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Home My WebLink AboutFalconer, Frederick '¢ S r1^7•� '1 L' • � i l� i6sa'.�n•:r.w:•:.�k'w«.'•Y'd�l:�"•iaSw,i^�dtitrt�+e.h.L'i.a ie�w _ - �'r TOWN OF SOUTHOLD TOWN CLERK'S OFFICE SOUTHOLD, NEW YORK WETLANDS PERMIT This Wetlands Permit No. ..N..........:. has been granted by the Southold Town Board according to information furnished in Application No. ......169 filed by Applicant ....Frederic !,Faleo�er,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, on ,,,October„3.... .......... 19$3...... A map of the proposed work will be kept on file in the Town Clerk's Office under the application number given. Permit granted to do the following work .... .................:.. ................................................................................................................................................................. ................................................................................................................................................................. Location of property on which work to be done .....north side„405„Fl..............d Road Cttrhogue ............ ......... ........ .. . ................................................................................................................................................................. ............................................................................................................................... .. .....:. . ......... Creek, Bay or Harbor fronting property ..............East..Greek.........................X .....`,........ .. ............................ .................i......................................................................... .t. .�... ........ .... Size of work: Length ..30„feet........................................................................ :.- l Width ...30..feet................................................................................ .............. Height Above High Water ....... ................................................................................. Depth Below Low Water ......1.-11.? ft. ................................................................................. Yards to be Excavated .100..Drax'.da................................................................................. Yardsto be Filled ..........none:...................................................................................... Manner in which material is to be removed or deposited ....drag.Aine.................................................... ................................................................................................................................................................. Intendeduse of property .................................................................................. ................................................................................................................................................................. Conditionsif any ........::-....................................................................................................................... ................................................................................................................................................................. Expiration DateRgvombex'..2.9....19,84.......a.E..VMO.R.K..HAS..IIIA.I..CQMUEMCED..RY-S.H.ID.DA.TE. Number of Inspections Required SE..NQ.T.I.E.I.ED..W.H.E.N.-P.RO.J.ECI...IS. Ib-- COMPLETED. InspectionFees ......$5..00..... .. .. ..I............................................................................................... Liability Policies in the Amount of ......................................................................................................... s The validity of this permit is or may be subject to the approval of other governmental or municipal authorities. The Town accepts no responsibility in applying for or obtaining such approval. In the event that such approval is necessary, the holder of this permit shall not commence operations here- under until such approval has been obtained in writing. The failure to obtain such other approval when required shall subject this permit to immediate revocation by the Town Clerk upon receipt by the Town Clerk of written notice from such other governmental or municipal authorities of its refusal or disapproval. The applicant does by the acceptance of this permit, assume all responsibility for operations under- taken pursuant to this permit, and shall take all precautions for the prevention of injuries to persons and property resulting from such operations. By such acceptance, the applicant also agrees to indemni- fy and save harmless the Town, and its officers, agents and employees from any and all claims arising from operations under this permit and any and all acts or omissions of