HomeMy WebLinkAboutTR-5411
Board Of SoutholdTown Trustees
SOUTHOLD, NEW YORK
PERMIT No.5.9J\ .. DATE: ....~.~p~:...~.:...=OOl
ISSUED TO .............~:l\y.~...~....!..Y.P.!.!.':f....~.~!j,;J?. .... .............................. ............
AutQurilutinu .
pursuant to the provisions of Chapfer 615 of the Laws of
the State of New York. 1893; and Chapfer 404 of the Laws of the
. State of New York 1952~ and the SoUtholdToWn Ordinance en-
titled ."REGULATING AND THE PLACING OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS and the
REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN . WATERS;!:, and in accordance with the
ResOlution of The 8Öard adopted af a meeting held on A~K,.....2..9.......
. ~~.~.~. and in consideration of the sum of $....~.º.º.~.ºº... .... paid by
Paul 8< Judith Fried
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of ...................:E.:~~.~....~.~.r..i()?:............................ N. Y. and subject to the
Terms and Conditions listed on the reverse side hereof,
of SouthOld Town Trustees authorizes and permits the foDowing:
Wetland Permit to remove the existing +/- 200 sq. ft. deck and
replace and extend with new deck of 325 sq. ft. Construct
t· 3.5'X 45' fixed walk @ 3' above grade with steps to grade.
Planting of indigenous material. Existin.&. vegetation to rerp;¡.in.·
aU in ac:c:ordanc:e with the detailed specifications as presented In
. the originating applic:ation.
IN WITNESS WHEREOF. The said Board of Trustees here-
by Cðuses its Corporat~ S~al to be a~xed. and these p~nts to
be subscribed by a maJority of the said Board as of this dat.e.
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Trru;u,
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TERMS and CONDmONS
The PemIittee
Paul 8< Judith Fried
residiag at 15155 Main Rd.. East Marion N. Y.. as
put. of the coasideraûoa for the sa..~ of die &mnt does bl>deøtoød aDd pœscribe to the £01-
Iowiøg:
1. TIw the said Boan:I 01. T~ aDd the Town 01. ScwtboId ace released &em IJ11 aDd
all damages, oe claims foe damages, of ~ adaiag cIIrecdy oe iacIireedy as a rauIt of IJ11 ~-
adoo pcáom>ed piGO....t to cbls peauIt, aDd the sdcI 1'0-. .0.1'. will, at his oe her own ape,....
defCnd IJ11 aÀd all such aüu·...w.-l br cbkcI pudes, aDd the said 1'0-. III~'" Uf fallJiaIiIItJ
with reSpect thereto, to the ~ .--LMInn of the )JQud. 01. 'i'rø..ea 01. the Town 01. SQ >ð ~
2. TIw chis Pemùt is· wHd foe a period of 24 _ ,.wœ is mbdllJe([~ to be the
('dI-te<! dme·œquired to œft\pJ- the wack ia~ butiboa1d~- wuøat, nqaest
for an ~ may be made to the Boan:I at a laces daII:.
3. TIw this Permit should, be reiaiaediadefiøiWy. or as .100g as the ..-Jd ~ wiabes
to _1....1.. the sttuCtUte or ptoject ùrrolved, to proride eYideaœ to aG)"OØe ~ cbac aøcb-
.oåzatioo was origioally """'Ined.
4. That the workilm>bed will be subject to the ¡,,'1' f ctloo aDd appmvü of the Boan:I oe
lis agents, aDd aoa-oomp1iaooe. with . the prooisioDS of the q-., appIicadoa, maybe canse foe
rewcadOQ of this Permit br ~ of the said Boud.
5. TIw Iheœ will be no WlfUsoofble iaterfereoœ with aavigadoa as a result of the wod:
herein _iLOriZed. .
6. TIw tbere shall be DO iŒedereoce with tbe right 01. the p¡bIk to pass aDd repess Iloog
the beach between blgb aDd low water matks. .
7. That if future operatioas 01. the Towu of Soucbold ftIIUÍ1'e the RmOftl ud¡oe akendoas
in the loci""" of the wack bereI.a _~"'\ or if. ia the opIaIoo 01. the Board 01. TtuSteeS, the.
