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HomeMy WebLinkAboutTR-5535 TERMS and CONDmONS The Permittee James Cavanaugh rcsidiag at 130 Riviera Dr. , Kings Park N. y~ as part of the coosideratioa for Ibe ¡...·.nee of Ibe PCrmit does uøderstaDd and prcsaibe to the fol- 10WÏn ¡ : 1. That the said Board of Trustees and Ibe Town of SoudaoId are released from II1'f and all damages, or daims b damages, of suits arising directly or iadirecdy as a result of II1'f oper- atioo performed ptinumt to rbis permit, and Ibe said p..r...I_ wi11, at his or her 01011 ~. defend II1'f aßd all such IUiIS"inidaœd by Ihird putÏa, &ad the said P.....III..... a......... fall JJabIIity wùb respect thereto. to !he <O"'{'I~ exclusion of the Board of T..- of the TOI011 of SoatbQId 2. That tbis Permit is' wJid for a period of 24 mos...tùch is coasidered to be the estimated time· required 10 aJCDplete the """" inwl~ but Should årcmiIstmces warnat, request for an exleftSÏoa may be made to the Board at a bœr daœ. 3. That tbis Permit should be retained inde£mild.y. or as loag as the said Permittee wishCs to . ""'i....in the structure or project involved, to provide evideoœ to aoyooe rooœmed !hat oøIh- orizatioa was originally obtained. 4. That Ibe work involved will be subject to the inopea;oa and approval of the Board or its agents, and noa-mmpliaooe with. the provisioÐS of the oti&i_fi..g appliatioa, may be cause for rcvocaûoa of tbis Permit by resolutioo of the said Board. 5. That !here will be DO IlOtCISOD.ble interfereoœ wilb navigation as a result of the wodc herein authorized. . 6. That there shall be DO iaterfereoce wilb the right of the public to pus and tepISS aIoag the beach between high and low water marks. 7. That if future operarioos of Ibe Town of Soutbold require the 1'CII1Oft1 and/or aIceradoas in the Iocatioo of the work herein ..,1bo1Þe<\ 0 r if; in the opinioa of the Board of Trustees, the . work sba11 cause uoreasooable obstIUCClOD to free navigatioo, the said Permittee will be nquired, apoo due ootke, to remove or alter this work or project herein stated wilbout eq>eoses to the Town of Soutbold. 8. That Ibe said Board will be notified by the Permittee ot the comp1edoo' of the work oøIh- oriud. 9. That Ibe Penuittee will obtain all other permits and cooseolS chat may be required IIJ¡i- plemeotal to Ibis permit which may be subject to revolee upon failure to obtain same. Long Island Permit servic~ '" . 181 ~ Middle Country Road Suite D Ridge, NY ¡19ó I Phone 631-345-6810 Fax óJ 1-345-9419 ,I, Date: 0 III 8/02 To: Town of South old Board of Trustees From: Sandra Savage Via: 1\[ail Re: Gull Pond Lane, Greenport - Wetlands Application - Granted (case #22 10/24/01) James Cavanaugh \Ve are submitting to you the following documents: No. Date Rev. 01/10/02 Documents being sent to you Revised Plot Plan 2 Remarks: Following please find the above referenced documents for your review and appro\-al. EI.4.87 Gull Plod '- ............ o;Íge of asph. oad '. .. EI.4.6 N 23" 58' 40" W " '·h ÌJ ~ ;IJ ~~ {~ \\"' \) ~ ~ I' " :-, IJ\ );..