The URL can be used to link to this page

Home My WebLink AboutTR-5694 IIIÞ TERMS and CONDmONS . ..\( \ ~ ' . J "~"-' The Permittee Walter Wappau's residing at 27.05 Bayshol'e Road, Greenport. N. y~ as pan of the coosideratioo for me jss,..n"" of the Permit does undetstaod and prescribe to the fol· lowiog: 1. That me said Board of Trustees and me Town 01 Southold aæ released from on.y and all damages, or claims fOl: damages, of suits arisiag ditecdy 01: indirecdy as a result of on.y o~' atioa per£onned punuaat to this petmit, and the said ¡>-nö- wi11, at his or her own apt-. defend any and all such IlÚU'¡"iti.-l by third parties, and the said F~ 1- £u1I1iIbi1Ity wiIh respect thereto, to the complete euIusion of the Board of Trustees of the Town 01 SoucboId 2. That this Pennit is ~ £or a period of 24 mos. wbich is <0. ¡'""'oed to be the estimated time' required to complete the wodc invol'YeCl, but sboaId cttcamstaoces warnøt, request for an exœosioo may be made to the Board It a later date. 3. That this PemUt should be retained indefinitely, or as loog as the said PetmÏ&tee wishes to maintain the stnlcture or project involved, to provide evideoce to anyone cooceroed !hat aoIh- orizatioo was ori8inallY obtained. 4. That the wotlc involved will be subject to the i"~ and approval of the Board or Us agents, and noo-compliaoce with the provisions of the origin.'¡..g applkatioa, may be ClOSe f« revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigatioo IS I result of the wod< herein au'tborized. 6. That there shall be no interference with the right of the puhIic to pass and repass a100g the beach between high and low water marks. 7. That if future operations of the Town of Southold zequire the remova1 and/or alteratioas in the location of the _tic herein IIIIbodzed, or if, in the opinioo of the Board 01 TrusteeS, the wodc shall cause unreasonable obsttoCÞOl1 to free navigarlon, the said Peaøittee will be required. npon due notice, to remove or alter this _tic « project herein stated witbour -¡.enKS to the Town of Southold. 8. That the said Board will be notified by the Permittee ot the coœp1edoo of the wotk auth· orized. 9. That the Permittee will obtain all other petmiu and c:onsenII dIat may be reqoired sup- plemental to mis pemUt which may be subject to revoke upon failure to obtain øme. Albert J. Krupski. President James King, Vice-President Henry Smith Artie Foster Ken poliwoda . . Town Hall 53095 Main Road P.O. Box 1179 Southo~d, New York 11971 Telepho~e (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: COASTAL CONSULTANT WAT'T'FR WAPPTTS J~~uaFY 11. ?nn~ December 16, 2002 that your application, dated by this Board, at the regular meeting of and the following action was taken: . Please be advised has been reviewed (-X-- ) Application Approved (-) Application Denied (-) Application Tabled (see below) (see below) (see below) If your application is approved as noted above, a permit fee is now due. Make check or money order payable to the southold Town Trustees. The fee is computed below according to the schedule of rates as set forth in the instruction sheet. The following fee must be paid within 90 days or re_application fees will be necessary. COMPUTATION OF PERMIT FEES: One Inspection @$5. 