applicant, his agent and employees. The applicant and the owner and occupants of the premises upon which the operations authorized by this permit are being conducted, do, by the acceptance of this permit, give consent to the Town, and its officers and employees to enter upon the premises where such operations are being conducted to make such inspections as the Town may deem necessary to insure that such operations are being con- ducted in conformity with this permit. This operation will not substantially: A. Adversely affect the wetlands of the town. B. Cause damage from erosion, turbidity or siltation. C. Cause saltwater intrusion into the fresh water resources of the town. D. Adversely affect fish, shellfish or other beneficial marine organisms, aquatic wildlife andvege- tation or the natural habitat thereof. E. Increase the danger of flood and storm-tide damage. F. Adversely affect navigation on tidal waters or the tidal flow of the tidal-waters of the town. G. Change the course of any channel or the natural movement or flow of any waters. H. Weaken or undermine the lateral support of other lands in the vicinity. I. Otherwise adversely affect the health, safety and general welfare of the people of the town. Signed �� ... .. .. ........ Town Clerk, Town of out a �i ( _.,� Date........Npvem.ber...29,...].983 ............................ n� { R- K Town Hall, 53095 Main Road P.O. Box 728 Southold, New York 11971 JUDITH T TERRY ' � f' TELEPHONE TOWN CLERK (516)765-1801 REGISTRAR 0VITAL S7 Al'IS PICS I' OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD December 1, 1983 To: Southold Town Building Department From: Judith T. Terry, Town Clerk Transmitted herewith are Wetland Permits 142 (Peter Micciche) , and 143 (Frederick Falconer). The Town Board requires two inspections of each project. You may make your first inspection whenever you determine feasible, and I will notify you when the projects are completed so you may make the second inspection. Town Hall, 53095 Main Road P.O. Box 728 Southold, New York 11971 JUDITH T TERRY 1" TELEPHONE To1VN CLERK (516)765-1801 REGISTRAR OI'VI FAL S I A]ISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD December 1, 1983 Mr. Frederick Falconer 4 S. Maryland Avenue Port Washington, New York 11050 Dear Mr. Falconer: The Southold Town Board approved your Wetland Application at their November 29th meeting. Upon receipt of $5.00 inspection fee your permit will be forwarded to you. Very truly yours, Judith T. Terry Southold Town Clerk At PUBLIC HEARING SOUTHOLD TOWN BOARD November 29, 1983 3:32 P.M. IN THE MATTER OF WETLAND APPLICATION NO. 169 BY LFREIDERICK FALCONER. Present: Supervisor William R. Pell, III Councilman John J. Nickles Councilman Lawrence Murdock, Jr. Councilman Francis J. Murphy Councilman Joseph L. Townsend, Jr. Town Clerk Judith T. Terry Town Attorney Robert W. Tasker Absent: Justice Raymond W. Edwards SUPERVISOR PELL: This is a hearing on the Wetland Applicastion of Frederick Falconer. The.notice will be read by Councilman Murdock. COUNCILMAN MURDOCK: "Notice is hereby given that public hearings will be held by the Town Board of the Town of Southold at the Southold Town Hall, Main Road, Southold, New York, on Tuesday, November 29, 1983, on the follow- ing Wetland Applications. 3:32 P.M. - in the matter of the application-of Frederick Falconer for permission to maintenance dredge at East Creek, on the north side of Fleetwood Road, Cutchogue, New York. All persons interested in said matter should appear at the time and place above specified and will be given an opportunity to be heard. Dated: November 15, 1983. Judith T. Terry, Southold Town Clerk." I have notice of publication by Judith A. Chien on behalf of The Suffolk Times, and notice of publication by Patricia Wood on behalf of The Long Island Traveler- Watchman. Notice of posting on the Town Clerk's Bulletin Board signed by Judith T. Terry, Town Clerk. I have a letter to Judith T. -Terry, Town Clerk from the Southold Town Board of Trustees: "Dear Mrs. Terry: Transmitted herewith is the action taken by the Board of Town Trustees at a regular meeting held on November 2, 1983: Resolved to recommend to the Southold Town Board approval of the Wetland Application #169 submitted by Frederick Falconer to maintenance dredge for sufficient depth of water, for boat moorings, fill is to be placed on own premises, in East Creek, Cutchogue. Signed by Paul Stoutenburgh, President." Letter to Judith T. Terry, Town Clerk, from the Southold Town Conservation Advisory Council: "Dear Mrs. Terry: The following action was taken. by-the- Conservation Advisory Council at a regular meeting held Tuesday, October 25, 1983: Resolved to recommend to the Southold Town Board approval of the wet- land application #169 submitted by Frederick Falconer to maintenance dredge, Cutchogue. Signed by Frank Cichanowicz, Chairman." Page 