HomeMy WebLinkAboutTR-4224
APPROVED BY
BOARD OF TRUSTEES
TOWN OF SOUTHOLD
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APPROVED AS PER TERMS
AND CONDITIONS OF
PEIUIlT NO. I ~41Jq'(jJ7~~ V""J\ 'J
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James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
Bob Ghosio, Jr.
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
September 19, 2007
Ms. Susan Hallock
Cleaves Point Village
2820 Shipyard Lane
East Marion, NY 11939-1265
RE: CLEAVES POINT VILLAGE
2820 SHIPYARD LANE, EAST MARION
SCTM# 38-7-4.2, 8 & 38-2-1, 45
Dear Ms. Hallock:
The following action was taken by the Southold Town Board of Trustees at their Regular
Meeting held on Wednesday, September 19, 2007:
RESOLVED, that the Southold Town Board ofTrustees APPROVE the Amendment to
Permit #4224 to install two metal brackets on an existing floating dock to secure a
docking platform for a wave runner in-place of the finger float, with the condition that the
finger float that was removed will not be re-installed for a total of seven (7) finger floats
and one (1) jet ski float, and as depicted on the. plans prepared by Susan Hallock,
Condo Manager, received on August 28,2007.
Any other activity within 100' of the wetland boundary requires a permit from this office.
This is not a determination from any other agency.
If you have any questions, please call our office at (631) 765-1892.
Sincerely,
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President, Board of Trustees
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James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
Bob Ghosio, Jr.
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Southold Town Board of Trustees
Field Inspection/Work session Report
Date/Time: ~ > \:) / 0 'I
CLEAVES POINT VILLAGE requests an Amendment to Permit #4224 to
install two metal brackets on an existing floating dock in order to secure a
docking platform for a wave runner. Located: 2820 Shipyard Lane, East
Marion. SCTM#38-7-4.2,8 & 38-2-1,45
Type of area to be impacted:
Saltwater Wetland Freshwater Wetland Sound L Bay
Distanc,,<of proposed work to edge of above:
Part of Town Code proposed work falls under:
_Chapt.275 _Chapt.lll_other
Type of Application: _ Wetland _Coastal Erosion \/Amendment _Administrative
_Emergency _Pre-Submission _Violation _Planning
Info needed: . I
. N tAlK {V.;-o~~ r -9-l0-0-l- l. \ bee. cvLh"f . -fu i-lr
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Modifications:
Conditions:
~ent Were: ~ng ~Doherty _--fDickerson ~ergen--.!B. Ghosio, Jr
_H. Cusack_b. Dzenkowski _Mark Terry_other
Form filled out in the field by
MailedlFaxed to: .
Date:
Environmental Technician
Review
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Donald Wilder, Chairman
Lauren Standish, Secretary
Town Hall, 53095 Main Rd.
P.O. Box 1179
Southold, NY 11971
Telephone (631) 765-1892
Fax (631) 765-6641
Conservation Advisory Council
Town of Southold
At the meeting of the Southold Town Conservation Advisory Council held Tues.,
September 11,2007, the following recommendation was made:
CLEAVES POINT VILLAGE to Amend Permit #4224 to install two metal brackets on an
existing floating dock in order to secure a docking platform for a wave runner.
Located: 2820 Shipyard Lane, East Marion. SCTM#38-7-4.2,8 & 38-2-1,45
The CAC did not make an inspection, therefore no recommendation was made.
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OFFICE WCATION:
Town Hall Annex
54375 State Route 25
(cor. Main Rd. & Youngs Ave.)
Southold, NY
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MAlUNG ADDRESS:
P.O. Box 1179
Southold, NY 11971
Telephone: 631 765-1938
Fax: 631 765-3136
LOCAL WATERFRONT REVITALIZATION PROGRAM COORDINATOR
TOWN OF SOUTHOLD
MEMORANDUM
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To:
James King, President
Town of South old Board of Trustees
'"
From: Mark Terry, Principal Planner \('(1 \
L WRP Coordinator
Southhold Town
Board of Trustees
Date: September 18, 2007
Re: Request for Wetland Permit for Cleaves Point Club and Marina, Inc.
SCTM# 37-7-4.2,8
CLEAVES POINT VILLAGE requests an Amendment to Permit #4224 to install two metal
brackets on an existing floating dock in order to secure a docking platform for a wave runner.
Located: 2820 Shipyard Lane, East Marion. SCTM#38-7-4.2, 8 & 38-2-1, 45
The in-kind replacement of existing finger float with a jet ski float is an exempt Minor Action
and not subject to LWRP review pursuant to Chapter 268-3; Items A and B ofthe Town of
Southold Town Code.
