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Levison, M S
TOWN OF SOUTHOLD TOWN CLERK'S OFFICE SOUTHOLD, NEW YORK WETLANDS PERMIT This Wetlands Permit No. .....61.......... has been granted by the Southold Town Board according to information furnished in Application No. ............ filed by Applicant .h�:...3- Levison ............................... ........................................ on October 21 19..81.... 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 ..,construct 35 ft of bulkhead, 30 ft by 6 ft . float , 10 ft, by 3 ft. ramp and 4 ft . by 6 ft . platform on ................................................................................................................................................................. private canal. ................................................................................................................................................................. Location of property on which work to be done ...Albacor.e..Drive. . . ,. . . . Southold. . . . ...Shores. . . , .. .. .. .. . ..... .. ...... .... . .. .... . .... .......... Southold, New York. ................................................................................................................................................................. .......................................................................................................................... ...:.. ..................`:....... Creek, Ba or Harbor Private Canal off Southold, Bay � �: Y 9 property .,... . .. .:::. ` .......................................................................................................................... .`'r".:..�:.....,......�.. 11 �... Size of work: Length ...35 f t, bulkhead `, �/j� { .`\r f . Width ....... ... t.................................................................................. .......................... Height Above High Water ,,,3 ft DepthBelow Low Water .......4..ft................................................................................ Yards to be Excavated .......None .................................................................................... Yards to be FilledNone ......................................................................................................... Manner in which material is to be removed or deposited ......................................................................... ................................................................................................................................................................. Intended use of property ...Private — Residential .......................................................................................................... ................................................................................................................................................................. Conditions if any ......... ................................................................................................................................................................. Expiration Date ....... Numberof Inspections Required ............................................................................................................. InspectionFees ..................................................................................................................................... Liability Policies in the Amount of ....-.--..... 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 and vege- 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. J` Signed . . ...��..:.r...l ... ............ Town Clerk, Town of Southo E J Date........... anuarv. 5.i. 1982 j IP PUBLIC HEARING SOUTHOLD TOWN BOARD DECEMBER 22, 1981 3: 30 P.M. IN THE MATTER OF THE APPLICATION OF M. S. LEVISON FOR A PERMIT UNDER THE PROVISIONS OF THE WETLAND ORDINANCE OF THE TOWN OF SOUTHOLD. APPLICATION NO. 77 COUNCILMAN MURDOCK: "Notice is hereby given that a public hearing will be held by the Town Board of the Town of Southold at the Southold Town Hall, Main Road, Southold, New York on December 22, 1981 as follows: 3: 30 P. M. in the matter of the application of M. S. Levison for a permit under the provisions of the Wetland Ordinance of the Town of Southold, for permission to construct bulkhead, float, ramp and plat- form on private canal off Southold Bay at Albacore Drive, Southold Shores, Southold, New York. All persons interested in said matter_,,' ' shall appear at the time and place above specified and will be given an opportunity to be heard. Dated: December 8, 1981, By Order of the Southold Town Board, Judith