HomeMy WebLinkAboutPollert, William P
TOWN OF SOUTHOLD
TOWN CLERK'S OFFICE
SOUTHOLD, NEW YORK
WETLANDS PERMIT
This Wetlands Permit No. ....��............ has been granted by the Southold Town Board according to
information furnished in Application No. ....51........... filed by ApplicantWilliam Pollert
............................
........................................ on .Aucj ..............ust 21 19..8.x... 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 ,,,constr.uct. .. ...a catw. ...alk.,.... ...
ramp and...float. . . ..........
.. .... .. .. .... .... .... . ......... ...... .. . .... ..
across the wetlands.
..............................................................................................................................................................
.................................................................................................................................................................
Location of property on which work to be done ...nort. ...
h side Pine Neck..Road, .
. Southold
.. ................................. ............ . .................
.................................................................................................................................................................
................................................................................................................................................................
Creek, Bay or Harbor fronting property ... Creek
....................................................... . ........).......... ....
........................................................................................................................ . .,.�.�:.. ......�.. . .�:....
60 feet (a roximatel ) �lj \�,���`
Sizeof work: Length ......................... ..pP.....................X................................ ,!/t�.r.i�.�. �.........
Width ......................5feet (a��roximate1
.... .................................................................
Height Above High Water ,3 feet
.............................................................................
Depth Below Low Water ---
Yards to be Excavated ..........---
.....................................................................................
Yards to be Filled ..............
Manner in which material is to be removed or deposited ......
.................................................................................................................................................................
Intended use of property ..................Resi. . d.ential..... . .... ...... ....................................................................................
.................................................................................................................................................................
Conditions if any ...........
.................................................................................................................................................................
ExpirationDate .....................................................................................................................................
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.
Signed . ... ......... .: .:.: ........... ................
Town Clerk, Town of Sout d
S(E AIL `
. � Date..... 0..........................
PUBLIC HEARING
WETLAND APPLICATION OF WILLIAM POLLERT
A public. hearing was held by ,the Southold Town Board at
8:00 o'clock P.M. , Tuesday, on September 23, 1980 in, the matter
of the application of Will,fam. Pollert. for a permit under the
provisions of the Wetland Ordinance of the Town of Southold for
permission to construct a catwalk, ramp and float across the
wetlands at his proPerty on the north side of Pine Neck Road on
Jockey Creek, Southold, New York.
Present were:
Supervi=sor William R. .Pell III
Councilman Henry,W. Drum
Councilman John J. Nickles
Councilman Lawrence Murdock
Councilmen George R. Sullivan
Town Clerk Judith T. Terry
Town Attorney 'Robert W. Tasker
Absent: Justice Francis T. Doyen
SUPERVISOR PELL: It is now 8:00 o'clock. I will ask
Councilman Murdock to read it. Application of William Pollert.
COUNCILMAN MURDOCK: I have a letter of affidavit from Joan
Gustayson , testif ying to the legal advertising of today's public
hearing. I have a letter of testimony from Patricia Wood of the
L.I . Traveler Wa'tchman,. .I have a letter from Judith Terry, the
Town Clerk saying that the notice was posted on the l own Clerk
bulletin board. The notice of hearing reads as follows :
"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 September 23, 1980 at
8:00 o'clock P.M. , in the matter of the application of William
Pollert for a permit under the provisions of the Wetland Ordinance
of the Town of Southold for permission to construct a _catwalk,
ramp and float across the wetlands at his property on the north
side of Pine Neck 'Road on Jockey Creek, Southold, 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: September 9, 1980 JUDITH T. TERRY
TOWN CLERK
COUNCILMAN MURDOCK: I have a letter of the Southold Town
Conservation Advisory Council to the following ef�fecti "RESOLVED
to ,recommend to the Southold Town Board approval of the appli--
cation- for a wetlands permit for William Pollert subject to ,the
width of the catwalk being decreased to three (3) feet". The one
that is missing is a copy of the letter from the •Town Trustees.
PUBLIC HEARING Page -2-
WILLI-AIS POLLERT September 23, 1980
COUNCILMAN MURDOCK: The Town Clerk recalls that the Town
Trustees did recommend approval but that the letter was left out
of here.
.SUPERVISOR PELL: Thank you., Does anybody wish to speak in
favor of the applicant?
