; If Ye.. indicate decl.lon required: '* ' Dzonlng amendment Dzonlng variance D.pecial use permit D.ubdivi.lon Dme plan '''1 Dnewfrevi.lon of ma.ter plan Dr,esource management plan Dother ... 2. What I. the zonlnl classlflcatlon(s)of the site! \2,- r-.J. ~ ;¡. 3. What Is the maximum potential development of the site If developed as permitted by the presentioning! OA "ff: - 8Ð.\'~ (t>1\''' ~~ .. '.... ~, What Is the proposed zoning 01 the site! n 'Co r: , 5. What is the maximum potential development of the site If developed as permitled by the propotÎd zoning! n\~ ~ 6, Is the proposed action consistent with the recommended uses In adopted local land use plans! ,t~es 7, What are the predominant land use(s) and zoning c1ass.lllcations withIn a ~ mile radius of propot"d aCtIon! ~G~ i"P\.i. ~~¡ oN<I .1--. 8. Is the proposed action compatible with adJoining/surrounding land uses within a Yo mile! 9. If the proposed action Is the subdivIsion of land, how many lots are proposed! C+\ ~, a, What Is the mInimum lot sIze proposed! 10, Will proposed action requIre IIny authorlzatlon!s) lor the formation 01 tewer or water districts! ¡J:OYes ~ 11. Will the proposed action crea~ demand for any community provided services (recreation, '.'I.ucatlon, pollee, fire protection)! DYes ~ !r a, If yes, Is existing capacity sulllclent to handle projected demand! DYe. oNo ' 12. Will the proposed action result In the generation of Iralllc significantly above pr..enl levels! :'bYes a, If yes, Is the exl.ting road network adequate to handle the additional trafflcl DYes #1' oNo D. Informational Details !; Altach any additional Information as may be needed to clarify your proJect. If thNe are or ml , be any adverse Impacts associated with your propo.al, please dl.cuss such Impacts and the measures which you pro We to mitigate or ~~ Æ..: E. Verification ,m I certify that the Information provl Applicant/Sponsor Name Date ~ - Signature. Title .it If the .ctlon I. In the Coulal Are., and you are . .t'le .gency, complete the Couhl Aue..ment Fo,m),e'ore proceeding wllh thh u.eumen!. :If' , I ,~:~ ~, oNo '$I, ~o " . t (;¡~nd_ I,I . . J.M.O. Environmental Consulting Services To whom it may concern: ~.': ~i J) >~, .....,.: ;, Please be advised that we have authorized the firm of J.M,Q, Fnvirnnmental Consulting Services to act as our agent on our behalf in applying for certain appwvals . through your agency and others involved with this project. J.M.O. Consulting Service~ has heen retained to coordinate all approvals necess'uy through your and olher involved agencies, as well as our architect, engineer and contractors. We request that all communications, correspondences, notices, approvals and calls be addressed directly to the offices of J.M.o. Environmental Consulting Services, ;:.' . C- Signature f.?:l~·~ ;;j''ltI·h!U.-:''--L.J~ ~:,.. Dated_dJç).1 /OL____ --- Phone (631) 65.1·0f)07 . r-ClX (631) 653-33-1R 121 Jessup Ave. ?r¡cf J"nor . P,O, Box 4117 Quogue. New York 11959-0447 " . ~ " , rlrd of 'frnstees APPlicatio' .. T '~,. ;'---. "<l :I~ "'j' ,~¡ ßvlZ'Të~ ~" '/""R..r-ll-IA¡,vt-'IiJ BF.WG DULY SWORN DEPOSES AND AFFIRMS 1'IIA liE SHE IS THE APPLICANT Fan TilE ABOVE DESCRIBED PERMIT( S I MID T ALL STATEMENTS CONTAI!lI':n IIEREIN ARE TRUE TO TilE BEST OF IIIS/IIER KNOWLEDGE AND BELIEF. AlID THAT ALL WORK WILL BE DOllE HI THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN B01\RD or TRUSTEES. TilE APPLICANT AGREES TO IIOLD TilE TOWN OF SOUTlloLD AIm THE TOWN TRUSTEES IIARMLESS AND FREE FROM 1\NY MID ALL DAMAGES 1\!1D cr,AIMs ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRI\IITED. IN COMPLETING THIS APpr,ICATION, I IIEREBY AUTHORIZE TilE TRUSTF.ES, THEIR AGENT(S) OR REPRESENTATIVES(SI, TO ENTER 0111'0 flY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS ·APPLICATION. County of Suffolk State of New York SWORN TO BEFORE ME THIS cZ7 +I-¡ ().t\C -~ C-'v-",~, ~:) c .l...O181-< ~ ~:':'-:J.¡ Signature ji ,'-~·k '1~ DAÏ OF Ie biW(ic..V. I .Q~ ìYh£J, Notary Public My Commission Exp.. Aug. 31,2002 7 . ;;J.1kl.6 , ~. ~, i' ., f , " : r ! . '\ . I . ~ ! ..' ". of Tr-u"te"" 7Inpllcatiore . '. J\U'l'lJoru ZJ\ T r (IN (whf!re the applicant is not the owner) I, , , ~ ~ II at óW't.) f,/'IW Jr-- (mailing addres.r--- H\ authorize_',,\, /II, (b., ( 7Igent ) I'; for permit(sl froml~e '.~ \0uP...:íorJ (;" ·~J,-JAfNf..¡;¡- reslrling (print owner of property) .'~ ¡\ol«'¿ À Ft,-, , ('-)' o{, L/,sÒ .- do her.eby C('..,) v (£,C' 1\l11::1~IM , . _ SS~iéJ(~'.9 l Ð.v3 VL ,4j to arply Southold Board of Town Trustees on my behalf. 0.1-ç'~ ~C~"r~ (OWner's signature) 8 II .' .