00 TOTAL FEES DUE: $ <; 00 f~J;~~ G-:,£;l, tltt.c.-I 11 11 ..,1., n SIGNED: y. ' ~, , ~' PRESIDENT, BOARD OF TRUSTEES BY: º!:~ç~ 4/98 Albert J. Krupski, Presida James King, Vice-Preside~ Artie Foster Ken Poliwoda \ Peggy A. Dickerson . Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (63l) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD January 27,2003 Coastal Consultants PO Box 1149 Madison Square Stalion New York, NY 10159 RE: SCTM#53-6-1 WIllter \1appaus 2705 Bayshore Road Greenport, NY Gentlemen: The Board of Town Trustees took the following action during a Regular Meeting, held on January 22,2003 regarding the above matler. WHEREAS, Coastal Consultants on behalf o!'l,Ütet· Wappau.s applied 10 the Southold Town Truslees for a permit under the provisions of the Wetland Ordinance of the Town of South old, application dated December 16, 2002. 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 January 22, 2003 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 submitled concerning this application, and, WHEREAS, the structure complies wilh the standard set forth in Chapter 97-18 of the Southold Town Code. . 2 . 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. NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approved the application ofWålterW<ippamfor a Wetland Pennit to reconstruct inkindlinplace exisling 50' jetty with timber or vinyl with the condition that the inshore part of the groin is lowered six inches and the seaward side is lowered one foot 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. Fee must be paid, if applicable and pennit issued within six months of the date ofthis notification. Ifinspections are required, at a fee of$5.00 per inspection (See attached schedule). FEES: $5.00 Very truly yours, /~·í·~~vb ~ t2f~~1 ? Albert J. Krupski, Jr. President, Board of Trustees AJKlcjc cc DEC Albert J. Krupski. pre.~t James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Main Road P.O. Box 1179 Southold. New York 11971 Telephone (516) 7'¡¡5-18~ Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: COASTAL CONSULTANT WAT'T'~R WAPPITS J&nuar~J~ 12:. ?