WILLIAM POLLERT: I thank you very much for having gone _this
far. There seems , to be a question of holding the catwalk to three
(3) feet. As a matter of fact, the wetlands that this catwalk goes
over has- a width of about three ,(3) feet, so there is no appreciable,
wetlands that we are talking about. The area is surrounded with
this beach grass or this grass. All - of the docks in the area are
at least six (6) feet wide. A three (3 ) foot wide dock is unnavigable.
I have small grandchildren coming down there. I myself Walk many
times with a cane. I was assured, when it was gone over with DEC,
that's the Environmental Council in Stony Brook, when the Town
Trustees went over it, they assured 'me that they would consider
the five (5) foot walk. I think that the five (5) foot walk
should be allowed.
SUPERVISOR PELL: Thank you very much. Mr. Pahl Stoutenburgh
speaking for the Town Trustees. ,.,
PAUL STOUTENBURGH, SOUTHOLD- TOWN TRUSTEES: I would just like
to say that we went over this and found out that the reason that we
went along with the three,- the wider width is -exactly the reason
stated here. That when a person has difficulty in navigating, we
feel that we would like to make an exception to the smaller width,
which we try to' stay within the three (1) feet, and therefore, we
recommended a wider width in this particular case.
SUPERVISOR PELL: The Town Trustees did recommend... . .
MR. STOUTENBURGH: The Town Trustees did recommend it. Yes.
SUPERVISOR PELL: They did recommend five (5) feet for him?
SIR. STOUTENBURGH s Yes.
SUPERVISOR PELL: Does anybody else wish to speak for?
(There was no response. )
SUPERVISOR PELL: All, right. Does anybody wish to speak
against the application?
(There was no -response. )
SUPERVISOR PELL: Does anybody else wish to be hea-rd -at .all. .on
this application?
(There was no response. )
SUPERVISOR PELL: If not, call- the hearing closed,
Respectfully submitted, -- •
Betty Neville --`
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RECEIVED AND FITIJED BY
THE, SOU'1 HOLD, TOWN CLERK
DATE 9/�y��D HOUR 9 L-3A4,W
70?ut'1'11'0-1a
Town Clerk, Town of
r
` ... : .�
JUDITH T.TERRY TELEPHONE
TOWN CLERK `a£ (516) 765-1801
REGISTRAR OF VITAL STATISTICS
Southold, L. I., N. Y. 11971
NEGATIVE DECLARATION
NOTICE OF NO 'SIGNIFICANT EFFECT ON THE ENVIRONMENT
Dated: September 23, 1980
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 will
not have a significant effect on the environment .
DESCRIPTION OF ACTION
Application of William Pollert for a wetland permit . Permission
is requested to construct a catwalk, ramp, and float across wetlands
at Jockey Creek, located at north side of Pine Neck Road, 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 effect 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 comments by that agency.
' Further information can be obtained by contacting Mrs. Judith
T. Terry, Town Clerkm, Town of Southold, Town Hall, Main Road,
Southold, New York 11971.
Copies to:
William Pollert
Commissioner Robert F. Flacke, DEC, Albany
David DeRidder, DEC, Stony Brook
Building Department, Town of Southold
Town Clerk Bulletin Board
1 _
LEGAL NOTICE
NOTICE OF HEARING
NOTICE, IS HEREBY
GIVEN THAT a public hear-
ing will be held by the Town- COUNTY OF SUFFOLK. 1
Board of the Town of Southold STATE OF NEW YORK, ss
at the Southold Town�Hall
Main Road, Southold, New
Yor8:00 o'clock
P.M., in the mj at .JQALV. GU.TAKS•QN. . being duly Sworn,
S:OOo'clockP.M., inthemgt-' • • • ° • • • • • • • • • • • • • •
ter of the application of Wil-
liam Pollert fdr a permit says that . °SHE, , is Printer and Publisher of the SUFFOLK
under the provisions of the
Wetland Ordinance of the WEEKLY TIMES, a newspaper published at Greenport. in said
Town of Southold for permis-
sion to construct-a catwalk, county; and that the notice, of which the annexed is a printed
rarnp and float across the
r wetlands-4t his property on copy, has been published in the said Suffolk Weekly Times
the north side,of Pine Neck
Road on Jockey Greek South- once in each week. for . • •one • • . • ° weeks
old;New York. e 1 eventh
-All persons interested -in successively commencing on the . . . . . . . . . . . . . . . . . . . . . .
said-matter should`appear at
the time--and—place— day of . . .Se-ptember . . . . . . . 19 80
me .
specified andmill be given an �• • • j,�j•�����✓�.�`" . . . . . . . .