T. Terry, Town Clerk." I have an affidavit of publication by Troy Gustayson on behalf of the Suffolk Times and I have an affidavit by Patricia Wood from The Long Island Traveler-Watchman. Statement from Judith T. Terry the Town Clerk that the notice was properly posted on the Town Clerk' s Bulletin Board. I have a letter from the Conservation Advisory Council Judith T. Terry, Town Clerk. "Dear Mrs. Terry: The following action has been taken by the Southold Town Conservation Advisory Council at a regular meeting held on November 24, 1981. RESOLVED to recommend to the Southold Town Board approval of Wetland Application #77 of M. S. Levison to construct 351 of bulkhead, 30" x 6' float, 10' x 3' ramp, 4' x 61 platform on private canal. " I have a letter to Judith T. Terry, Town Clerk from Anna Hataier on' behalf of the Trustees of Southold Town. "Dear Mrs., Terry: The following action was taken by the Board of Southold Town Trustees at a regular meeting held November 4, 1981: RESOLVED to recommend to the Southold Town Board approval of the wetland application, #77, of M. S. Levison to construct 35 ' of bulkhead, 30 x 6 ' float , 10 x 3' ramp and 4 x 6 ' platform on private canal off Southold Bay, at Albacore Drive, Southold Shores, Southold. " SUPERVISOR PELL: Thank you. Anybody wish to speak in favor of the application of M. S. Levison? (No response. ) Anybody wish to speak in opposition to it? (No response. ) Does anybody wish to be heard at all on it? (No response. ) If not, I declare the hearing closed. Judith T. Terry Southold Town Clerk � i LEGAL NOTICE NOTICE OF HEARING NOTICE IS HEREBY' GIVEN that a public hearing will be held by the Town Board of,the Town of Southold at the j Southold Town Hall, Main j Road,Southold,New York,on December 22,1981 as follows: p is tion of thematter of the _ COUNTY OF SUFFOLK, application of M.S.Levison for r' a permit under the provisions- STATE OF NEW YORKE ss: of,the Wetland Ordinance of i 1 the Town of Southold, for permission - to '"construct Tr',cy Gustayson being duly Sworn, bulkhead,float,ramp and plat- i form on,private canal off . says that . . he. . , is Printer and Publisher of the SUFFOLK Southold Bay at Albacore Drive, Southold Shores, WEEKLY TIMES, a newspaper published at Greenport, in said Southold,New York. All persons interested in said county; anti +that the notice, of which the annexed is a printed matter shall appear at the time and place above specified and will be given an opportunity to i copy, .has been published in the said Suffolk Weekly Times be heard. DATED:December 8,1981 once in each week, for . . . . . . . . . one. . . . . . . . . . . . . . weeks BY ORDER OF THE successively commencing on the 10th SOUTHOLD TOWN BOARD . . . . . . . . . . . . • • • JUDITH T.TERRY, D e.c emb e r TOWNCLERK day of . . . . . . . . . . . 1TD10-3822 . . . . . . . .� . . . . . . . . . . . . . . . . . . . . . . . Sworn to before me this day of . . . .December . 19.8 j - . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . HELEN K DE VOE NOTARY PUBLIC, State of New York No 4707878, Suffolk County Term Expires March 30, 19Z3 COUNTY OF SUFFOLK ss: LEGAL NOTICE , ' I STATE OF NEW YORK NOTICE OF HEARING - � I NOTICE IS HEREBY GIVEN 'that a public;hearing Patricia Wood, being duly sworn, says that she is the will be held by the Town Board of the Town of Southold at the Editor, of THE LONG ISLAND TRAVELER-WATCHMAN, Southold-,Town '•Tall; Main Road, Southold, New York, on a public newspaper printed at Southold, in, Suffolk County; December 22, 1981 as follows: and that the notice of which the annexed is a printed copy, � 3:30 p.m. in the matter of the application of M.S. Levi- has been published in said Long Island Traveler-Watch- son for a permit under the man once each week for .....................................weeks provisiohs of the Wetland Ordinance of the Town of - successively, commencing on the ........�.... d....................... Southold, for, permission to construct bulkhead, float, , 19 1\ •ramp and platform on private day f ... ......... r ................ canal off Southold Bay- at ( Albacore Drive ........ ... .......................................4.!J.................. Southold 'Shores, Southold, New York: All persons interested in said matter shall appear at the time and place above specified and will be given an opportu=- nity to be heard. Sworn to before me this �....................... day of 'DATED: December 8, 1981 ....... BY ORDER OF THE ............, 19... .� SOUTHOLD TOWN BOARD JUDITH T.TERRY TOWN CLERK IT-12/10/8](5) ...... �. ............ .. . .... ................... Notary Public CLEMENT J.THOMPSON NOTARY PIALIC,State of Now York ML 52-9321725 Ring In Suffolk Cw C=ML3don Edeas much 3.x,11 .l i STATE ,OF NEW YORK: SS: COUNTY OF SUFFOLK: I� JUDITH T. TERRY, Town Clerk of the Town of Southold, �1 New York, being duly sworn, says that she is over the age of 1 twenty-one years; that on the 9th day of December 19 81 lj 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 Count New York place in the Town of Southold, Suffolk � Y, , to wit : - Town Clerk Bulletin Board Town Clerk Office Pain Road ' Southold, New York 11971 1. ii Notice of Public Hearing - 3: 30 P.M. , December 22, 1981, II' upon application of M. S. Levison for a permit under the 1� provisions of the Wetland Ordinance of the Town of Southold. i� i i; Judith T. Terry I` Southold Town Clerk f �i 11 Sworn to be before me this 9th day of December 19 81 Notary—Public ELIZABETH ANN NEVILLE NOTAR'! PUBLIC, State of New YoPR ' No 52-8125850, Suffolk Cou t Term Expires M rCh 30z 19 f I f 1 t LEGAL NOTICE NOTICE OF HEARING NOTICE IS HEREBY GIVEN that a public hearing will be held by the Town Board of the Town of Southold at the Southold Town Hall, Main Road, Southold, New York, on December 22, 1981 as follows: , ,' 3: 30 P.M., in the matter of , the application of A9, S. Levison for a permit under the provisions of the Wetland' Ordinance of the Town of Southold, for permission to construct bulkhead, float, ramp and platform on private canal off 'Southold, Bay at Albacore Drive, Southold Shores, Southold, New York, All persons interested in said matter shall appear at the time and place above specified and will be given an opportunity to be heard. DATED: December 8, 1981 BV ORDER OF THE SOUTHOLD TOWN BOARD JUDITH T. TERRY, TOWN CLERK PLEASE PUBLISH ONCE, DECEMBER 10, 1981, AND FORIMRD ONE AFFIDAVIT OF PUBLICATION TO JUDITH T . , TERRY,. TOWN CLERK, TOWN HALL, AA-AIN ROAD, SOUTHOLD, NEIN YORK 11971. Copies to the ,following: The Suffolk Times The Long Island Traveler-watchman Town Board Members Town Clerk' s Bulletin Board M. S. Levison F N- CS -V 0V.ls"v N JUDITH T.TERRY TELEPHONE Town CLERK (516) 765-1801 REGISTRAR OF VITAL STATISTICS S NEG ATIVE' DECLARATION1 NOTICE OF NO SIGNIFICANT EFFECT ON THE ENVIRONMENT Dated: December 8 , 1981 Pursuant to Article 8 of the Environmental Conservation Law State Environmental Quality Review and 6 NYCRR 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 M. S. Levison for a wetland permit to construct bulkhead, float, ramp and platform on private canal off Southold Bay at Albacore Drive, -Southold Shores, Southold , 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 effects to the environment are likely to occur should the project be implemented as planned. Because there has been no response in the allotted time from the New York State Department of Environmental Conservation, it is assumed that there is no objection nor comlhents by that agency. Further information can be obtained by contacting Mrs. Judith T. Terry, Town Clerk, Town of Southold, Town Hall, Main Road, Southold, New York 11971. Copies to : David DeRidder, DEC, Stony Brook Commissioner Flacke, DEC, Albany Southold Town Building Department Town Clerk Bulletin Board M. S. Levison SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL WCOVER Southold, N. Y. off' ;�i iJ�1 so 001 25 November 1981 Mrs. 'Judith Terry, Town Clerk Town Hall Southold, NY 11971 Dear Mrs. Terry: The following action has been taken by the Southold Town Conservation Advisory Council at a regular meeting held November 24, 1981. RESOLVED to recommend to the Southold Town Board approval of Wetland Application #77 of M. S. Levison to construct 35' of bulkhead, 30' x 6' float, 10' x 3' ramp, 41- x 6' platform on private canal. Application #78, Strong's Marine Center, for an extension of bulkheading will be temporarily tabled until December 4, 1981 at which time other inspections will be done. r Yours truly, FRANK CICHANOWICZ III, CHAIRMAN CONSERVATION ADVISORY COUNCIL By Jane Moffatt, Secretary 0, I(:;E'OFf'Tr.' �I;,��8K a A—Z >.nc amv T4WN`:O �OL1T JUDITH T.TERRY SOP F-..01 If COUN "Y TELEPHONE TowN CLERK d' (516) 765-1801 REGISTRAR'OF VITAL STATISTICS Southold, L. I., N. Y. 11971 November 10, 1981 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 M. S. Levison for a Wetland Permit to construct bulkhead, float, ramp and platform on private canal off Southold Bay at Albacore Drive, Southold Shores, Southold, New York. 