2 - Public Hearin Wetlarid Application of Frederick Falconer SUPERVISOR PELL: Thank you. You've heard the reading of this applica- tion for maintenance dredg'ing only, application No. 169, does anybody wish to speak in favor of Frederick Falconer's applicastion? (No response.) In opposition to? (No response.) Does anybody wish to be heard at all? (No response.) If not, the hearing is closed. Judith T. Terry Southold Town Clerk COUNTY OF SUFFOLK ss: STATE OF NEW YORK NOTICE OFhEARINGS _ Patricia Wood, being duly sworn, says that she is the NOTICIt"IS HEREBY GIV- ENthat public hearingswillbe Editor, of THE LONG ISLAND TRAVELER-WATCHAAAN, held by the Town Board of the j Town 'of Southold at the a public newspaper printed at Southold, in Suffolk County; Southold Town Hall,, Main and that the notice of which the annexed is a printed copy, Road, Southold,New York;on has been published in said Long Island Traveler-Watch- Tuesday, November 29, 1983, j on' the following Wetland man once each week for ......................... ...weeks Applications: I 3:30 P.M.-in the matter of successively, commencing on the 17 - the application of The Land Use Company, on behalf of .... day of ............. :........................, 19 �3 ........ Peter Micciche,for permission to construct bulkhead, and ......:.................. ................ ramp on'. Corey Creek, at ....... private road off Bayview Road, Southold, New York.- 3:32 ork:3:32 P.M.- in the matter of the application of Fiederick. Falconer, for permission to z� g � ` maintenance dredge' at East I Sworn to before me this ................................ day of Creek, on the north side of � Fleetwood Road; Cutchogue, I . .............. ...........:`.':...... � 19.... 3 New York. .All persons interested in said matters should appear at the time and place above specified and will be given an opportunityto be'heard. ........ ................. ...... . ... .. ...... .............. DATED: November 15, 1983." Notary P is JUDITH T.TERRY SOUTHOLD TOWN•CLERK CL.EME�N'6'J.TH®MpSQR9 '1T-11/17/83(9) NOTARY PUBLIC,State of New York No.52-9321725 Residing in 3uffoiia Count Commission Expires March 30,I(52 STATE OF NEW YORK ) ) SS: o� COUNTY OF SUFFOLK ) permission to construct i bulkhead and ramp on Corey Creek. at private roar) off ti JUIITTU A (-UT-FN of Greenport, in YorkBayview Road,Southold,New said County, being duly sworn,says that he/she is 3:32 P.M.An the matter of ; Principal Clerk of THE SUFFOLK TIMES,a Weekly LEGAL NOTICE the application of Frederick NOTICE OF HEARINGS Falconer for permission to Newspaper, published at Greenport, in the Town NOTICE IS HEREBY maintenance dredge at East of Southold, County of Suffolk and State of New GIVEN that public hearings Creek, on the north side of will be held by the Town Board Fleetwood Road, Cutchogue, York, and that the Notice of which the annexed is of the Town of Southold at the New York. I a printed copy, has been regularly published in Southold Town Hall, Main All persons interested in Road,Southold,New York,on said matters should appear at said Newspaper once each week forone 1) Tuesday, November 29, 1983, the time and place above 17th on the following Wetland specified and will be given an weeks successively, commencing on the Applications: opportunity to be heard. day of November 19 83 3:30 P.M.--in the matter of DATED:November 15,1983. the application of The Land JUDITH T.TERRY Use Company, on behalf of SOUTHOLD TOWN CLERK Peter Micciche, for 1TN17 4397 f,4. Ct C bu' �`-- ---- —— Principal Clerk Sworn to before me this 17 t1L JOAN N.MAGEE day ember 1983 NOTARY PUBLIC STATE OF NEW YORK EDSU508K8 COMppALIFIINFOLCOUNTYSSION —P EXPIRES MARCH 30, 19AF ' STATE OF NEW YORK: t' �l SS: i COUNTY OF SUFFOLK: f i' JUDITH T. TERRY, Town Clerk of the Town of Southold, New York, being duly sworn, says that she is over the age of j twenty-one years; that on the 16th day of Noverrber 1983 i' f, she affixed a notice of which the annexed printed notice is a ' f true copy, in a proper and substantial manner, in a most public place in the Town of Southold, Suffolk County, New York, to wit : - Town Clerk Bulletin Board, Town Clerk Office, Main Road, j Southold, New York 11971 i= 1 Notice of Hearings on Wetland Applications: Tuesday, November 29, 1983, ! Southold Town Hall. 1 3: 30 P.M. - The Land Use Company, on behalf of Peter Micciche !' 