()fI~ December 16, 2002 that your application, dated by this Board, at the regular meeting of and the following action was taken: . Please be advised has been reviewed (---4- ) Application Approved (see below) (-) Application Denied (see below) (-) Application Tabled (see below) If your application is approved as noted above, a permit fee is now due. Make check or money order payable to the Southold Town Trustees. The fee is computed below according to the schedule of rates as set forth in the instruction sheet. The following fee must be paid within 90 days or re-application fees will be necessary. COMPUTATION OF PERMIT FEES: One Inspection @$5.00 TOTAL FEES DUE: $" 00 "? /~ ~~ SIGNED: tlt-i..-I ~ ~"'l'...I..' 9, PRESIDENT, BOARD OF TRUSTEES BY: ºE~~ç:~~ 4/98 Albert J. Krupski. Pre"'t James King, Vice-Pre5~t 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 (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTH OLD WALTER WAPPUS YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction. hay bale line 151 day of construction Y:z constructed -X- Project complete, compliance inspection. Albert J. Krupski. pre.t James Kingt Vice-Pres t Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold. New York 11971-0959 Telephone (63l) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD ". YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. lA/o..¡:;p,,-vJ INSPECTION SCHEDULE Pre-construction, hay bale line 151 day of construction Y:z constructed V Project complete. compliance inspection. ~oDe I 765-1892 Town Hall. 53095 Maio Road P.O. Box 1179 Southold. New York 11971 . . . SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL I\t the meeting of the Southold Town Conservation Advisory Council held Wednesday, January 1S, 2003, the following recommendation was made: NAL TER WAPPUS to reconstruct inkind/inplace existing SO' jetty with timber or vinyl. _ocated: 270S Bayshore Rd., Greenport. SCTM#S3-6-1 fhe CAC did not make an inspection. therefore no recommendation was made. < m ~ V> o TI m X V> -I Z eI '.-" -< ~,- .. .-' .~ ..~. -, ': --., < ~"'-;.. ,,%,...... ' '.~~ » z o m » V> -I Q '-/ A - å::r- ~ _ __~,: _ _"... _~'. .":t_-..~* ;-.':".- '<~--~~iI:~ðIl!J . """~~¿¡r-~j'" ..'¡C"!.o_';;·~~{.~: ^ , t:, :.}/ " j ...c__ t ,,~ :;::¡. o~ (3» V> " m" 0» c -V> Z' '1jIV çè'J ('IV> mü::J :;::¡» m-< '1jV> ç:r: ('10 m:;::¡ ~~ mO Z» -jO 0' "eI m:;::¡ Xm _m v>z :::!'1j ZO eI:;::¡ .....-1 mZ ~:< ..... m ::j -< " :;::¡ o ~ V> o C -I :r: ~ .-,,1 .."",.,,,,T.. ,.t'f..·- S' '::-" Z o ~ I r-, ~ ,,;~,:;~!'.;¡".'_'J'" _~'i'; , ~.,!~~~t~' ;.t~c ~:::1-..,-:;;;~;;¡i':~~~;;~>' <:'. . ··i'::~·'·<m~.,....1, . "". T~<t:::~~':~:~ kt~...:~:!;~~:- .:"," "~:. :~'.' .w:: '·11 '1j :r: o -I o V> }! ^ m Z -. :...1;.. ""f- - '- "i ..... C r- -< :!'" IV o o IV ,,>!"~.:t:~~~c~III' ~,~,~" '-- -"-', "". ~".'''''''~''''''''~'' .. ....·,.A,~.:.,..... )#Îtfi...:;~:L,;.;!~::"~~ .,'~~ -"'::-~~;... .....'....,.....;-. ." -." ~ J ;..- ..,.'~ ~;::::-,~~ ,:,::~~-;::' \,~. ! *,..'" -.- - - . . ~'If'0 £.~ / . .' j , . . .. ; . " ~ .! 13 'I 2 t, .. t·; P !J~' '-', .,' ~SJ If ¡¡"i,-' ,- ! ~ ~.. ¡¡. , n· - I· f J! iy ~IN o~~k'h!dH;' . :' '2 ; ~ ~ ~ ~'~ ~ ~ .:: . J',' . - .' ....lJIè... . Àt78 -!"' .!!,. .. .11 oJ: ,.. ptI,d -'ø4 ~I.J!I ~ O'OS - ·3,1s;.e¡¡n¡: 7 ~7--i\ I. -I' ',I.