¿ " !J1<'~ :b.. ~" u. J ': Ctr ~ <. Ih ~ "' " 's " ., ~ " 8 " ~ t"' ~ 0 - :!- ., " .... ~ 0 " ~ ~ .,. o O! " o ., " " :\. 5 " po p,lJ,f1f#". \'\,). C;,oIIJóiCAG. ~ " .- " 00 "-~ o o - z ~ " '" c .,. ~ c ~ " " " ~----~ õ' " :f' N o . . 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"\ 6~~ ~~8 Î.J\ ~ S~~ ;~~ ~~ "':z~ :E¡¡;» "'j ~ :;~~ ~:Þ.ê 1\ (' ~~~ ~~~ "''' 10:>- ....ç-< .... ii;, E.~ "> "'''<:> ~:o:.... U\" ;;¡ ~, > .... ..... I '- \) , <) I~ ~ '^ "' l c, , ~ EI.4.1O ,,---., ....-..... ~ \ \. u , ~ <Þ D \ Z 0\ 0\ o o - !õ' '^ :... N o :--.........,,--- t"1 ~.2'N. Meta] Shed O.2'N. Olqn. 150.00' 99~129S ~ ~ ... = t"' 0 - -> .-.. 2: 0 ;:¡ =- ::c 0 ., Q. ~ ~~~ \ þ ~ " '. ~ -- "" '- ---- 0 ........:wood float 100.00' (;'0".., !r./"r.,. "",,/It"': 6(,. -t.I:!:) Highwater IDarkon face of~ulkhead(7-16-99) (/:(.,0.(;':::) Known as Fordham Canal Tax Lot: 028.031 -I o '" '" ;.: !õ' o ¡;;' ... ... -. r:> ... .. IJJ (j > t'" t"j - :... o C .... C C t'" C o ~ W C ~ C .. ~S C(JJ C Q C ...- = II tool to!! o ~> .. ~ :" t"'j =~'"' . c Q ......- ,., "! ?:~- C~C\ ~ të C \0 C '0 ~ ~g' ~~ OI\oC ~ ~ o -¡;a. [; .... 3 . -» !. r:> -.:> ... a-- '" !" '" ~ W .... ,., " ... ~ õ· .... ::I ~O ~ ::I r = , = CD Ü ..... > '"1:J '"1:J ÃJ o < :-n \:) '-;} (j~IJJ~ 0000 d~~~ ZZ<O ~O~~ 0""10~ ~IJJ~=: ClJo~.... cs.::tI(j :::¡=-O....... o::2."'t !';" -c.t"j_ ;I;" :;0- Z ~O . """' SE :< ........L, ~ Q ~ Q.. 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 (63li 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD April 29, 2002 Mr. Kerry P. Heaney Heaney Marine Construction 141 Bay Ave. Greenport, NY 11944 RE: JA~VIESCAVANAVGH 205 Gull Pond Lane, Greenport SCTM#35-4-28.39 Dear Mr. Heaney: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, April 24, 2002 regarding the above matter: WHEREAS, Kerry P. Heaney on behalf of JAMES CA V ANAVGH applied to the Southold Town Trustees for a pennit under the provisions of the Wetland Ordinance of the Town of Southold, application dated March 13,2002, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on April 24, 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 standards set forth in Chapter 97 ofthe 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 approve the application of JAl\ŒS CAVANAUGH to rebuild a 6'X 20' floating dock, 4'X 16' ramp and re-sheath trom behind approx. 104 linear ft. of bulkhead using C-Loc vinyl sheathing, with the condition that a la' non-turf buffer is established behind the bulkhead. BE IT FURTHER RESOLVED that this determination should not be considered a determination made for any other Department or Agency, which may also have an application pending for the same or similar project. Permit to construct and complete project will expire I\vo years from the date il is signed. Fees must be paid, if applicable, and permit issued within six months of tile date of this notification. Two inspections are required and the Trustees are to be notified upon completion of said project. Fees: None Very truly yours, fl~ ~ /4.