•� v" . .
j opportunity to be heard. • • • • •
ff DATED.-September-9,1980__ Sworn to before me this tweLEth. °
_ JUDITH T.TERRY' �
TOWNCLERK day of . . . . . . $ . .. . . . . . 19�.�800 J
1TS11-3518. .. . . .
MARGARET YOUNG
NOTARY PUBLIC
Suffolk CountY'Noa5 -Of
9 5
New York
Term Expires March 30, 1982
COUNTY OF SUFFOLK ss:
1 LEGAL NOTICE STATE OF NEW YORK
NOTICE OF HEARING !
l � '• ' l
NOTICE IS HEREBY
GIVEN THAT a public l earing 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 Hall, Main o public newspaper printed at Southold, in Suffolk County;
Road,Southold,New York, ow
September 23, 1980 at 8:00 and that the notice of which the annexed is a printed copy,
o,clock P.M., in the matter of has been published in said Long Island Traveler-Watch-
the application of William
` Pollert fora permit under the J man once each week for ............./........................ weeks
provisions"of the'Wetland
i I
Ordinance 'of--the' -Town '.-of successively, commencing on the ..... ................................
Southold for permission to
construct a-catwalk, ramp and
d .... ........., 19. ......
-float across.the-wetlands•at-his
-property on•the norrh side-of
4 Pine Neck Road on Jockey Lj 7_�
Creek, Southold_, New York. ...... . .............................................. .....
All persons interested in
said matter should appear at,;1
the time and place-.above, -
specified,and will be given an,
opportunity to be heard. Sw�obe me this day or
DATED: September 9, 1980 ,
JUDITH T.TERRY
MO..
k Town Clerk =
1T;9/11/80(30)
IT
.......... .... .. ... . .• .. ...... .... . ................
Notary b
CLEMENT J.THOMpSoV
NOTARY PUBLIC,Stage of New Yor;,
No.52-9321725
Residing in Suffolk County
Commission Expires March 30,19_Z�-
I�
II
I`
I' STATE OF NEW YORK:
�I
s, S S :
; COUNTY OF SUFFOLK:
I�
i'
f� JUDITH T. TERRY, Town Clerk of the Town of
Ij
!! Southold, New York, being duly sworn, says that she is over. the
-
i
k age of twenty-one years; that on the 5th day of September
!; 19 RO she affixed a notice of which the annexed printed
;jnotice is a true copy, in a proper and substantial manner, in a
I'
;, most public place in the Town of Southold, Suffolk County, New
i'
I�
1! York, to wit:-
Town Clerk Bulletin Board, Town Clerk Office
Main Road, Southold, N.Y. 11971
gPubli_c Heari-ng - 8: 00 P.M. , September 23, 1980
�Applicatio•n of William Pollert for a wetland permit -
_ t
t
C =
Judith T. Terry, own Clerk
s
I
;I I
�jsworn to before me this
5th day of aSePtamhPx
lg 80
I
otary Public
ELIZABETH ANN NEVILLE
10TARY PUBLIC, State of New York
No. 52.8125850, Suffolk County
form Expires March 30, 19Ld -
. i
II
f;
- li
LEGAL NOTICE
NOTICE OF HEARING
NOTICE IS HEREBY GIVEN THAT a public hearing, will be held by,
the Town Board of the Lown of Southold at the Southold Town Hall,
Main Road, Southold, New York, on September 23, 1980 at 8: 00
o' clock P.M. , in the matter of the application of William Pollert
for a permit under the provisions of the Wetland Ordinance of the
Town of Southold for permission to construct a catwalk, ramp and
float across the wetlands at his property on the north side of
Pine Neck Road on Jockey Creek, Southold, 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: September 9, 1980
JUDITH T. TERRY
TOWN CLERK
PLEASE PUBLISH ONCE, SEPTEMBER 11, 1980, AND FORWARD ONE AFFIDAVIT
OF PUBLICATION TO JUDITH T. TERRY, TOWN CLERK, TOWN HALL, MAIN ROAD,
SOUTHOLD, NEW YORK 11971 .