~ :i¡ ~ () ,t:t ~ ; - :-:1 . ..p,¡,~ .. -- - ;'II I! , b- ~. J l"- T u ~ ~ ~. C> ..j } \ .--.1 o·~.,..: '1 ~. .& " II I. '" \, " . ",' ot:?Oè1 ~. ",1_ , ";4 :1\ ~) , '.! ....~,1} ~ I ,~ ~~ ~e \) C<):7,t <ß-öQ !~' ['., ~::::~ !" Ii ?! ¡;; ~: t-~{j ~- d ~ ~ 1 ~ ~~ :ã ,J¡ ~ "" ~ ,,:.,.¡.. .il ~.:,; ~ ':3. ('t¡ ~ ~.~ ~l ~!~ < "- ] .~ ~ ) r}l:·~ . ~~\1J\1cr: g ~r: ~'~, ~ ~~ .~ ~.. l!) ~'I-. ~ ª ~~ - ~~ ~ ~ ~,~ B ~r~ I ~ & ~~m ~~ ~~F q~ -1 ~ ~. j ~ I:: r1r~ I 6 ' 3ZJOHSAt?g /.--------.------.-. I ~ - t; ~~ .. ä -11 E o k tlI ID' - 1 .~ ~ ff~ ~ >l~\J § '~ IÏ1 :: t ~ p~~ t ~g~ ~ (.~ s f I: ') q' ~ ~~l ; ~¡~ . . (¡COASTAL CONSULTANTS Waterfront Planning, Permitting & Engineering P.O. Box 1149, Madison Square Station, NY, NY 10159-1149 Fox 212/460-5667#99, Email raycooch@rcn.com. Phone 212/777-0083 Date: Board of Trustees, Town of Southold Richard Raymond, Coastal Consultants, Authorized Agent for Walter Wappaus December 10, 2002 I b To: From: RE: Walter Wappaus, 2705 Bayshore Road, Greenport, NY 11944 SCTM No. 053-6-1 Please find attached: · General Data & WetlandfTrustee Lands Permit Application, 3 copies · Project Description, 3 Copies · Short Environmental Assessment Form, 3 copies · Adjacent Property Owners List, 3 copies · AcceS5 Consent Form, 3 copies · Project Plans, 3 Copies · Project Photographs, 3 copies · Property Survey, 3 Copies · Fee, ~200.00 , ,'(~ ,. l> g: ~'~ ~ Ü 'I :': (r¡ :»,i: ~,QQ , r, ., ..¡, (11 . I ~~!I ~Q\ ,t~n ~__ ~ i1't :f: ~ ~ : i . ~ .f: ~:;. ~ ~'2t- I "I ~.:; ~ ~ ~ :] ~ .t ~.~ ~l ~Ltj <~~U H~I~' '~''- ~ 1/).0 .~ '~-'- ~ o~ ~ ..................., .~" . .~ "'<~-''I-. '. '--.. I.f) ~Q~~! ~ ~ ~¡ ~ ~ \1. \"II W \I) <I~F ~~ ~ .J t2 ~ Á,t:?fi} L5 1., (Pt . ,< 11 J I ~ .. '3í hj j)y. n· ~j '¡J1!e J I NO? f1 ~ Hh n~.' ~~~ '" . ~ .!¿, .ì l' 'of:: ... ~'d ..., ""!I / O'OS - ·...,Iiõ.&.n¡; -~'--I\ .. I.~ ~ .~ ...../;1."'" :1 ¡ j o ,l' ~;¡ " .opt ',:n.æ ..I.... _ __ _ ~ ~ , :21 'f~ ~-.t. f J ..!" u ;:r. :11 \) -. ¡ ~ () I . ~ .J ;¡ . ¡ t:¡ ~ ~ ' f I, L.-t:ì ~ .J. ~W I!' 1 .~ .. ~~S '. 3 I! I ~." ;ß [ N. ;'14;1 ~ l/I ~¡lL -7 -,'A p<.JOJ<';1 Ii --+ _- Of ..~·08S' - ---- ,- Î =aaOHSAt/g .~ ~ ~ to t- .,. ~ ~w II} ~ .~ ~ ~ ]: 1I. o ~ \ -J O.~.,..: ,~ -' t-t~í " l~' Ot102J ~. /.--...--.-..------ .-. 1 , . of- - I:: . \) ~§ j¡ ~ o h J\ III' d¡i ~ ~~~ § 'f~ ~t~ ~ j.~~ t~&i1 ~ t~ S ~ I: ~ J<t' :ì ~ ~1J. l~ ~~~ 722m .., -< .~ 72 2~ ..~ .~.... ...""(- "" \ "Ÿ ,:." \ .,., \,. .I.:~ ,",,'. .".. . ,~ ..~' \ \ ~I ... ~ i; <; +:.z- --Z'¡ + MHI'V 8 ~ UJ Õ > N Z II Z :5 = 0 - ~ 0- :J ãj « I t;¡ 0- w LLJ w '" z Iñ :J ~ // ~ 0 . u:J: Ó <J> ::¡~ 0 . ~~ :r: .J' m '" '" ~ 0 ~~ ~ d '" ~ z VlO ~ ::> ~ [30- !;( uo ::> u Uz c- o '" «w ~~ LLJ ..J U. "'~ u_ «!¡¡z i~~ ,,,,,,, o~a: ~it~ "'",:2: ~I¥¡:: '~I o '" ~ ¡" .... « ..