3:32 P.M. - Frederick Falconer i, 1 I I I i Judith T. Terry Southold Town Clerk i l is Sworn to be before me this 16th day of November 1983 s Notary Public- ELIZABETH ublic ELIZABETH ANN NEVILLE NOTARY PUBLIC, State of New York No. 52-8125850, Suffolk Cour ty, Term Expires March 30, 19 1i i I I j I l� S. i LEGAL NOTICE !i >> NOTICE OF HEARINGS !! i !I NOTICE IS HEREBY GIVEN that public hearings will be held by the Town si ! Board of the Town of Southold at the Southold Town Hall, Main Road, Southold, i; , New York, on Tuesday, November 29, 1983, on the following Wetland Applica- tions: pplica- tions: 3:30 P.M. - in the matter of the application of The Land Use Company, on behalf of Peter Micciche, for permission to construct bulkhead and ramp on ; I I iCorey Creek, at private road off Bayview Road, Southold, New York. lj li 3:32 P.M. - in the matter of the applicastion of Frederick Falconer for I �i permission to maintenance dredge at East Creek, on the north side of Fleetwood II Road, Cutchogue, New York. I, ii All persons interested in said matters should appear at the time and place I! above specified and will be given an opportunity to be heard. DATED: November 15, 1983. I� JUDITH T. TERRY li ii SOUTHOLD TOWN CLERK s i j i; PLEASE PUBLISH ONCE, NOVEMBER 17, 1983, AND FORWARD TWO (2) AFFIDAVITS OF PUBLICATION TO JUDITH T. TERRY, TOWN CLERK, l� TOWN HALL, MAIN ROAD, SOUTHOLD, NEW YORK 11971. Copies to the following: 1! �j The Suffolk Times The Long Island Traveler-Watchman Town Board Members Town Clerk's Bulletin Board i; The Land Use Company, on behalf of Peter Micciche Frederick Falconer 1' i i( I !i I Ii it fl It I jII it i! li e .} PEA Town Hall, 53095 Main Road P.O. Box 728 Southold; New York 11971 JUDITH T TERRY TELEPHONE TOWN CLERK (516)765-1801 REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD NEGATIVE DECLARATION NOTICE OF NO SIGNIFICANT EFFECT ON THE ENVIRONMENT Dated: November 15, 1983 Pursuant to Article 8 of the Environmental Conservation Law State Environmental Quality Review and 6NYCRR Part 617, Section 617.10 and Chapter 44 of the Code of the Town of Southold, notice is hereby given that the Southold Town Board, as lead agency for the action described below, has determined that the project , which is unlisted will not have a significant effect on the environment . DESCRIPTION OF ACTION Application of Frecerick Falconer for a wetland permit . Permission is requested for maintenance dredging on East Creek on the north side of Fleetwood Road, Cutchogue, New York. The project has been determined not to have a significant effect on the environment for the following reasons: An environmental assessment has been submitted which indicated that no significant adverse effect to the environment are likely to occur should the project be implemented as planned. Because there has been a response from the Board of Southold Town Trustees and Southold Town Conservation Advisory Council indicating that this project would not have a significant effect to the environment. Because there has been no response in the allotted time from the New York State Department of Environmental. Conservation and the Southold Town Building Department, it is assumed that there are no objections nor comments from those agencies. Further information can be obtained by contacting Mrs. Judith T. Terry, Southold Town Clerk, Southold Town Hall, Main Road, Southold, New York 11971. Copies to: David DeRidder, DEC, Stony Brook Commissioner Williams, DEC, Albany Southold Town Building Department Southold Town Trustees Southold Town Conservation Advisory Council Town Clerk' s Bulletin Board Frederick Flaconer \ s_ z o ® � TELEPHONE (516)765-1892 BOARD OF TOWN' TRUSTEES TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 728 RECEIVED Southold, New York 11971 NOV 410 November 4, 1983 Town Clerk Southold Mrs. Judith T. Terry Southold Town Clerk Southold Town Hall Main Road Southold, New York 11971 Dear Judy: Transmitted herewith is the action taken by the Board of Town Trustees at a regular meeting held on November 2, 1983 : RESOLVED to recommend to the Southold Town Board APPROVAL of the Wetland Application #169 submitted by Frederick Falconer, to maintenance dredge for sufficient depth of watbr, . for boat mooring, fill is to be placed on own premises, in East Creek, Cutchogue, Very truly yours, Board of Town Trustees Paul Stoutenburgh President PS:ip r SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL Southold, N. Y. October 26, 1983 Mrs. Judith Terry Town Clerk Main Road Southold, NY 11971 Dear Mrs. Terry: The following action was taken by the Conservation Advisory Council at a regular meeting held Tuesday, October 25, 1983. RESOLVED to recommend to the Southold Town Board approval of the wetZand application #165 submitted by the Land Use Company on behalf of Maureen Sullivan to instaZZ a elevated ramp leading to a float secured by two piles. Southold. Application #166 submitted by the Land Use Company on behalf of WiZheZm Franken to remove 17 ' of bulkhead and instaZZ a "L" shaped bulkhead as well as 155 ' of new bulkhead to connect with existing structure at basin entrance. This application is being given. eonditionaZ, approval untiZ .the Conservation Advisory Council can see that the wetlands will be restored to Southold Town 's satis- faction. Southold. RESOLVED to recommend to the Southold Town