1VOIk sbo11 cause unreasooable obsttucIIoa. to free ..mg.doo. the said 11 ....III~ will be nqaIœcI,
apoo due aodœ, to remove or. alter cbls wod< «'project bereI.a lUted ~ e..¡.easCf to the Town
. 01. Soucbold.
8. TIw the said Board will be nodfiecI by tbe Permiaee ot the [1)"'fIedoo. Of the wod: aøcb-
orized.
9. That the Permittee will obWø all ocher peanits aDd cnneenj;¡ dIM may be nquired sap:.
piemental to this pemlÍt which may be subject to revoke upoo fa1lute to o&taIa -.
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Situate, East Marion
TOl"Jn, Southold
Suffolk Count~
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FROM AG TUAL FIELD SURVEYS
GONDUG TED AUGUST 1, 2001
ROBERT H, FOX, NYS Llc# 501<n
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Proposed, Fixed Dock
Situate, East Marion
TOl^ln, Southold
Suffolk Count~
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CONDUCTED AUGUST 1, 2001
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PHONE 516-12r-3151
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0RAPHIC SCALE 1"= 30'
Applic.cmL Paul Fried
Proposed, Fixed Doc.k
Situate, East Marion
TOY'4n, Southold
Suffolk Count~
Purpose, Boat Ac.c.ess
Datum, A.L.I^I.
Tide Range, 2'+/-
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Timber Doc.k
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min. 3' above grade
Y'4ith steps to grade
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THIS DIAGRAM V'lAS DEVELOPED
FROM AG TUAL FIELD SURVEYS
GONDUG TED AUGUST 1, 2001
ROBERT H. FOX, NYS Lic..# 501''11
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PAUL & JûëlTH FRIEe
SCillAj 1QOO-2M'"
1&1Sð MAIN ROAD, EAST MARION, NY
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CATHERINE MESIANO, INC.
Licensed Real Estate 810m
Land Use Consultant f:I Permit Expediter
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CATHERINE MEslANO, PRESlDEN'\'
12 Mill Pond Lane . East Moriches, New York 11940
516,878,8951
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PAUl." JUDITH fRIED
SCiM,10OO-,,3-1-4
161M MAIN ROAD. Wi MARION, NY
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CATHERINE MESIANO, INC.
Licensed Real Estate Broker
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CATHERINE MEslANO, PRESIDEN'f
12 Mill Pond Lane . East Moriches, New York 11940
516.878.8951
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Albert J. Krupski, President
James King, Vice~President
Henry Smith
Artie Foster
Ken Poliwoda
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
September 6, 2001
Ms. Catherine Mesiano
Catherine Mesiano, Inc.
12 Mill Pond Lane
East Moriches, NY 11940
RE: PAUL & JUDITH FRIED
15155 Main Rd., East Marion
SCTM#23-1-4
Dear Ms. Mesiano:
The Board of Town Trustees took the following action during its regular meeting held on
Wednesday, August 29, 2001 regarding the above matter:
WHEREAS, Catherine Mesiano, Inc. on behalf ofP AUL & JUDITH FRIED applied to the
Southold Town Trustees for a pennit under the provisions of the Wetland Ordinance of the Town
of South old, application dated August 2, 2001, 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
August 29,2001, 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 of the Southold
Town Code,
WHEREAS, the Board has detennined that the project as proposed will not affect the health,
safety and general welfare of the people of the town,
2
.
.
NOW THEREFORE BE IT, .
RESOLVED, that the Board of Trustees approve the application of PAUL & JUDITH FRIED
to remove the existing +/- 200 sq.ft. deck and replace and extend with new deck of 325 sq.ft.
Construct 3.5'X 45' fixed walk @ 3' above grade with steps to grade. Planting of indigenous
material. Existing vegetation to remain.
BE IT FURTHER RESOLVED that this detennination should not be considered a detennination
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 two years ftom the date it is signed. Fees
must be paid, if applicable, and permit issued within six months of the date of this notification.
Two inspections are required and the Trustees ate to be notified upon completion of said project.