The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review ofthe
Town of South old Town Code and the Local Waterfront Revitalization Program (LWRP) Policy
Standards. Based upon the information provided on the LWRP Consistency Assessment Form
submitted to this department, as well as the records available to me, it is my recommendation
that the proposed action is exempt from review pursuant to Chapter 268-3, Exempt Minor
Actions, item B which states:
"Replacement, rehabilitation or reconstruction of a structure or facility, in kind, on the same
site, including upgrading buildings to meet building or fire codes, except for structures in areas
designated by the Coastal Erosion Hazard Area (CEHA) law where structures may not be
replaced, rehabilitated or reconstructed without a permit".
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James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
John Holzapfel
Town Hall
53095 Route 25
P.O. Box 1179
Bouthold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
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LAND PERMIT
APPLICATION FOR AN AME
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DATE \.lu :{ f2. .~._ __.--1
Q,L~ POI NT VI L. L!1. ~ L--S"':',':C\,,:,> .
UL E'S> 'POfl\.J I ~--
OWNER CL\J6" /)JJ\lLII\.l/\ D~lTpHONE(~~I)t ~.~-~1o~7 ,;'
:~:~:~J~:~NE1~;,~;~i.~~. 117~~. 120'
ADDRESS F\ s A-elJi l2'." .
PROPERTY LOCATION ~S A'f\o ~E
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Signed By:
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CPC
CLEAVES POINT CONDOMINIUMS
o VILLAGE 0 COMMONS 0 CLUB AND MARINA. INC.
P.O. BOX 29
GREENPORT. NEW YORK 11944
(516) 477-8657
-~
August 15,2007
Town of Southold
Board of Trustees, James F. King, President
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Town Hall...., -;- i. i, II 'ii'
53095 Route 25 \r'\'\ \1,-..:'" ... \
P.O, Box 1179' <'
Southold, New Yark 11971-0959
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Dear Mr. King:
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The purpose of this letter is to define that the attached Application for an
Amendment to a Wetland Permit concerns the installation of two metal
brackets on one of our (already permitted) floating docks.
,
The brackets would accommodate the securing of a docking platform on
which a recreational boat, generally called a "wave runner", would be
slipped. The docking platform (see attached manufacturer's specifications)
is taking a location already permitted for slipping a boat.
Having received a comprehensive application package when inquiring of the
necessity for and procedure to acquire an amended Permit, please let me
know if the filing, as it concerns this specific request, requires Notice to
Adjacent Property Owners, L WRP Consistency Assessment Form, etc..
Thank you for your prompt attention to this matter.
S;ncere y~~
. . Susan Hallock, Manager
Enclosures (2)
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James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
Bob Ghosio, Ir.
.
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
BOARD OF TRUSTEES: TOWN OF SOUTHOLD
---------------------------------------------------------------
In the Matter of the Application
of
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COUNTY OF SUFFOLK)
STATE OF NEW YORK)
I, 3IJS~LOCK
AFFIDAVIT OF POSTING
'~;'~5 at I\~ In A1\l1lCn<lZ fi1f2 Q~(?o,tJJ l1~0l6( J l.LA~)
being duly sworn, depose and say:
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That on the I 0 day of ~"'r T ,2001, I lersonally posted the property known as
(I J_-1-"'k1\~ Po I NT 01) fJ () m I N \ lJ 'YY\ S @
by placing the Board of Trustees official poster where it can easily be seen, and that I have (I\'N.. ~ Cwl,mt.l~
checked to be sure the posth has remained in place for eight days prior to the date of the public Of!.l/el..l<:-
hearing. Date of hearing noted thereon to be held Lthi. ~pt- r 19 tYro7 ~
(J n. O'l 0 btu+. ~: ~ fm.
Dated:
VERONICA F. CIOONE ......
Notary Public, State 01 New M"
No.01CI4661406
Qual~ied in Suffolk Countv
Commission [xplles nee. 31, <'009
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James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
Bob Ghosio, Jr.
.
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
BOARD OF TRUSTEES: TOWN OF SOUTHOLD
---------------------------------------------------------------
In the Matter of the Application
of
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COUNTY OF SUFFOLK)
STATE OF NEW YORK)
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AFFIDAVIT OF POSTING
'~;':5"l A:~ tnftl\l~Crl<l( fi1(( Q~Q,tJ1(1~Ol6(j~)
being duly sworn, depose and say:
That on the day of ,200 ,I personally posted the property known as
by placing the Board of Trustees official poster where it can easily be seen, and that I have <.1\1\11> ~ ~t.Jnt.lVE
checked to be sure the poster has remained in place for eight days prior to the date of the public 70 Q.f/eLK -
hearing. Date of hearing noted thereon to be held Uhf. "'&pt-, 19 Olffi7 ~ .