Board approval of the wetZand application #167 submitted by Ron Dobert to install a nature walk and a means to launch a canoe. Mattituck. RESOLVED to recommend to the Southold Town Board approval of the wetZand application #168 submitted by Michael J. HaZZ, Attorney on behalf of Frank and Margaret Rosenberg to instaZZ buZkheading on northern terminue of Sterling Creek. Greenport. RESOLVED to recommend to the Southold Town Board anproyaZ of the wettand application #169 submitted by Frederick Falconer to maintenance dredge. Cutchogue. Respectfully submitted, FRANK CICHANOWICZ, CHAIRMAN )_alz� _/2�c� By Jane Moffatt, Secretary Town Hall, 530 95 Main Road trs d� P.O. Box 728 Southold, New York 11971 JUDITH T.TERRY TELEPHONE TOWN CLERK (516)765-1801 REGISTRAR 01,VITAL STA"I ISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD October 5, 1983 Mr. David DeRidder Environmental Analysis Unit N.Y.S . Dept . of Environmental Conservation Building 40, SUNY - Room 219 Stony Brook, New York 11794 Dear Mr. DeRidder : Enclosed is application of Frederick Falconer for a wetland permit and Short Environmental Assessment Form pertaining to the same. This project is unlisted and our initial determination of non-significance has been made and we wish to coordinate this action to conform our initial determination in our role as lead agency. May we have your views on this matter. Written comments on this project will be received at this office until We shall interpret your lack of response to mean there is no objection by your agency. Very truly yours, • ��r�Q.hhti . Judith T. Terry Town Clerk Enclosures cc : Commissioner Williams Southold Town Building Department Hall, 53095 Main Town Road P.O. Box 728 Southold, New York 11971 JUDITH T.TERRY TELEPHONE TOWN CLERK r (516)765-1801 REGISTRAR 01'VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD October 3, 1983 To Whom It May Concern: Attached hereto is Environmental Assessment Form completed by rederick Falconer in connection with his wetland application no. 169 for a wetland permit . Permission is requested for maintenance dredging on East Creek on the north side of Fleetwood Road, Cutchogue, New York. /-I&udith T. Terry Southold Town Cler Posted on Town Clerk' s Bulletin Board on 10/3/83 TOWN OF SOUTHOLD SHORT ENVIRONMENTAL ASSESSMENT FORM INSTRUCTIONS : / a In order to answer the -questions in this short EAF it is assumed that the preparer will use currently available information concerning the project and the likely impacts of the action . It is not expected that additional studies, research or other investigations will be undertaken. (b ) If any question has been answered Yes the project may be significant and a completed Environmental Assessment Form is necessary . (c ) If all questions have been answered No it is likely that -this project is not significant . (d) Environmental Assessment 1 . Will project result in a large physical change to the project site or physically alter more than 10 acres of land? . . . . . . . . . . . . . . . . . . . . . . . . YesNo 2 . Will there be a major change to any unique or unusual land form found on the site? . . . . . . : . . Yes_�LNo 3 . Will project alter or have a large effect on existing body of water? . . . . . . . . . . . . . . . . . . . . . . YesNo 4. Will project have a potentially large impact on groundwater quality? . . . . . . . . . . . . . . . . . . . . . . . YesNo 5 . Will project significantly effect drainage flow on adjac-ent sites? . . . . . . . . .. . . . . . . . . . . . . . . . Yes No 6 . Will project affect any threatened or endangered plant or animal species? . . . . . . . . . . . Yes No 7. Will project result in a major adverse effect onair quality? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes N0 8 . �'�ill project have a major effect on visual character of the community or scenic views or vistas known to be important to the community? Yesf` No 9 . Will project adversely impact any site or structure of historic, prehistoric or paleontological importance or any site designated as a critical environmental area by a local agency? . . YesNo 10 . Will project have a major effect on existing . or future recreational opportunities? . . . . . . . . • Yes ')( No 11 . Will project result in major traffic problems or cause a major effect to existing transportation systems? .