Fees: None
Very truly yours,
~9· /~~.~,
Albert J. Krupski, Jr.
President, Board of Trustees
AJKIhns
DEC
ACE
Dept. of State
.
.
Telephone
(631) 765-1892
Town Hall. 53095 Main Road
P.O. Box 1179
Southold. New York 11971
SOUTHOLD TOWN
CONSERVATION ADVISORY COUNCIL
At the meeting of the South old Town Conservation Advisory Council held Monday,
August 20, 2001, the following recommendation was made:
Moved by Scott Hilary, seconded by Bill McDermott, it was .
RESOLVED to recommend to the South old Town Board of Trustees APPROVAL of the
Wetland Permit Application of PAUL & JUDITH FRIED to remove existing +/-200 sq.ft.
deck and replace and extend with new deck of 325 sq.ft. Construct 4'X 50' fixed walk
@ 3.5' above grade. Planting of indigenous material. Existing vegetation to remain.
15155 Main Rd., East Marion. SCTM#23-1-4
The CAC recommends Approval but also recommends that the length of the fixed walk
is limited, as needed.
Vote of Council: Ayes: All
Motion Carried
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Town Hali
53095 Route 25
P.O. Box :179
Southold, New York. 11971-0959
Albert J. Knlp,.kj, President
J amðS King, \'ioe-President
Henry S <nit!!
Artie Foster
Ken poliwoóa
Telephone (631) 765·1,,92
Fax (631) 765·1366
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BOARD OF TOWN TRUSTEES
TOWN OF SOUTH OLD
_Coastal Erosion Permit Application
........wetland Permit Application -c. Major Minor
_Waiver! Amendment/Changes
...-tteceived APPli~ti .
...Received Fee:$ /
~pleted Applicatl _ tl~ 01
__Incomplete
SEQRA Classification:
Type I_Type lI_Uclisted_
_Coordination:(date :ïß
..x;AC Referral Sent: ~
,..fJite oflnspection:-Îli ~
_Receipt of CAC Report
_Lead Agency Determination:
Technical Review:
...-f'úblíc Hearing Hel~
_Resolution:
-
Name of Applicant ?A-U,- ~ '\(Jr.,IT¡.. "ÇI<.\GD
Address '-1\ S"tH; Q.Mea.¡..\"IUJ s,+. 91'1'1'" 1'1.5 ÎÒI(. '-" IV, rv,! 1¡2-D /
Phone Number:(1 ~ ,,'Z- 5- 1'4(.-¡
-
Suffolk County Tax Map Number: 1000 - '1'3- I - ~
Property Location: ~~\S~ MAIN Ro....~ e. M.AIL,,, N
NY
<~\
:ø-~~\?J
(3,cI d("'....^~ ¿(~ ~"" 9ono r"I'H"""~)
(provide LILCD Pole . distance to cross streets. and location
AGENT: (' ..nT..!nE.III~(l. ¡Vi, ~1"',jO. INC..
(If applicable)
Address: 1'2 M, 1\ (Jo,,",1) L". ¡;;. Hal? Ie ",".;ŠS tv 'f II If"'~
Phone: 103/- 1<78-8'15/
.
.
Truste.. Application
Board of
GENERAL DATA
Land Area (in square feet): :!: o.¡ o. 0 0 0 '13
Area Zoning: Roo ~C
Previous use of property:
6,n.,9\e -k..1'V'I' \'1
.
d.1l1 Li\ ,,\~
Intended use of property: ~r....'"^ ~
Prior permits/approvals for site improvements:
Agency
Date
10 \ 2. 0 I q 'I
~. cf1fZ.,US'TëéS
-
\No..l"¡~ "
( w:r)
,
~r2..~ 'I'i
tJ'I5 Ì)E'c...
_ No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspended by a governmental agency?
~No_Yes
If yes, provide explanation:_
Project Descr;.ption (use attachments ifneCessaryCP R<'2.MOÚ e. ~"'s+~_
! ¿DO å1 /1Pr 1(; t'e--p 1&1..0 a...v.I. e f l-'e.-f\d wa. (JI!W cJPt.k.