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 November 30, 1981 . We shall interpret your lack of response to mean there is no objection by your agency. Very truly yours, v Judith T. Terry Town Clerk Enclosures cc : Commissioner Flacke Southold Town Building Department ROAR STEES ' OUT FO COUP Telephone 516-765-1938 RECEIVER Southo . 11971 NOV 6 1981 Town CaerR SM450K November 6, 1981 Mrs. Judith T. Terry, Town Clerk Town Hall Southold, New York Dear Mrs. Terry: The following action was taken by the Board of Southold Town Trustees at a regular meeting held November 4, 1981: RESOLVED to recommend to the Southold Town Board approval of the wetland application, #77, of M. S. Levison, to construct 35 ' of bulkhead, 30x6 ' float, 10x3 ' ramp and 4x6 ' platform on private canal off Southold Bay, at Albacore Drive, Southold Shores, Southold. Yours truly, Anna T. Hataier, President Southold Town Trustees OFF.ICE�OF{:TOWN CL•ER�K TOWN OF'SOU D JUDITH T.TERRY SUFFOLK`COUNTY TELEPHONE TOWN CLERK :r.' ' '' R (516) 765-1801 REGISTRAR OF VITAL STATISTICS > Southold, L. I., N. Y. 11971 October 22, 1981 To Whom It May Concern: Attached hereto is Short Environmental Assessment Form submitted- on behalf of M. S. Levison in connection with Wetland Application No. 77 for permission to construct bulkhead, float, ramp _and platform on private canal off Southold Bay at Albacore Drive, Southold Shores, Southold, New York. �dith T. Terry Southold Town Clerk Posted on Town Clerk' s Bulletin Board October 22, 1981 . . - .;,... - '�-"z C;� %�,^>'`'�' `r.'.':'�xiaSWx�,-.*�,e•^'s_ri.• ci:' ,>.csar=ri�,r,,. w:;;5",r;' rY+�zt ?+.";°" ;a.>,K;.;.-;'; "k':';`,. - �t°• � Yeti=.;;r,.... - JZi 'c{ F eXkin`R.S:riC.t✓°c5V r`,1'i.�i.'.'', twt'ryi,,v'1j•W _ - -. ....".. a-.-....v r.—... ...,....-to _ .rr. ., r..R, • • _,. ! .t, t.ras �'�,.•.�,lY �M'..•�!-'.'+<'.i�'`- I'.�.. 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 projec-t may be significant and a completed Environmental As-sessment 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? . . . . . . . . . : . . : . . . . . . . . . . Yes�No 2 . Will there be a major change to any unique -or . unusual land form found on the site? . . . . . . . . . . . Yes_�_No 3 . Will project alter or have a large effect -on existing body of water? . . . . . . . . . . . . . . . . . . . . . . . Yes yNo 4. Will project have a potentially large impact ` on groundwater quality? . . . . . . . . . . . . . . . . . . . . . . . YesY- No 5 . Will project significantly effect drainage flow on adjacent sites? . . . . . . . . . . . . . . . .... . . . . . . . Yes_)L__,No 6 . Will project affect any threatened or endangered plant or animal species? . . . . . . . . . . . Yesy' No 7. Will project result in a major adverse effect on air quality? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes_1 _No 8 . Will project have a major effect on visual - character of the community or scenic views or vistas known to be important to the community? Yes_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 bya local 'agency? . . . . . . . . . . . .: . . : . . : . . .� . . . Yes 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__�LNo 12 . Will project regularly cause objectionable odors, noise, glare, vibration, or electrical- disturbance as a result of the project ' s operation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes_�L_No 13 . Will project have any impact on public health or .safety? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • Yes1,rNo 14. Will project affect the existing community by 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? . . . Y"es�Na 15. Is there public • controversy • concerning the project? . . . . . . . . . Yes '( No PREPARER ' S SIGNATURE i REPRESENTINGDATE /O OFFICE-E'OF:TQWN- C�ItERK TOWN-O SOiJTHOIJD' JUDITH T.TERRY %SURFOL I{'COU 'T'Y TELEPHONE TowN CLERK y' (516) 765-1801 REGISTRAR OF VITAL STATISTICS Southold, L. I., N. Y. 11971 October 22, 1981 Southold Town Board Southold Town Hall Southold, New York 11971 Gentlemen : Transmitted herewith is application 'no . 