Copies to the following on September 5,' 1980:
The- Long Island Traveler-Watchman, Inc.
The Suffolk Times
William Pollert
Town Clerk--',Bulletin Board
Town Board Members
}
BOAR STEES
® T
Telephone c3�'
516-765-1938
Southo . 11971
October 10, 1980
Southold Town Board
Town Hall
Southold, New York 11971
Gentlemen:
The following action was taken by the Southold Town Trustees
at a regular meeting held Wednesday, September 3, 1980.
RESOLVED to recommend to the Southold Town Board approval
of the application as submitted for a wetlands permit of
William Pollert.
Yours truly,
ANNA T. HATAIER, PRESIDENT
BOARD OF TOWN T STEES
By Muriel Tolman, Clerk
SOUTHOLD TOWN
CONSERVATION ADVISORY COUNCIL RECEIVED
Southold, N. Y. S E P 3 1980
Totin Clerk Southold'
September 3, 1980
Mrs. Judith T. Terry, Town Clerk
Town Hall
Southold, New York 11971
Dear Mrs. Terry:
The following action was taken bytthe Southold Town
Conservation Advisory' Council at a regular meeting held-)
August 26, 1980.
RESOLVED to recommend to the Southold Town Board approval
of the application for wetlands permit of William Pollert
subject to the width of the catwalk being decreased to three
feet.
Yours truly,
FRANK CICHANOWICZ III, CHAIRMAN
CONSERVATION ADVISORY COUNCIL
�urielolman, Secretary
®EMU,OF;<T04V1V'�C LERK
TOWN OF�SOUTHOLD
JUDITH T.TERRY SUFFOLK--COUNTY TELEPHONE
TowN CLERK R�X4 ;, w s' (516) 765-1801
REGISTRAR OF VITAL STATISTICS c �
Southold, L. I., N. Y. 11971
August 26, 1980
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 William Pollert 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
1980. We shall interpret lack of response to mean there is
no objection by your agency .
Very truly yours,
Judith T. Terry
Town Clerk
JTT/bn
cc : file, Commissioner Flacke,&Southold Town Building Department
Enc. /
�.fi°
®rFFICE;O" OWN',CLERK
TOWN OF ISOUTHOZD
JUDITH T.TERRY -SUFFOLK-COUNTY TELEPHONE
TOWN CLERK `r� ;A§r ;'-.. s ;�
_ �i`� (516) 765-1801
REGISTRAR OF VITAL STATISTICS
Southold, L. I., N. Y. 11971
August 21, 1980
Southold Town Board
Southold Town Hall
Southold, New York 11971
Gentlemen:
Transmitted herewith is application no . 51 for a
wetland permit submitted by William Pollert .
Copues 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
cc : file
Enc. /
�r'-
AV 171 1
Ott ICE`UF°'TOWN 4 -'LERK
TOWN:6 SOUTHOLD
JUDITH T.TERRY `SUFFOLK`COUNTY TELEPHONE
TOWN CLERKr8;;a r< (516) 765-1801
REGISTRAR OF VITAL STATISTICSr1Tt
Southold, L. I., N. Y. 11971
August 21,' 1980
Mr. Frank Cichanowicz III, Chairman
Conservation Advisory Council
Southold Town Hall
Southold, New York 11971
Dear Mr . Cichanowicz:
Transmitted herewith is application no. 51 for a
wetland permit submitted by William Pollert .
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/bn
cc ; xle.