,,/ ± "3.'-5 ¡jJ.
, ~ r ~:z.. I
(¡) ~r'''''\''r(.td 't 150 "tl' ,ecl It>^dc @ - ....6 0...100("- g..rc....de.
(j) ?\.ø..A\-\.i~ of 1r.&ijfMU:':> N\oJ-e.r~.1 as 5\--.0.'......·' 0(\ a..~.I...P
\~c.A-f-e jJ~. 5' .i~i·hÑf ve.,5ddlOI'\ {.o r-uv-ú-,OO",·
.
BOaaof Trustees APplicatiOn.
.
Purpose of
WE'l'LAND/'l'RUS'rEE LANDS APPLICA'l'ION DA'l'A
CD
the proposed operations: (~P \er...r to ~ t' ~ ¡,..... ~ .l
~\tI"",,.L,~
d",~
(i)
~\lJ ,;)ör't: ç., ""-,,,..,>5 -to l>o.."" Q" "'~
..
Area of wetlands on. lot: - 4
, 'to,ooo square feet
Percent coverage of lot:
+
"'1
\
Closest distance between nearest existing structure and upland
edge of wetlands: =- ~ feet
Closest distance between nearest proposed structure and upland
edge of wetlands: :!: ~ 5@,,-d~~ feet
Does the project involve excavation or filling?
x
No
Yes
If yes I how much material will be excavated?............... cuÞic yards
How much material will kle filled?............... cuÞic yards
Depth of which material will be ~emoved or deposited:_ "-
feet
Proposed slope throughout the area of operations: .. d.d vI: :t:¿
Manner in which material will be removed or deposited:
statement of the effect, if any, on the wetlands and tidal
waters of the town that may result kly reason of such proposed
operations (use attachments if appropriate):
no slgn·,.ç,;" ",t \'\e:8o.:h~e. ;.mpc.d ì."'i oJ'd.i(l.p~he,pm~..5~
~~:r~ "i~~::;'~~,~ ~~t~~b~~:::;:
v...-e.t:Ø..~. Qß ~~ ~~
~ A ~ ~ ~ '1~ a.€cl<..-tb
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F;\ 1-<0. : ~186;?:;1467
--.
Au~. 21 2DGl 08:34AM Pi
...........'_.~,
New York State Department of IInvil'<lnmental ConMrvltlon
BuIlding 40 -SUNY, &tony Bsook. New YDrIc 11790-2356
rellpll_ (616) 444.03.6
FIDlImIIe (&181444-0373
JoIv1'.CahUl
Commllllonlr
LI~~BR OP lOø-JaRI.DICTI01
October 20, 1999
Mr. and Mr.. Pil~l 'ried
172 Clinton Str.et
Brooklfn, New York 11201
Re: 1-4738-02457/00001
15155 North Road
Ea.t Marlon! New York 11939
SCTHI 1000-~30-l-04
Dear Mr and Mrs. Fried:
Sa..d on the info~.tion yo~ have submitted, the New York state
Department of Bnvirol11!lentaì con.ervation haa <1eta1"/l\ined that:
The portion ot prop8rtf located landward of the 10' contour on ill
qra4~al natural elope as 'hown on the survey by John T. Metzqer
dated 11/12/97 last reviSed. 10/:1.3/99 is beyond t~e jurisdiotion of
Article ae (Tidal Wetland.).
Theretore, in accordance with the current Tidal Wetlands Land Use
Requlations (6NYCRR Part 661J no penit is requireä under the Tidal
Watlands Act. Please be advised, however, that no construction,
Ba4tmentation( or dist~rbanc. Of any kind may take place ...ward of
the ti«al we~lands iuris41ctional ~undar¥, as indicated ahove!
without a permit. tt is four reapon.ibil~ty to ensure that a1
neoeGeary pr.cautions are taxen to þr.v.nt any .e41mentatlon or
other alteration or dilturbance to the ground. surface or vec etation
witÁin '1'1dal Wetland.s juri.ClictionWhiah lIay r..ul t frolll your
prQject. Such precaution. may include maintaining adequate work
araa between the ti4al watland jUt'ildlctional boundary And your
p~oj.et (i... a 15' to 20' wide construotion area) or erecting a
temporary fance, barrier, or hay bale berm.