77 for a wetland permit submitted by M. S. Levison. Copies of this application have -been forwarded to the Board of Town Trustees and Conservation Advisory Council on this date for their report of findings and recommendations . . Very truly yours , Judith T. Terry Town Clerk JTT/bn Enclosures OFFICE OF'T6- C„ ERK •OWN'QFSOUTHOL _ JUDITH T.TERRY S,; ,F. `K COUIV Y TELEPHONE TowN CLERK +� d'° (516) 765-1801 REGISTRAR OF VITAL STATISTICS Southold, L. I., N. Y. 11971 October 22, 1981 Mrs. Anna Hataier, President Board of Southold Town Trustees Southold Town Hall Southold, New York 11971 Dear Mrs. Hataier : Transmitted herewith is application no. 77 for a wetland permit submitted by M. S. Levison. Please prepare a written report of findings and recommendations with- respect to this application and submit said report to me within 20 days of receipt of this letter. Very truly yours , Judith T. Terry Town Clerk JTT Enclosures OFFIC QFtO„ CLERK T-1 QiJTHL F ., JUDITH T.TERRY U rFO '-K-CQL7NTY TELEPHONE Town CLERK a` � lie (516) 765-1801 REGISTRAR OF VITAL STATISTICS Southold, L. I., N. Y. 11971 October 22, 1981 Mr. Frank Cichanowicz III , Chairman Conservation Advisory Council Southold Town Hall Southold, New York 11971 Dear Mr. Cichanowicz : Transmitted herewith is application no. 77 for a wetland permit submitted by M. S. Levison. Please prepare a written report of findings and recommendations with respect to this application and submit said report to me within 20 days of receipt of this letter. Very truly yours, Judith T. Terry Town Clerk JTT Enclosures M ' Town Of Southold Town Clerk's Office :S' utlio d - Y." APPLICATION FOR WETLANDS PERMIT Application No. .......� ................ Date of Application ........ I................... Identity of Applicant ......... ...�� ...�_E.VZ S O hj.......................................................................... Address of Applicant ...... ....��„ �j}l. ��.....7A 01.......................................................... 06977 INSTRUCTIONS FOR PERMIT 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 ma p% 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 structures or to dredge or deposit fill on said premises and whether any such permits or licenses were ever revoked or suspended by a governmental agency. 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. H. The Town Board upon reque t'o Lthe applicant for a permit, may waive in whole or in part, the provisions of Article II, Secti subdivisions (16) and Qrwhere 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. PONDAN AlbacOre v 00 �ocusr a Jir umvAxeD Conal. (. O /coo Za®o'nr yooe Rim°Y3. 3o'x �' F/oot � - � .�L�U��D�r,•+�- �U7�����{ �C�• � T, Q Robi C/7 Ow Dobe® \ BXN, 2s, toy L evi ter, f/ac�f - �o' X � azv p .rt Y ` 6 x 4 t1la Aarx,�, - Nn rx >1 3eCC124000d Lr-'le Rel vote 10P,/Pj rn� 'I, f i,:--V r i3 T 6 51a v1 ! oG�F77 F/oaf�. I L®CGT r�Fi - r, el �4L"12tWok 171e,- 5u C rall 4 _ �✓Jpa 3trC%101/ Z fir) ft7j o z 41 c �n ,µ r Examined ................................................. 19..,.... Approved ........................................................::..... Disapproved ........................................................... Conditions, if any ................................................,....................................:.:.-:....................................... .................................................................................................................................................................. ................................................................................,................................................................................ 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 Dr/coinage Areas of the Town of Southold: Permit requested to .....„cqv ?Sb-//fGe... ��.5. .® .��r.' /..l?e..l..G......., i K„�,o„1 ...�,A ........ ....... .?�6... �cr �-�n....Q �'ijla7le .(faoa/........................... Location of property for which permit wanted....,.././../ ��CQ/'�..✓�.'1. .....� v ,rv.,l......... S �r.n lv off .. .2r ff©/k..�,-�.. .... Home address of permit applicant if different from aforesaid location .. ......................... . ........... ....................................................../...... ....... ............................................................. Creek, Bay or Harbor fronting property ..... T!...O;f ,,, Size of proposed work: Length ..............tea.S.'......°.�� .....Ol�............................................................................................ 72- 1 Width ..................................................................................................................................................... Height Above High Water .........✓..........................,................................................................................ DepthBelow Low Water ......................................................................................................................... Yardsto be Excavated .................A/0.0...4' ........................................................................................... Yardsto be Filled .........................../ti,®r''JLf........, ...............................:............................................... 