Enc. /
OFRTCE'OF 'T'O/NNC LERK
TOWN OF.SOUTHOLD
JUDITH T.TERRY SUF,,FOLK COUNT,YY TELEPHONE
TOWN CLERK tea•; r,. S':a `'.<;
ta, (516) 765-1801
REGISTRAR OF VITAL STATISTICS ;
Southold, L. I., N. Y. 11971
August 21, 1980
Mrs. Anna Hataier, President
Board of Southold Town Trustees
Southold Town Hall
Southold, New York 11971
Dear Mrs. Hataier :
Transmitted herewith is application no. 51 for a
wetland permit submitted by William Pollert . _
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/bn
cc: file
Enc. /
OFFICE, ���6w�, tr—JZK
TOWN OF'.SO.UT_HQI✓D -
_•k
JUDITH T.TERRY SUFFOLK:CGUNTY TELEPHONE
Towle CLERK ` ? T �„ ° S ` }f' (516) 765-1801
REGISTRAR OF VITAL STATISTICS
Southold, L. I., N. Y. 11971
August 21, 1980
To Whom It May Concern:
Attached hereto is Environmental Assessment Form completed by
William Pollert in connection with his application no. 51 for a
wetland permit . Permission is requested to construct catwalk, ramp,
and float across wetlands at Jockey Creek, located at north side of
Pine Neck Road, Southold, New York.
Judith T. Terry
JTT/bn Town Clerk
cc :file
Posted on Town Clerk' s Bulletin Board - 8/21/80
I
Town Of Southold
Town Clerk's Office
Southold, N. Y.
APPLICATION FOR WETLANDS PERMIT'
- i
Application No. ......11�/.................. Date of Application .......F W ..W.....................
Identityof Applicant .... .��Lf. h..... T.........................................................................
,&,Y 57f)
Addressof Applicant ....................................................,.... ......................................................../........y
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 some 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
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 request applicant for a permit, may waive in whole or in part,
the provisions of Article 11, Section subdivisions A and ('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 ...........................................................
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 /I'n�terior Wetlands, Flood Plains and Drainage Areas of the Town'of Southold:
Permit requested to ..::.e�r/GdCT.......4RIf7 vAC/e... ...ZA/�'I/ ...../..k'Zi�W�...........................
.................................................................................................................................................................
Location of property for which permit wanted....,...`��.G�1 .y........................................................
..................................................................................................................................................................
Home address of permit applicant if different from aforesaid location ..............................................
..................................................................................................................................................................
Creek, Bay or Harbor fronting property ...........JD .........Ic. ....
Y cf&� 'L
.. .. ...............................................................
....................................................................................................._............................................................
Size of proposed work:
Length ..........................4gKe C........ ..1...............................................................................................
Width l
.....................................................................................................................................................
HeightAbove High Water ...................?...............,................................................................................
DepthBelow Low Water .........................................................................................................................
Yardsto be Excavated ........................... .........................................................................................
Yardsto be Filled .............................. D/l/E......................................................................................
Widthof canal, creek or bay fronting property.............<... ..�.:�.....................................................
Depthat Low Tide ................................................,................................................................................
r
1 .'
AverageRise in Tide .............................................................................................................................
el
Isthis for private or business use? .........../P.1/.I/ .. .....................................................................
AreaZoning ................................... �s................................................................................................
Manner in which material will be removed or deposited .................................................................. .
..................................................................................................................................................................
Intended use of property O!9
......T
...........................................................
.... ......................................................................................4.......................................................................
Written consent of owner of property, if not the some as the applicant ........................................
..................................................................................................................................................................
.........................................................................................................................................................
COUNTY OF SUFFOLK )
STATE OF NEW YORK SS:
.................................�..�./ J. ............PA. ............ 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 o the Town of 'Southold.
The applicant agrees to hold the Town of SoutholdW
Boa armless and free from
any and all damages and claims arising under or bp�i ��granted.
lei.'
.........4....... ............................................................
Signature of Applicant
Sworn to before me this
....�1. �...........
day of ............. &C,.&mss .............. 19. .
Notary Public
ELIZABETH ANN NEVILLE
NOTARY PUBLIC,State at New York
No.52-8125850,Suffolk Cou
Term Expires,March 30, 19
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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 resu tin 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 VXwo
3 . Will project alter or have o 'large effect on
existing body of water? . . . . . . . . . . . . . . . . . . . YesZNo
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? . . . . . . . . . . . Yes ✓No
7: Will project result in a major adverse effect
on air quality? . . . . . . . . . . . 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?—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
by a local agency? . . . . . . . . . . . ...: . . . V, . . . . .,. V Yes ✓No
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✓ No
12 . Will project regularly cause objectionable
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 character of the community or
neighborhood? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes ✓No
15 . Is there public controversy concerning the
project? . . . . Yes ✓No
PREPARER S SIGNATURE
REPRESENTING DATE YL v 18v