?laase be further advised ~.t this lattar does not relieve you of
the responsibility of obtaining any n.c....ry pe~it. or approvals
froll othar ag.ne1... .
v.~ry t~ur.,
Ro~ Ivan.
Pa t Admini.trator
ce: !MIIP/KEP
Jenniter Crawley
FROM : C MESIANO INC
.
.Ld.
Bc:>ard. of Trustees Application
FAX NO. : 631-878-8951
31 2001 03:38PM P3
Au'l'buaúZAnOH
(where the applicant is not the owner)
.'
I,
J (j 1:> 11"\-1 1='\2. IE (':)
(print owner of property)
residinqat '+1 SLHeRMf'2.\-I-C>)'!~ SI-.
TiiiãII1ng address)
Su.!':",':; (,0::,,, J.) !\J "
,
\12.0 I
do hereþy authorize
LF\-Tl-leõ:.,"-'"t". Mi7!'.'þ...,o. \",r.
( Agent)
to apply for permit(.' fram the
Southold Board of
on œy behalf.
I<
Þ}~{:' .-_
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.. AUG I 0 2001
.1
,
,
8
FROM : C MESIANO INC
.__ FAX NO. : 631 ~~951
.'d.
31 2001 03:39PM P5
Board of Trustee. Application
County of Suffolk
State of New York
- I..){)() \1 M ~<"!2Ú _BEING DULY SWORN
DEPOSES MID AFFIRMS THAT HFJSHE IS THE APPUCANT FOR THE ABOVE
DESCRIBED PER.MlT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE
TRUE TO THE BEST OF HIStHER KNOW'Ui.DGE AND BELIEF, AND THAT ALL WORK
W1LL BE DONE IN THE MANNER SET FORTH IN nus 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 SAm PERMIT(S), IF GRANTED. IN COMPLETING nns
APPLICATION, 1 HEREBY AUTHORIzE THE TRUSTEES¡ THEIR AGENT(S) OR
REPRESENTATlVES(S). TO ENTER ONTO MY PROPERTY TO INSPECT THE
PREMISES IN CONJUNCTION WITH REvmW OF 'IHlS APPLICATION.
$7 ~
I DAY OF )It-IT _.,20J.Ù
SWORN TO BEFORE. ME THIS
_ Pi:µ- ðt ~
Notary Public #
PIYUSH B. SONI
Notary Public, State Of New York
No. 01S06038647
Qualified In Kings County
Commission Expires March 20, 2002
r.¡:;::---,._.,---,,~
r< c,_ \ F ;;! !-~- r "-,
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AUG ! () .
FPm1 C MES I AND ¡ NC
~ FAX NO. : 631-878-8951
~P'LtCAN'I'
~~N~CTI0M~L Þ1S0~OiUR' rOR"
411rUI. 31 2001 03:38PM P4
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.''''t ·.nllny. ..." .. . ...,any. U .e. ~n4'ço"
tn. e\~.. ,.~...i' or ga.,an,-' .....)
MAtuliS Ot' ~ZOA'tIOIh ,elt.... .u .hlt 'PD1';)
'I.... .rh"'''..
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ø...,..." '.c~ ,.¡¡-;i cf.l01.1 ..,
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De pIS ...."'.U, '01' ''''''11' t.... ....IIJ" ......, .IIIU....
......... ... ,""UI, ".ft . "I... ...IIi, vbli ."y .rri...r .r
....1.,.. of .1140 _ 0& __I." ·hl.'I....."I.· ......1.'"
10J WISO" ".Ul...., "" ....1.... hll...... -BIIII.II'"
1.'oz,." ..... . baa!...., ,...t.'I.II' . ,...nee.hi" In
ñ...... "". _ ofU..... ""' _1.,.. hili _ . pñid
........111, at C.. ..,1011_' 111'1 . CI_fadCl. b ..hie"
tllo 'CI" o.n_ or _lor" 0"' .... 'loll.. ." cf .100
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.... ... ailD ~~~. 1n'1aa\e4.