- lIIOdSN'V'IIl l'tHOllJl ~o NOID3!110- '" '" ~ } ~ ~ -\iJ , .. '" d :2: ~ ....~ ><:0 80 enð ~~ '" ~ .. '" N .... ..... ....- -. Z'L - Mll'V -- -. -- .... ...., -- . Z'¡ + MHI'V - ~ , m'3H)Ilf1B !l38Wll ~NIlSIX3 ..J ì>: '-- ¡" '" z ~ ~ :J. i § ~ ~9:J.8 ~ ~!:È ~ ~ sa rôN i:i zffi I.L. .. 0 (XI o~ð~ ~",::¡õ ~~ It .. u «~ ~ 0 UJ~>- '" '" Z ~L1'Iw ~R!;¡ "- N 0- Z .. II> <::0- 0« z ~ 2>0 ~;:ðI.l..N ë~~~ ~~E8 g; ~ ª ¡;¡ VI z 0- 0 z 1='" >< « <If) C'Ø >-~.-~tñO~;:: CD _w-Q\Þ o _",>-'1'<0 ~z><<(z"-L? :<f 00::>.",,"" 0 a..ucoO'a:f'o.\þ "'-I .VlO~'" g:<tOZ>N_ t;~O~N~ < ~LU-N o ~z ~ U :::E w :::E 0 ...J :J: ì>: w ¡;., ~ .... u. ¡" ..; ... ...J ì>: z ~ I I - ,os ]'\10M 3MOHSÁ '\18 w '" ~ i$ 8 :Q LLJ z 159 ~~ ~~ OOLLJ g:"'o 'z~~ LU~~ uo'" ~I-U o . . «~N a VI VI W U U « o ~ VI ! '" Iñ §Ë ~ ¡:¡ :::E o '" u. VI 0- Z w :2: '" '" ::> ~ w :::E o w o " « N o -- o N -- - - o w VI > W '" to ~ .... ~ ~ ...J ¡" '" ¡¡: ~ ...J '" .... "'to .... '" . 'Z ~ '" <[ -;¡: ~ ¡" ~ ~ §~ m >= CI :-; ~ '" + N <[ :-; . ::t '" 6 ::t ....~ N", ~ 8 ~~ ~~ ~ .. ::t ;:;:> >= , , N ... ~ ~ ~~ íø .... X M ¡;;~ , '" t ..¡. 1;š~ , :-,; " ", , , " , , -',. " I.. CI w ... ... ð ~ ::! « ~ ~ 0 to ci to '-! Z ¡¡¡ >= ~ '" + 1;š ~ ~ '-! « - . ~ .... ~ '-! to to ~ '+ ~ ¡" m ~ . ." !ã ~ I'\! >< + :£ 0_ UJ « ¡¡¡ . ! I::E~ , , ~ :<[ : :.:.......' I ~ ", , I I'.,.' 1- !D I I....', 1',', " \ ~ ". , " '" ~ « ~ , '" 1< <ø ..¡. ~, " ."',' " , .~. '. o '" ", , '. " " '. .'. " . ¡., .... .. + , " , , ix> y;) " + o ci --' '" ~ ~ => ';;: CI " !D I !D. Z 0, t;~ w V) 1\ (l " ".', '.' ,.', '" '.' \, '-." '~".... '" , w , ...J "'-, a: 'c< .... '" ~ >= Ñ - , o x o - " " CI " ~ " ~~ '¡;;g ~ª ~ :E ~ ::t '" N - . o x , M !D cr: «~ z " O· - co t;~ ¡7 ê ...., tJ:) z ~ B u.. o ~ UJ ~ u :5 ~ UJ IX UJ u :5 ~ ~ ~ z :ï2 ~ c UJ en ~ o f Z ° ~ ~ <i! R: ~ ! ~ ~ N ""9<i!8 ~2~~ ~~"'N !!J '" '" ¡;s ~.... ""ci~¡g o<[<[g ~ á1 ~ .. ~~g;~ ....u°<[<[ ::t CI ~ ~<[ ,.. .... Z '" '" WLnüj ~Of- ..J '" <[ o..Nt;; Z .. ,!;t !ii1 ,.. :s ;<<[0 ~mttN .. !.! ¡;¡ ~ S ~ .. N "'!¡!~t; ~ .. =>!i! fi58", Z ~ Q", .. Z I-Lt') J! <[",;5õ::3", >~'III2"V)...o(Q "'=>-....,..0'" o(J).-c:::z~L/') ~~x~>l¡::g Q.ugV)~_"!t ~<i!ciz,..~Ñ' 0..1- '0 N ",o..!Q~~N « OW _ ° <[z u ~ E ~ "" ° ... g CI Z w CI I s ~ ~ ~ w S CI ~ oJ ° .... ° N "- - - CI !Ij > ~ e.. ..,., Town Hall 53095 Route 25 P.O. Box 1179 Southold. New York 11971-0959 Albert J. Krupski. President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit APPliC~ _Wetland Permit Application . Major Waiver/ AmendJl.l/Ch¡;es _Received Application: It-? Ý _Received Fee:$ m-~ '.J _Completed Application J v¡ (, I Ù _Incomplete _SEQRA Classification: Type I_Type II_Unlisted_ _ Coordination:( date sent) . CAC Referral sent~O ~ Date ofInspection: (J _Receipt ofCAC Report _Lead Agency Determination Technical Review: . Public Hearing Held: II'4-D:>' Resolution: ' Minor fIr-,., I 6 Name of Applicant \)Jfd ~«-.. W~~~R.Us. \ ì ,1.