6 (\ 01 a bcu1-c ~; (J) pm
Dated:
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VERONICA F. ClarDOJl!.......
NoIIIY Public, Slate ..........
No. 01C14661406
Qualified in Suffolk County .
Commission [xplfes Dee. 31. 2009
PROOF OF MAILING OF NOTICE
ATTACH CERTIFIED MAIL RECEIPTS
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Name: '"
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U.S. postal Service, ,
CERTIFIED MAIL, RECEIPT
(Domestic Mail Only; No Insurance Coverage Provided)
STATE OF NEW YORK
COUNTY ~FOLK
G"~,,tJ Lcc..t
-la1lt day of ~~~e1l.. ,20 fl, deponent mailed a true copy of the Notice
set forth in the Board of Trustees Application, directed to each ofthe above named
persons at the addresses set opposite there respective names; that the addresses set
opposite the names of said persons are the address of said persons as shown on the current
assessm t I of th Town of Southold; that said Notices were mailed at the United States Post
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Of I , that said Notices were ailed to ea of said persons by
(certified) (registered) mail.
USE
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postmark
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,~t 1\<; !)'IAN A,6ett fOfL (\~6 Q~ aNOC,/JLL~
, being duly sworn, deposes and says that on the
Notary PublU~ICA~t~::WYortl
NoIaIY ~b1~iCI4661406
Qualified in Suffolk Coun~ 0
Commission hp"es Dec. 31, 0 9
4IJoard of Trustees APPlica~
AUTHORIZATrON
(where the applicant is not the owner)
c.ltaiNe:. l'ol NT U-\lB <1 "'\Itfljrllll'I~c.. . ~
I, J1)A1ZtL &LOItI.mJ residing at V I 3 - ~es (iy'rJI Cc~~
eJ~~p~.~~~~ o~n;:erty) (mailing address)
1:= ,. I 3 do hereby authorize
..,
(Agent)
to apply for permit(s) from the
Southold Board of Town Trustees on my behalf.
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, (Owner's signature)
f1i12.. ~e5 't'O/tJ"T e.t.\.Jfh mf\1l.ltJtI,IIOC..
-----._~-----------
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Board of Trustees Application
County of Suffolk
State of New York
s lJ Sac..... H-C\...ll 0 elL BEING DOL Y SWORN
DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE
DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE
TRUE TO THE BEST OF HlS/HERKNOWLEDGE AND BELIEF, AND THAT ALL WORK
WILL BE DONE IN THE MANNER SET FORTH IN THIS 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 AND CLAIMS ARISING
UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS
APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR
REPRESENT ATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE
PREMISES IN CONJUNCTION wrBJl:.~;;;;'
SIgnature
SWORN TO BEFORE ME THIS .;;r:tib DAY OF AvS'uS,t _,202:1-
Notary Public
L .
OEVON J. MASSAR
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.c:GIi.. '1I1u flll*Ii . 2O.Q. 7-
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APPLICANT/AGENTIREPRESENT ATIVE
TRANSACTIONAL DISCLOSURE FORM
The i.o~ of S:~thold' ~ Code of Ethics orohibits conllicts of interest on the Dart of town officers and emo]ov..s. The ouroose of
this _onn :5 to __ vide i_formation which can alert the town of nossibJe conflict.; of interest and allow it to take whatever action is
necessarv to avoid same.
YOUR NAME: Ql...eJlrJes ~1\0\ O.J..UB ~ m~NI\,INC.
(Last name. first name, .tpiddle initial, lUlless yo'u are applying in the name of
someone else or other entity, such as a company. Ifso, indicate the other
person's or company's name.)
NAME OF APPLICATION: (Check all that apply.)
Tax grievance
Variance
Change of Zone
Approva' of plat
Exemption from plat or official map
Other
(If"Other", name the actIvity.)
Building
Trustee
Coastal Erosion
Mooring
Planning
.I
Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee
of the Town of South old? "Relationship" includes by blood, marriage, or bus'iness interest. "Business interest'! means a business,
including a partnership, in which the town officer or employee has even a partial ownership of (or employment by) a corporation
in which the town officer or employee owns more than 7he shares.
YES NO
If you answered "YES", complete the balance of this fonn and date and sign where indicated.
Name of person employed by the Town of Southold
Title or position of that person
Describe the relationship between yourself (the applicant/agent/representative) and the town officer or employee. Either check
the appropriate line A) through D) and/or describe in the space provided.