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'un. 01 .....Hlon of 'II., ,OI_n ;.,..')--¡.
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.na n. .... ..rUnr .. ..,1.,... 111\,... ahe.. 'II. '.
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,rovi"" .
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Th~ town olf10.~ D' ."lD1.. øt hi. or har .,oø.. .1bl¥ng,
p...nl, or ~IIU' i. lob...k .U ItII~ ."Lf)' I
~) ,". 09",' .f ;....., tll.. ,. ot Ohe ...... or III.
o..po..'. .IClCIe of III. .P.1..... ,oll.n ,". .p,~"
L. . o..,...'lcn), .
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nøn"orpor...·.n~l" (vh.. ,,,. ."t..,., I. ... .
"".,..,.1..), ..
an .f"..f, 'Ir.o~or. ,.rl.." Of ,..I'Y'. or ~h.
...lI.a..~' ". . .
'ill. ~''IJ''&. ......tC'.ftt. .
AUG I 0 2001
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FAX NO. : 7186251467
~9. 01 2001 01:34PM P4
FROM:
F ï~ (11"1 : C N[S 1 ,·"¡··I,:: : ~L
F ~X HJ. : C:<~'l'-I:;I7B'''C::1!5'J
JI,~l. :]1 2001 ¡)~:1'J~r1 r-s
. ~....~.....--.
. -- ..-....---..-'
-,..-.----.
Board ot TrUlta.. App~iaati~n
COUllty of SutToli,;
5tm otN.w York
--.
. I.. )( )~ l" t-;- E<'I2'~ .BEING DULY SWORN
DEPOSES AND AFFIRMS THAT HMHE]$ THE APPUCANT FO.1 THE ABOVE
D!SClUBBI> PE&M1T(S) AND THAT AU. STATIMENTS CONT ,w,1!D HEREIN ARE
TRUE TO THE BEST OF HlSIHD. KNOWLa'Dœ AlII!> BEUØ, .uID 'l'HAT ALL WORK
WJLL 1m DONE IN nœ MA..~ SBT FORTH fNTHlS APPIJCATlON AN!! AS MAV
BE APPllOV!!.D BY nm SOUTHOl.D TOWN 80AlU> OF Tl.tJSTBES, nœ AP1>UCA."IT
AGlUiiS 'TO HOLD !'HB TOWN OF SOVTHOLD AND TIiE TOWN TAUSTEJ:!S
HARMLESS A."1]) FUB FllOJd ANY AND ALL DAMAGES ,",'I'D CLAIMS ARISING
t.1NI>U. OIlDY "!R.n.'! 011 SArD PEIMlT(S), 1P GRAN'l'ED. IN COMPLETING THIS
APPLICATION,l HmlEBY AUTHORIZII TJœ TRUS'ÆBS¡ THEIR. AGENT(S) OR
REPRBSENT ATIVE!(9). TO EN'1t!1l ONTo MY PltOJlEllTY TO INSPECT THE
PBP.MISElS IN CONJUNcTrON wrm IlBVlÈW OF THlS APPLICATION,
ST Æ;
I DAY of'Jh.jT .,20...GL.l
SWORN TO 1IE1"ORE ME 'tHIS
_ f¡~ð! ~
Ncwy Public I
ÞMJ$H B. SONI
Noiery Publle:. State Of New York
No. 01$05036647
Qu.llfied In Kinos County
Oomml88lon expire. Merch 20", 20C1:i
.'
106·115·4 (2r871-ie.t 12
I PROJ ECT 1.0. NUMBER
.
.
617.21
Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART I-PROJECT INFORMATION (To be completed by ApplIcant or Proieet sponsor)
SEe
,. APPI.ICANT ¡SPaN
...)\..) \ .,. Au<-
3. PROJ ECT I.OCA TION: ~ A
Municipality £ . IV \ County S U F F-o '- I
4. PAEC:Se I..OCAT:ON (Str.et address Ind loaC ìntersectlans, prominent landmarks, etc., or ~roviae :'!'Iao! n
N \.5 M....iN RD (5.JL~5) ~rcl dn......u..>--r 6{. C-lÅ..UA...... -..J epï:>...", ronq
\ 5 I '5 S N\A' '" R.d..