-9 TQ,Cci(... L-Au.nJ 'DL\\R )\.h-iö (\) ~D 'U>861- ì::> -S~-rL Phone Number( ) ~ l - Î ì <-( - I gg 8' o '5 ~ -0 - \ d- 105 ~A.'fS~O~L ïL.(')~() bQ.(é~~ ~ÐIL+_ N~ \\q4~ ( \ 58064' (provide LILCO Pole #, distance to cross streets, and location) AGENT COAS..4l Co~çv ~~$ (\2.lc:.-~~'!:J (If applicable) Address Suffolk Counly Tax Map Number: 1000- Property Location: to.~ -~~ Ni \~ N Ct ~\"o.>O \/1' 1. l-A ue- ~,~Uþ) ~ ",'$ "" ç{ ,,"'- Yv\~OúùAJ <~(~ui\fl-é. <Çt-I\-fì'\)~ \ Phone 'Ll2 -111- OOc!.3 Address: \ () lS~ - . . Board of Trustees Application GENERAL DATA Land Area (in square feet): ~\<So Area Zoning: Previous use of property: \>t..\ \JA ''t.- (¡2,'fç l 0 f Vc f'= Intended use of property: \\,¡O eN () I\J 6 ~ Prior permits/approvals for site improvements: Agency Date \> ~ (l.. ""-ì. + ^\ ~ \ "AJ1'., ~ \oJ $ s <t> f/c... \..) S f\.O¿ N,< S~òl\ (Csd-l l' v- $ e µo ¡Iù 6 " ~v\tOJ) Cl<) 'v-S.l ~ Jy ~ 5tcJt~ A-~ ~; ¿ f€- '-'0 I ~ ( _ No prior pennits/approvals for sile improvements. Has any permit/approval ever been revoked or susXed by a governmental agency? No Yes If yes, provide explanation: Project Description (use attachments if necessary): K Q".r(')~S '"\- Q.IJG"\ \^-.:>t.\."-J\) I (10 ?Li\C£ \~:.:i-l ~-t \',..) 6 'S 0 \ . ') ¿ ~T'( \ "-.) l "\ \-t \\ Mbe'(L DCL ~\~\\.-. . ' . . Board of Trustees Application WETLANDITRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: 5 l~ Q.-'é. L-l '-5'{?_ S <r I) 9:, I L- 1 ~ -.(\ 'Tl() kJ Area of wetlands on lot: ~ I Ç" +/-'square feet Percent coverage oflot: ~ % Closest distance between nearest existing structure and upland edge of wetlands: \ ~ -r/_ feet Closest distance between nearest proposed structure and upland edge of wetlands: feet N I A- Does the project involve excavation or filling? X No . Yes If yes, how much material will be excavated? NIA-cubic yards How much material will be filled? iVll<r cubic yards Depth of which material will be removed or deposiled: Nt ~ feet Proposed slope throughout the area of operations: N l ~ Manner in which material will be removed or deposited: N(Rr- Statement of the effect, ¡fany, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): y ~V:>~ D Ac't-\\J \'t\.( \ So Ì"~~ ~ ~c ~ I"k '\J'T è F A µ 'é.>l..lSq-\~6 t:uNC"nðr0,(\{...- ~~ ~'< ~ Îl+ê-U \.A.-I!'" L- ~ ~ (\iO C ~ f.\-\-.J 6 iL ð<L ~ 0f F <. ì /!r<;. At- Q.. tS' u& '\ d F- ï ff - P ~ ~ 0 ':>~ I) ,~-ct-l v\. 't'-( . . . Board of Trustees Application to(A- COASTAL EROSION APPLlCA nON DATA Purposes of proposed activity: Are wetlands present within 100 feet of the proposed activity? No Yes Does the project involve excavation or filling? No Yes If Yes, how much material will be excavated? (cubic yards) How much material will be filled? (cubic yards) Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts reasonably anticipated resulting ITom implementation