-~~' G.. " I ,. Albert J. Krupski, Jr. President, Board of Trustees AJK/lms DEC . . Telephone (631) 765-1892 To'AA~ Hall. 53095 Maio Road P.O. Box 1179 Soothold. New York 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: Moved by Bob Ghosio, seconded by Bret Hedges, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH A CONDITION of the Wetland Permit Application of JAMES CAVANAUGH to rebuild the existing 6'X 24' floating dock, 4'X 16' ramp and re-sheath from behind approx. 104 linear ft. of bulkhead using C-Loc vinyl sheathing. Located: 205 Gull Pond Lane, Greenport. SCTM#35-4-28.39 The CAC recommends Approval with the Condition of a 1 q' non-turf IJuffer landward of the bulkhead. Vote of Council: Ayes: All Motion Carried .~ ~bert J" Krupski. President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda . BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD . Town Hall 53095 Route 25 P.O, Box 1179 Southold. New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 Office Use Only Coastal Erosion Permit Application ~t\and Permit Application ~ajor ____Waiver/ Amendment/Changes rReceived Application: ZJB b).J _Received Fee:$ ~- -Completed Application~ß \ÐP _Incomplete _ SEQRA Classification: Type I__Type II_Unlisted_ Coordination:( date sent) ~AC Referral sent:~~ ~ate ofInspection:_ " O~ _Receipt ofCAC Report: _Lead Agency Determination: Technical Review: Þ'Public Hearing He[d:~ Resolution: ,~, -I Minor 411î fT, ~ ¡;. I. JC' -{ \1.."0-- \- 1'0\ ( '1\0 tu{..\e, l:c.I.\i..0(\ ~l\QClðiQ{' bu.\V-.iM.utI ,j - Name of Applicant \./, "'" C "'- L/ t~ 1\., 'c L ' J ~ Address,--.L.3 0 tê. v(f". ¡'f'.. r-- (_ f(·,/.,t·,::; fr:Y l< A../ '¡'" II ) :- l/ Phone Number:( )l~ f I - 3 c) - '?"" :;: ,. Suffolk County Tax Map Number: 1000 - S:. - '$I' - Property Location Á. 0 ç (i'v /I r", I'd) hiÜ.H' (..,.51",",C ./ / /:.4 #2- ~ý-ø", oFrÇ-tJlr'o¡....-cI A"'¡A.'~, (provide LILCO Pole #, distance to cross streets, and locatión) """J ,....... '? ,-  !-,,, '°)'1 .- ., f ,-y.{".< A'f'c / \ , / io I C;:cJu7'I. uF -F/7( ¡¿¡ 0}~ç¡ ~ ^?J~ V~ AGENT: t-I" h 1'-- ( 'r (If applicable) v> '1 ". 'n ''-i't' r /..,.--;-' ,..-<".'r. S v(.. r (íc 1'..1 Address: / V' , ~vf, '< I,;,.·... Î , -,- (,,;y"C-' ~J/'/...~ ý r r Phone: '//7- j/ ~ /-/ . /', " J . . Board of Trustees Application GENERAL DATA Land Area (in square feet): /(! - 5-'0 ~ C' r~ ¡ r'_' C) s"'( / F( . , Area Zoning: ,,/ ~. I ~.~./r"'>v/ '/G/ U/v'r:/" ¡,{r,·(~t'r:f , Previous use of property: Intended use of property: 8d I r/ of' r'j~ ( Prior permits/approvals for site improvements: Agency -- /"',_....."'/1... .. ,r: r ,f ":0-- /'/ Date (.: /, ') /7 {.,. . I _ No prior permits/approvals for site improvements: Has any permit/approval ever been revoked or sUSPen~d by a governmental agency? L~o_ Yes If yes, provide explanation: \ Project Description (use attachments ifnecespry): /f:" 5~'/ 7/C/ .¿¡;o ("- / .~ c:. y¡ .. :,;<--1 /' /' - £f /t-Zy r/?;,/,;...", . </.., c /< , / / '.' Æ:? y x/I: _c,--,.-,.