ê·M"Ht.'"..v
5. IS PROPOSED ACTiON:
o New (25j EJcølnlion 0 Modiflcation/aUeratlon
6. OESCRISE PROJECT SRIEl'I. Y:
0~~rnOH. .ll..f ·,"~I"-<cd-e...c.k (1:-2.0041) CLV\.d (f..PQpH-!4~ c.Ú¿o, l'\~d-e.J.:..
(-:.3
c.o";::>+<-vd ~'~ 50" f..e.cI w.....uc..
7. AMOUNT OF LANC AFFECTED:
( :! (
In Wally ;t acres Ultlmate!v _ acres
3. WILl. ?ROPCSEO ACTION COMPLY WITH EXISTING ZONING OA OTHER EXISTING LAND use !=I:ESTRICTION$1
~ Yes 0 No It No. de,cnblt briefly
9. WHAT 1$ PRESENT I..ANO usa IN VICINITY OF ?ROJECT?
~ Resld.:ntia O.!nd\lstri8! 0 Cûmmerciai
Oesctibe:
o Agricujt1Jle
:J Park/Forest/OOln ,,,ace
L.i Olner
'0, Does A.CTION INVOLve A peRMIT APPROVAl.. OR FUNCING. NOW OR ULTIMATeLY FROM ANY OTHER GOVERNMENTAL AGENCY (FeüeRAL.
ST'" Të 0;1 I.OCA'11
¡¡ Ves 0 No If yes. riSI agency(sJ and permiUaøørova s
N '1$ bee..
50VT"<>~~ ~\d ì:>~p"1.
11, DOes ANY ASPECT OF THE ACTIOfol HAVe A CURRENTlY VAL¡C FERMIT OR API'ROVA!.?
o Yes' []I No It yes, list a,.,Ð"CY name and permit/aøøroval
':r
12. AS A RESULT OF PROPOSED ACT)ON WII.,t,. EXISTING PERMITIAPPROVA;" REQUIRe MOOtFICAï¡ON1
0_ ~. _.
I CEi1TIFY THA T THE INFORMATION PROVIOED .SOVE IS Ti'lUE m THE SEST OF MY KNOW",DCE
.PPliconllsoon/ì nam., ~- tnL-L.'-: ~ . JJnr.
Slonatu,.; LI+THE¡¿w,~ Ht55 tA-AJÙ INC",Aßt='.J1.f-'¡:¡ F¡¿¡¿¡:.ò
D¡¡lð:
7/3'¡0,
If the action is jn the CODsta! Area, and ,OU are a state agency, complete the
Coastal Assessment Form before proceeding with this a.:¡.~essment
OVER
1
FROM :
.
FRX NO. : 7186251467
~9' 01 2001 01:33PM P2
n::nl' '.- I.~<; I ~iI'~O J 1''''-:
(' -t;o( t'U. b·.1~ U('U·'í:I;,.'.:'>l
.Tu.l, ....1 ;::'001 ù3; ::8PI" f--:;:
boarl! of '.era_tee;) App1.:I.cation
.'
AU'œQJIQnOH
(where the 4¡1PUce.n~ 1/1 not tÄiIiI ower)
I.
J U 1'> ,","\-I -<f'R.I':: b
(1IrJ.1i~ ow.ez ot propIJ~Y)
r..1.d.ing .t '1-\ .5.'-KE'Ii!.I'!i'I2.¡';'''~¡.J Sf..
Tiiãmi; aWe...)
St.:4a. 'b..'; 6~,,,, j,j t\J ~ H'1.Q I
.
â.o hII:_ ."tborlla
(~ent)
to QplV for permit(.! fRIll t.hG
-
CA-THifQ.\)oJ-tIr~ ""u'=J!i~I"'lttJa. \fI.J,..
southoll! :soue!. of ~ 'rxuat... QIi r.t beba:l.f.
,
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FROM:
ti"';'"
.
FAX NO. : 7186251467
~g. 01 2Ø01 01:33PM P3
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