The town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply):
_A) the owner of greater than 5% of the shares of the corporate stock of the applic~nt
(when the applicant is a corporation);
_B) the legal or beneficial own~r of any interest in a non-corporate entity (when the
applicant is not a corporation);
_C) an officer, director, partner, or employee ofthe applicant; or
_D) the actual applicant.
DESCRIPTION OF RELATIONSHIP
Submitted this ~ day of
Signature
Print Nam
Form TS ]
Si
Cu:l\IJe:, AmlT<~.u)B"t ,t1~~
Town of'Southold
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LWRP CONSISTENCY ASSESSMENT FORM
A. INSTRUCTIONS
I. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for
proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This
assessment is intended to supplement other information used by a Town of Southold agency in
making a determination of consistency. * Except minor exempt actions including Building Permits
and other ministerial permits not located within the Coastal Erosion Hazard Area.
2. Before answering the questions in Section C, the preparer of this form should review the exempt
minor action list, policies and explanations of each policy contained in the Town of Southold Local
Waterfront Revitalization Program. A proposed action will be evaluated as to its significant
beneficial and adverse effects upon the coastal area (which includes all of Southold Town).
3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will
affect the achievement of the L WRP policy standards and conditions contained in the consistency
review law. Thus. each answer must be explained in detail. listine: both supportine: and non-
supporting facts. If an action cannot be certified as consistent with the L WRP policy standards and
conditions, it shall not be undertaken.
A copy of the L WRP is available in the following places: online at the T
website (southoldtown.northfork.net), the Board of Trustee_ I'~' ~~l Co .
B. DESC::;~::i:F ::T:e ;:P::;;:~::CTION ~~~. ;'~:~"~- -~, '
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SCTM# I {)A.l.-(J - 3'6-1-- 1- ~ , rt <>l- 3 'S - 2 ~ l"- ~ _,/~ J
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PROJECT NAME
The Application has been submitted to (check appropriate response):
Town Board D Planning Board D Building Dept. D Board of Trustees E?J'
I. Category of Town of Southold agency action (check appropriate response):
(a)
Action undertaken directly by Town agency (e.g. capital
construction, planning activity, agency regulation, land transaction)
D
D
(b) Financial assistance (e.g. grant, loan, subsidy)
(c)
Permit, approval, license, certification:
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Nature and extent of action: . "rgL 1\'II-mrtl I _
\ N'S'r"In..L /WO, rYll2:rA L~c..'( 1:?1S t)~ I eXI~TlI\'(,. ItoAnNG Dot-/(
J.hLQ~(}e{2 C10 ~ A DOLiLING- C1LA-Tfbelh FOR- It
~~~ ;:T~~ ~~(;,t P~~Ju ~~'" &1>1
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l.oc>>tinn or octinn ..n ~ ~ t'fll'to W 12, t' ~ Tn 1l1';.,]) ~' 1/93 'i
Siteacreage:~'.l'ro~TE~ 13 ~s (()V'dtPrLL. ')
Present land use:~QO m 11\1, Uf\'\ Q/)m PL\2 'X
Present zoning classification:
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2. If an application for the proposed action has been filed with the Town of Southold agency, the following
information shall be provided:
(a) Name ofapplicantDl.l!fWE'S t1. {:Lt..f6.t. - fu rwes ~/wr OluB'I f/1m'rJA,I~.
(b) Mailingaddress:Y O. Box Rq ('~ftJfl...l} ~.\I, I/q~tJ-OO"2,9
I , ~
(c) Telephone number: Area Code (0)31- ~- ~ inS 7
(d) Application number, if any:
Will the action be directly undertaken, require funding, or approval by a state or federal agency?
Yes D No if If yes, which state or federal agency?
C. Evaluate the project to the following policies by analyzing how the project will further support or
not support the policies. Provide all proposed Best Management Practices that will further each policy.
Incomplete answers will require that the form be returned for completion.
DEVELOPED COAST POLICY
Policy 1. Foster a pattern of development in the Town of Southold that enhances community character,
preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and
minimizes adverse effects of development. See L WRP Section 111- Policies; Page 2 for evaluation
criteria.
DYes D No B'Not Applicable
Attach additional sheets if necessary
Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See
L WRP Section III - Po~s Pages 3 through 6 for evaluation criteria
DYes D No B Not Applicable
.
.