-.,~ , ~ Ic~' s:J."?<, I·'.... FYo)-->-o. he/' ,;,....J ~ -£0 x:: _ /.-?¿, -' '/' ' / (// ^;/~ L/,;'/;"'_j' v/A--Y t*u..\~~ c..../~ rJ ~ . Board of Trustees . Application WETLANDITRUSTEE I,ANDS APPLICATION DATA Purpose of the proposed operations: fe'''' '; (.,('\_ G~ ( - B~""l ,1 'e, _ (X,~)C·I k,;~, j , ,'- ,,' ~ 1\ 1'\ 'r (. ~ Ý I>, ~'- { -,:.;,- 1'_.1 Ct../ J<:-. - /0 kfJdf:;/ . /-,-.. " t- c'~ ! r:: .1\./ f." ' (1 í') ; 5(./ { K h. ~r._,=V --;. f\f'!", .-.- , (A I "-t¡- Area of wetlands on lot: o square feet Percent coverage oflot: ;9 % Closest distance between nearest existing structure and upland --> edge of wetlands: ..:..0 feet Closest distance between nearest proposed structure and upland edge of wetlands: 0 feet Does the project involve excavation or filling? ~ No /' Yes It yes, how much material will be excavated? '10 ,cubic yards 1 Fyt"~ ~.¡.:;,I p~-I/(Áe&j I~w much material will be filled? ''2. <;j cubic yards ~pth of which material will be(r~pr deposited: -5' feet .,$.- I~roposed slope throughout the area of operations: ~anner in which material will be removed or deposited: /?xÆ-ck&,'_ 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): A./c'" J,;.Y> :-~~øFF"c,! LuIIIJ ft', ¡"""..../p, (,~ , ¥ \'3víK'f-."",::- J ~ c" ,iI,x.-r. fY'''- )~_,vl I-¡ ,,¡'.t'c· :Sf' t" ¡.j ~ ,A/C --¡: '-~ c F /',¡7:...... .:';~,y; ~, i, t iit.':\" / "L....·/^- rr· /)~~ ~ r-l#.-¡;'·,.( 5.-/::1T J 7l( ~·v ) '¡7... / '7.... if 7Á. e.,.'(' _-"/'- l"'( ¡ Cj -C'''- {';J.,. , . Ii. 0 ~~ 'ìo\\fFOl,f ~ '~.~- ,§ "a Q . rn ~ ~ ~ ~~. ~ ~ . Albert ,J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Route 25 P.O. Box 1179 South old, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD ----------------------------------- In the Matter of the Application of _~C~~----------- COUNTY OF SUFFOLK) STATE OF NEW YORK) 1.;1 R222112 ¡ . ~ r I J__,\, _ LEi. ~~/.~.~ O,r: ~:J,~ f; :..-~tH -- --.-.--- AFFIDAVIT OF POSTING I, /<Ý'ý!^f 1-I'eM;^/'C f , residing at /'Tj 1"'3';-7 /¡~v--f'- G-yy.. <- ,../;:,0--/( ..Æ- /' / /7 1/ C / being dulý sworn, depose and say: That on the ý' day of Þ;::,YI'I( 2000 I personally posted the property known as 2.s>)" (;.v/ ocJ?>.-cf I....A. GY-<?..-(I-n~ .,-.-(NY l,e¡ ifS/ by placing the Board of Trustees official postér where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the elate °11~e nn""".ðll .1"",.. public I}~~ring. Date of hearing noted thereon to be held~" ~~ 0(\ r:¡- dDOUt ",00 ~ vY\ Dated: Sworn to before me this ;?JNJ day of f!fl£IL 200ó\ k~hJ.~~ Notary Public KAREN W. BOERGE.ô3C, I -.y P\dJIIc. 81m 01 New Yo," No,OIB0484218O QuoIifledInSUffolkCou'7 ~---','-, £'-:-',-..3 l 3 1/ (i.'j Bo4 of Trustees Application . AUTHORIZATION (where the applicant is not the owner) .' I, Jr;c)v\ (5 (print I (y"Vol /I/''ZL'2, t" owner of p operty) residing at '30 I'll.'Ié'Y,"_ V:'y'. (mailing address) \,', oJ",', f..~ (;, A' 7" II 7 '¡ ({ do hereby authorize_tff-,^,,,/.< ~' ,r--: é'J r'í"' f' (Agent) (~Fi'<:( fv( t. 0'''' to apply for permit(s) from the Southold Board of Town Trustees on my behalf. ,~ /7 It _J r, /'."