1, -F Widthof canal, creek or bay fronting property..........o.................................................................... Depthat Low Tide .......... : ..............................,................................................................................ Average Rise in Tide ............................................................................................................................. Isthis for private or business use? ........ .......................................................................... AreaZoning .............. � � '`? / ........... ................................................ .......................... Manner in which material will be-removed or deposited .................................................................. . ..................................................�..............................,................................................................................ Intended use of property 1 ����' r/!/l� �OCAf................................................. ........ ...... .......... ...... ... ........................... ........................................................................................................................................................ Written consent of owner of property, if not the same as the applicant ........................................ .........,........................................................................................................................................................ .................................................................................................................................................................. COUNTY OF S ) r STATE OF CN�-�f•6f. ) SS: I As� I�1 c4iirnfe'Cu .................................................... .t.:s.....6 d...lS .................................. being duly I worn 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 he manner set forth in this application and as may be approved by the Town Board of the Tow 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 virtue of said permi if gran ed. .. 1� a .............. Signature of Applicant Sworn to before me this (�)( day o. 014 ............................. 19. �.. "-Nory Public cow#Ao'civ J-A)W-6 (tit: I Z 1981 MICHAEL S. LEVISON 44 BEECHWOOD LANE RIDGEFIELD. CONNECTICUT 06877 Totem C�er� �o�or� 44 Oyu ' �, .s:'; 1� _ est , ;.r L Kl< - TO OFOUT `t- - S 0 D: - WN H L ,. 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, resu t in _ a- large " physical change _ - __, to the project site or physically alter more than 10 acres of land? . . Yes No 2 ._• Will there be a `major change . ta any unique or unusual land form- found on the site? . . . . . . . . . . YesNo ' - 3 . Will project alter or have a ,large effect on existing body of, water? . . . . . . : . . . . . . . . . . . . . . . Yes N0 4: Will project have a potentially large impact on groundwater quality? ... . . ..... . . . . . . . . . . . . . . . . Yes No 5. Will project significantly effect drainage' - flow _on adjacent sites? . : .•. . . . . . . . . . . . . . ... . . . . . Yes�No 6 . -Will: project affect any threatened or endangered plant or animal species? . . . ... . . . . . . Yes4No 7. Will project resu'lt - in a major adverse, effect on air quality? . . . . :... . . . .I. . . . . . ... Yes_�(.No 8 . Will -project have a major effect on visual character of the community or ''scenic -views or vistas known to be important to ,the community? YesNo 9•. Will project adversely impact' any site or structure of historic, prehistoric or - paleontological importance of any site designated` ds .a critical environmental area by a local agency? . . . . . . . . . . : . .: . ::: . � . . .� . . . Yes No 10 . Will project have amajor 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? . . . . . . . . . . . . . . . . . . . . . YesNo 12 . Will project, regularly cause objectionable 7, odors; 'noise, glare, vibration, or electrical disturbance as a result of the 'project ' s operation? . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . � . Yes _No 13 . Will project have any impact on public health or .safety? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes�No 14. Will project affect the existing � community by 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 charac,t�er of the -community or neighborhood? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes )( 15. Is there public contro-versy concerning the project? . . . . . . . Yes _,A No PREPARER ' S SIGNATURE . REPRESENTING DATE /O