Attach additional sheets if necessary
Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See
L WRP Section III - Policies Pages 6 through 7 for evaluation criteria
DYes 0 No c1' Not Applicable
Attach additional sheets if necessary
NATURAL COAST POLICIES
Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See L WRP
Section III - pOlicie~s 8 through 16 for evaluation criteria
DYes 0 No Not Applicable
Attach additional sheets if necessary
Policy S. Protect and improve water quality and supply in the Town of South old. See LWRP Section III
- Policies Pages 16 throuJlt 21 for evaluation criteria
DYes D No g'Not Applicable
Attach additional sheets if necessary
Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including
Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III - Policies; Pages 22
th~gh 32 ~ eva~ criteria.
Yes
No
Not _Iicable
.
Attach additional sheets if necessary
Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies
Pages 32 through 34 fo?aluation criteria.
DYes 0 No ~ Not Applicable
Attach additional sheets if necessary
Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous
substances and w~ See LWRP Section III - Policies; Pages 34 through 38 for evaluatio\l criteria.
DYes D No ~ Not Applicable
PUBLIC COAST POLICIES
Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public
resources of the Town of Southold. See LWRP Section 111- Policies; Pages 38 through 46 for evaluation
criteria.
DYeD N00NotAPPlicable
Attach additional sheets if necessary
WORKiNG COAST POLI~S
.
Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in
suitable locations. Se9' WRP Section 111- Policies; Pages 47 through 56 for evaluation criteria.
DYes D No Q"NotApplicable
Attach additional sheets if necessary
Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic
Estuary and Town w~ers. See L WRP Section III - Policies; Pages 57 through 62 for evaluation criteria.
DYes D No S Not Applicable
Attach additional sheets if necessary
Policy 12. Protect agricultural lands in the Town of Southold. See L WRP Section III - Policies; Pages
62 through 65 for ev~tion criteria.
DYes D No 8' Not Applicable
Attach additional sheets if necessary
Policy 13. Promote appropriate use and development of energy and mineral resources. See L WRP
Section III - Policies;Yages 65 through 68 for evaluation criteria.
DYes D No 0 Not Applicable
PREPARED BY l-\M ~e1. TITLE
N)fL C lI:tiH'e" I~T QW& 'I rnf/fG/ ru~,1 rvC,
DATE~7
.
.
CPC
CLEAVES POINT CONDOMINIUMS
o VILLAGE 0 COMMONS 0 CUJB AND MARINA INC.
P.O. BOX 29
GREENPORT, NEW YORK 11944
(516) 477-8657
~
August 15,2007
Town of Southold
Board of Trustees, James F. King, President
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
~" "
L___.
ii;Jm
II
Dear Mr. King:
SL
B(:;:::[I
The purpose of this letter is to define that the attached pp lca Ion 0
Amendment to a Wetland Permit concerns the installation of two metal
brackets on one of our (already permitted) floating docks.
,
The brackets would accommodate the securing of a docking platform on
which a recreational boat, generally called a "wave runner", would be
slipped. The docking platform (see attached manufacturer's specifications)
is taking a location already permitted for slipping a boat.
Having received a comprehensive application package when inquiring ofthe
necessity for and procedure to acquire an amended Permit, please let me
know if the filing, as it concerns this specific request, requires Notice to
Adjacent Property Owners, L WRP Consistency Assessment Form, etc.,
Thank you for your prompt attention to this matter.
Sin"re yn~t/c
. Susan Hallock, Manager
Enclosures (2)
.
.
James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
John Holzapfel
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
APPLICATION FOR AN AMENDMENT TO A WETLANDI'
,\i.::,-r.' '.. !~~i -'~i n
DATE Ck ~ ~ iilJ(L .~~
Q.L~ POI NT VI L Lfr. ::.---
UL E'S 1'0 I tV I 8i i,.-
OWNER QL\J 6 'I /)}J\tC11\)& l..-lli-. PHONE ~I' - Io~
ADDREsso1~,:mr ~:~~ ~~~1 (:~ 11J~~~ 1'T 1/7'>'j-12b{
f,CEm~\)S~ CU>N~ PHONE (G3~ lff7-kfoS/
ADDRESS F\ s A-e,tJ ~ tr
PROPERTY LOCATION ~s. ~~r:::
TAX MAP NO. .!J IYIlQ - 3 ~ - "1-=--1 ,'2 ) g <>t- 3 ~ - '2 - I, ~~{
~"1 &u. ~
0..Al~ ~ .
request an Amendment to Permit # ~ ~ 2. Y
u~ ~d
~e
i~Q
to.
Signed By:
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PROTECT YOUR CRAFT AND ENJOY
AST. CONVENIENT ACCESS TO THE
ATER with the HydroPort2™ PWC
ocking Platform. Its exclusive bow bumper
.;.;;;-<.,
'~jY(:s~t craft's forward motion and
A replaceable keel guide and bow
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unitsloguher.