-... . . . . . . . . . . . . ... . . . . . . .. .. Yes N0 12 . Will project -regularly cause objectionable odors, noise., glare, vibration, or electrical disturbance as a result of the project ' s _ operation? YesNo 13 . Will project .haveany •impact .0n .public �health • or safety? . . . �b. . . . . . . . . . . . . Yes-)( No 14 . Will projectaffect the community directly causing a growth - in permanent - population of more than -5 percent over a one year period or -have a major negative effect on the character of the community or neighborhood? . . . . . .. . . . . . Yes No 15 . Is there public controversy . concerning the- project? heproject? . . . . . . . . . . . . . . . _ _ YesNo P.REPARER ' S SIGNATUR REPRESENTING_ - DATE PAM Town Hall, 53095 Main Road P.O. Box 728 Southold New York 11971 JUDITH T.TERRY R �' TELEPHONE TOWN CLERK (516)765-1801 REGISTRAR OP VITAL S1 A I ISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD October 3, 1983 Southold Town Board O Southold Town Hall Southold, New York 11971 Gentlemen: Transmitted herewith is application no. 169 for a wetland permit submitted by Frederick Falconer. Copies of this application have been forwarded to the Board of Southold Town Trustees and Southold Town Conservation Advisory Council on this date for their report of findings and recommendations. Very truly yours, Judith T. Terry Southold Town Clerk Attachment _ g< Town Hall, 53095 Main Road P.O. Box 728 Southold, New York 11971 JUDITH T TERRY TELEPHONE TOWN CLERK (516)765-1801 REGISTRAR 01:VITAL S1 A 1 ISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD October 3, 1983 Mr . Frank Cichanowicz, III , Chairman Southold Town Conservation Advisory Council Southold Town Hall Southold, New York 11971 Dear Mr . Cichanowicz: Transmitted herewith is application no.169 for a wetland permit submitted by Frederick Falconer. Please prepare a written report of findings and recommendations with respect to this application . Very truly yours, ------------ Judith T. Terry Southold Town Clerk Attachment Town Hall 53095 Main Road P.O. Box 728 Southold New York 11971 JUDITH T TERRY TELEPHONE TowN CLERK (516)765-1801 REGISTRAR OP VITAL STA-I IS"PICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD October 3, 1983 Mr , Paul Stoutenburgh, President Board of Southold Town Trustees Southold Town Hall Southold, New York 11971 Dear Mr. Stoutenburgh: Transmitted herewith is application no. 169 for a wetland permit submitted by Freder.ck Falconer. Please prepare a written report of findings and recommendations with respect to this- application. Very truly yours, Judith T. Terry Southold Town Clerk Attachment _ Town Of Southold Town Clerk's Office Southold, N. Y. APPLICATION FOR WETLANDS PERMIT Application No. .....1.fa...��............... Date of Application �z- Identity of Applican � �� V ................................................... .. Address of Applicant .t. .. . �� ,... ... ....... . . ,... INXRUCTIONS FO EitMOT �-3 dIL A. This application is to be completely filled in by typewriter or ink and submitted to the Town Clerk in quadruplicate, accompanied by written- permission from the owner of the property if not the same as the applicant. B. Pilot Plan must be drawn to scale on the reverse side of this application showing the location of property, the names and locations of owners of adjoining properties, and a detailed description of proposed project. (Note: Copies of the Pilot Plan may be made by a copy machine and attached to the Permit Application.) C. No operation shall be initiated by the applicant until all permits that are required are issued. D. A detailed statement of the rehabilitation and proposed condition of the premises after the work is completed must be given, including a survey if required. E. If permit is being sought for a more sizeable excavation than the construction of a private single dock or jetty, then this application must be accompanied by a survey and topographical map certified by a registered land survey or Professional Engineer. The horizontal control of survey shall be based upon an approval local coordinate system. The vertical control for elevation and sound- ings shall be based upon United States Coast and Geodetic Survey and/or United States Geological Survey datum. F. A statement must- accompany the application describing any known prior operations conducted on the premises in question and whether any prior licenses or permits have been issued to erect i structures or to dredge or deposit fill on said premises and whether any such permits or licenses were ever revoked or suspended b P y a governmental agency. i G. A filing fee of $25.00 shall accompany the application. This filing fee includes one inspection. there is a $5 00 fee for each additional inspection. t H. The Town Board upon request' t1h applicant for a permit, may waive in whole or in part, the provisions of Article 11, Section subdivisions (b and (O'where it finds that nature of the ! proposed operations are such that the requirements of .such provisions are not necessary for a proper consideration of a permit application. I. Upon approval of this application the Town Clerk will issue a permit to the applicant. Such permit shall be available for inspection at any time, upon request. Examined .................................................. 19....... Approved ................................................................ Disapproved ........................................................... Cr1rl,�ition�, .f arra. ........... ..... . ............. .... .t .. .................. ........._ .»............................ .................................................................................................................................................................. .................................................................................................................................................................. ExaminingBody ..................................................................................................................................... Signatureof Chairman ......................................................................................................................... APPLICATION IS HEREBY MADE to the Town Board of the Town of Southold, Suffolk County, New York, for the issuance of a permit pursuant to the Laws, Ordinances and Regulations govern- ing the Coastal and Interior Wetlands, Flood Plains and Drainage Areas of the Town of Southold: Permit requested to ..... L ...... :t !�LG` ,....... „�!!f. � �� .......... .................................................................................,................................................................................ �l s Location of property for which permit wanted.... �.... ...... ................ ................ 4.-:.6.�d:�............................... Home address of permit applicant if different from aforesaid location ;—A' .. ;:!.. Creek, Bay or Harbor fronting property ..... ., ..................... .. .................................................... .................................................................................................................................................................. Size of proposed work: Length ....................... .................................................................................................. Width ........... �.. .....�... ........................................................................................................ HeightAbove High Water ................................................................................ .............................. Depth Below Low Water ............... ..... .. ... ....... zf... .. .................................. Yardsto be Excavated .................<... ............................................................................. Yardsto be Filled ........................... .................................................................. .............. Width of canal, creek or bay fronting property......... . .. ... ®:,,.,,,,,, Depthat Low Tide ............/ ... .............................................................................................. AverageRise in Tide ............ .....`.....................:..................................................................... Is this for private or business use? .................... ..Ic .....4.1c. C/ AreaZoning ....................... .. ..• . ,��!d .................................................................... .......... Manner in which material will be removed or dec1 . „• ,.. .. . . ............................................................................................................................................ Intended use of property ....... a ................... . .......................................................................................................................... Written consent of owner of property, if not the some as the applicant ............................. . ............................................................................................................................. . ........................................................................................................................... COUNTY OF SUFFOLK ) STATE OF NEW YO SS: .. . ............ ........... .. ' ' ' ••• •• ..................................... being duly sworn deposes and says that he is the applicant for the above described permit, and that all statements contained herein are true to the best of his knowledge and belief; that the work will be done in the manner set forth in this application and as may be approved by the Town Board of the Town of Southold. The applicant agrees to hold the Town of Southold and the Town Board harmless and free from any and all damages and claims arising under or by vi ue of said p rmit, granted. r .s.... .................. . . ... ...... ............ .......................... Signature of Applicant Sworn to before me this ............. day of .... .............. 19,23.. Notary Public ELIZABETH ANN NEVILLE VOTARY PUBLIC, State of Mew York Na. 52.8125850, SuffolkCo Term Expires March 30, 19 - ' �. 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