\.-12. r:;;; bc~-<:,~, '--''1} ~ (OWner's s nature) I c 8 · . Board of Trustees Application County of Suffolk State of New York , /? ft ~'C ý,v ~ ,H'é'" "'. ~ %Œ BEING DULY SWORN DEPOSES AND ~IRMS THAT HE/SHE IS APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF illSIHER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN TillS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AiND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGIENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY 1'0 INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF TillS APPLICATION. .., ,/ SWORN TO BEFORE ME TillS -A ~' ~?A 7 '7 Signature / 3 DAY OF 1:/í1~ / 20 ð ~ '- ') ~. /4 ¿<---- / Notary Public /' 7 (~I --- FØRICM_ Nola1y "'- .......... M No,OlCØ!Ol7l52 QualifillllilSllllllkCotlllY COrnmi$aian __ _13, :..2{¿' J 1 ~·~6-.t (2/871- Tex! 12 1 PROJESf 1.0. "UMaE" . . 61;.21 Appendix C Sfate Environmental QuaJ,ity Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I-PROJECT INFORMATION (To be completed by ADplicant or Prolect sDonsor) SEC ,. APPLICANT ¡SPONSOR ....,1 I:· (' ...(\ ~^Ji~~ i.. . 3. PROJECT LOCATION: If' :ì- ".(~. ¡"'-'t" MunicIpality "_1' .p,..',:,1 \ ., - Cuunty r. -...../ ¡-::- - i..1 ¡ 4. PREC:SE LOC),TlON (Street a dress ana (oaa IntersectIons, prominent fanamarK:s. ¿tc., ûr ;Hovlae ,,,al) '-.' "'/. .~ -A/) ['",....,,,·/1 /J,_, "_ 1-' .....,....; ¡..,.,..- r..... "-r:- -r.~;- 1[" r /.....-, ~ j 2. ~ROJES~ NAME v . ~ () \' .....- ' ~ r=c. ý ¡fl/, ,~ 5. IS PROPOSED ACTION: r o New 0 ExpanSion Moaification/af!erarion VC '(. bv ~ It,Y ô. DESCRIBE PROJECT 9RIE:=LY /.,-/-I/"'I..L' "l!' ,.I~- /'t:'r. ~1;...... C·,* ~ X· U,. K~~.J? Æ~.. ::"'^~¿:~ e:-_/r...~x'-. /~''7-'' /}r: ...;',,)f-t/ I....J ~·.A"'~ v/A..-';7 /: C;ÁPG /"""----: (:' ): , < T;'_ t'~ '7 ,./! lce/ .~~, ' / ~ _. __/ :;:" -., I.. ___~_.. c:-rc~,,-.,...__ "'~e=- rJ- ¿3;~/i~~Å~..('~/Y)r.t.?v"\ ..,. AMOUNT OF UNO AFr-ECTED: r_~ ~) Initially acres Ultimatelv acres 3. 'IJIL!..¡.=qQ?I)SE~ ACTION COMPL':' 'NITH 2X!SïJNG ZONING OR OTHER EXISTING 1"";,\10 USE :::1e.s7RIC71CNS? ~Yes U No It ~~o. descnbe Drlerly '.'Jt-<A IS ?RESE;\IT LAI'"~C U:.:ë: IN '/ICIN!r:, OF ,:JqOJECT? ..~es den[fa I I.!naus:nal C C.:Jmmercial :Jesc~IDe: L..1 AgncUlture ~ ParK/Forest/QJen space LJ Other ~O" DOES AC"TION INVOLV A ?'=.¡:UAIT APPROVAL OR FUND!~~G. ,~OW OR UlÏIMATEL'f FROr.1 ANY OTHER GOVERNMENTAL AGENCY iF:::DERAL, STATE vi=! lOCAL)? o Yes If yes, list agency(s) and permllfapprovals .::-- 11. DOES ANY ASP CT OF THE ACTI0r~ HAVE A CURRENTLY VALID PERMIT OR APPROVAL? o Yes No II y~s. list agency name and permlllapproval 12. ..),$ A RESULT OF ~OPOSE¡) ~CTlON WIL!..... !:XISTING PERMIT/APPROVAL r1EOUIAE .'.100rFICA'ION? OY~s Ø'No _.. ! CERTIFY THAT THE INFORMATION PROVIDED ~eOvE IS TMUE -0 THË 3ESï OF MY KNOWL'::ûGE ).,ppricanIISt:!onsor "ame: ~~ //~""~---.. ..-¡ ~,. ¡'í'¡ / /'7 /1 .rt.-'¿" 'é.AY.-......" /" /v_ ¡~nf { '"7/_}, ¡ f !t~,-,.1Y( rl D.,e -" C-'r:r...t.. _~Æ~,-~:,,-'l ) { !. ~ j:,"-¡ -' ------. / - SIgnature: ~-;- If the action is in the Coc!5tal Area, and IOU are a state asenC'{, oomplete the Coas:al Assessment Form before proceeding with this 3~..~esSmen! OV!:R At't'LtCAN'1' TRANSACTIONAL DISCLOSURE FORM . . The Town of Southold's Code of ~~hlcð Þrohlbl~s contllc~s of in I;eres I; on ~he part of town of f icers and emPloyers, '1'he purpose of this form Is to provide Informatl?n wh ch can alert I;he town of possible conflicts of Inl;eres~ and allow it to take whatever action is necessary to avoid same. YOUR NAMBI C I ! ·;·,..:,,:t~:<:{~¥J!~l~~:~:.~ fl. IÃrJ tA.U "'- Last name, f rs~ name. n ~ al, unless you are applying in the someone else or other entity, such ~s a company. If so, Indicate ~he other person's or company's name.) '.1.: NATURE 011 At'PLWA'1'IONI (check all I;ha~ apply.) ;. ;"' ,. !¡~~,L : ".: ';~~' :;;j..'.\.: !:~~ Tax grievance Variance Change of zone ^p.p'ípolal of piat . " ~xemptlon from plaVor official map other 1L- .c f 111 -- r./ -,- <:r.c. "other." name ~he ac~ivHy.) r("bvl ~ E",.t'S!''''IL )1r-ur'_Ic/(-e:5 Do you peroonally (or through your cÖMpany, spöuøJ, sibling, parent, or child) have a relationship with o,y officer or employee of the 'l'ovn of Sou!:hold7 ·nelatlonljlhlp· includes by blood, marriage, or business in!:eres!:. ",usiness Inl;eresl;" Means a busineos. including a parl:Ii1ership. in vhich I;hs I;ovn officer or employee has even . parl;ial ovnerohip of (or employmenl; by) a corpora\;ion in 'Which I;he I;ovn of ricer "'ir e playee ovns more I;han 5% of I;he shares. YES NO If you ansvered ØYBS," complel;e I:he balance Øf ~his torm dal;e and sign ~here indica!:ed. ".:.':" and Name of person employed by I;he Town of Sou~h~ld Til;le or posi~ion of tha~ person Describe the relal;ionship be~ween yourself (~he apþlicanl;) and the ~own officer ør employee. Either check ~h~ appropriate line h) through D) and/or des~ribe in the space provided. The town officer or employee ot his or her SPOUs9i sibling, parent, or child is (check all ~ha~ apply), h) the owner of grea~er ~han 5% of ~he ~hares of ~he corpora~e stock of I;he appllcan~ (when ~he applicant Is a corporation), B) ~he legal or beneficial owner of any intere~~ in a noncorporate'enl;ity (when ~he applicant is no~ a corporation), C) an officer. direcl;or, parl;ner. or emplöY99 of ~h9 appl1can~, or D) ~he actual applicant. . .," .,"'.. " ,",,': .' DESCR! PTION 01,' IŒLATIONSIIt P J1.·'." ,"" . . .", ,... ., ... ..".. .... ,"., ,"'. ...,,;"~l·... ~_ .' ·,.l~" .... ......,,"-.. . . ", :. ':;.....;..·.:,:,~:;.;~ff~I~~~;·(·I~:~~;~·,}.~';:¡>.·.:..~ sublnitted ~his&:d'!li oti";¡~'1J..~·· " SIghat:Ure~~, ~t?;;"j"~~' "·'·~·..·'L~..¿<:...¡,¡'Ii~,r1- C_ . ¿7 ...n.., .'. .,', ¡ '" ".." '~~,.. ....,.. ·print:. name' ~. . ,:Jr:j{'.,.'~" ,"' . - :.t". ;!¡~"' .;. ~·t ' ,.:.:1ji:;;'f,"i'~~'.o:," ,:y.I!;'$"~r,r"-'\I.,. ~ ," '''¡;,1-\, \~..,..:I}\ "'~í~~~~ .¡"I;t!.'1_~ ' '.~ ·1~'..~;.1.··.1. "~'." ...l(J'J.' ,:-4,. r- '......¡,.Ij~. i¡;':;'~j:" ; 5,f" ~.:c! , " ~ " ;;..