of the project as proposed. (Use attachments if necessary) . . c¡ COASTAL CONSULTANTS Waterfront Planning, Permitting & Engineering P.O. Box 1149. Modison Square Station, NY, NY 10159-1149 Fox 212/460-5667#99. Emuil roycooch@rcn.com. Phone 212/777-0083 Walter Wappaus 2.705 BaY5hore Road Greenport, NY 11944 See. 053 Blk 6 Lot 1 ADJACENT PROPERTY OWNERS To NORTH: Town of South old Town Hall 53095 Route 2.5 P.O. Box 1179 South old, New York 11971 Phone: (631) 765-1889 To SOUTH: Carol Ruroede 2.875 Bayshore Road Greenport, NY 11944 . . ~COASTAL CONSULTANTS Waterfront Planning, Permitting & Engineering P.O. Box 1149, Modison Square Stotion, NY, NY 10159-1149 Fax 212/460-5667#99, Email raycoach@rcn.com. Phone 212/777-0083 To: Town Clerk, Town of Southold From: Rick Raymond Date: January 13, 2003 ,¡!.II" I 7 I ~OO!> RE: PROPOSED INKIND/INPLACE REPLACEMENT OF AN EXISTING GROIN Walter Wappaus, 2705 Bayshore Road, Greenport, NY SCTM No. 053-6-1 Notice has been send by USPS priority, certified mail to: Carol Ruroede 2220 NY 32nd Street Lighthouse Point, FL 33064 SCTM No. 53-6-2 Mary & Blasé Lombardo 1815 E. 34th street Brooklyn, NY 11234 SCTM No. 53-6-44.1 Town Clerk Town of Southold Po Box 1179 Southold, NY 11971-0959 SCTM No. 53-4-46 notifying them of the project and hearing scheduled for January 22, 2003 at Town Hall, Southold. A copy of the materials send with the notices and the certified mail receipts are attached. " . . PROOF OF MAILING OF NOTICE ATTACH CERTIF1ED MAIL RECEIPTS \..... í. '~Tl\òJ,>~ 1.,-"1..-1. 0 ~OVJÌ' . llìl\ '. iJ'( \>0- ~~ ~\ . ~..i~ \ l4 ì{ u'é fL '~"2-~ So t . "Z,<.,O'o'f E.. ""2;,L("ti S:q- . Name: G) \buJ10 Cle~\..- ®--CM/..o\ ~. Address: ~¡,) <;c)~ \k~. ~ \J(2..0e. Je -.---- Œ) '{V\A <\..'-\ 4. ~ltl.se. loVV' t,.¡~~o -i(:¡ C\.L..:( -.lLt.. Ù ~ \ 5' S'" ll1..:-S{ STATE OF NEW YORK COUNTY OF..sJJFFOIK/V"''-'-' ;jùÆ-L . Co^<\O\\... c..c)tJ..U L \,.<\ 1vt"S Ç(\(.~,I'\.Û ~:\m.úU) , residing at It4:L é.., z..O\:!st t- ~ Ë.. IV '( ( ~I r ' being duly sworn, deposes and says that on the I:' ~ day of .) ".....J~ ,200 ), deponent mailed a true copy of the Notice set forth in the Board of TrusteeS Application, directed to each of the 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 assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at ~ \(, .10'< , that said N . ces were mailed to each of said persons by (certified) ("gi~t8red) mail. Sworn to before me this / t.¡ Day of -:JlI/lv'tI"-'1 , 200 7 /ØlluJ{i~1~-d9~ Notary Public ARTHURINE J. DAVIS Notary Public, State of New York No. 01 DA5060677 Qualified .In Kings coun~@2:r Commission Exp"ss May 20. '7 - . . Walter Wappaus, 2705 Bayshore Road, Greenport, NY PROPOSED INKIND/INPLACE REPLACEMENT OF AN EXISTING GROIN Certified mail receipts for Town of Southold hearing, 1/22/03 U.S. POó;I.:¡1 Sr-tVlc!.' CERTIFIED MAIL RECEIPT IÐornl'stlc {¡lail On/v: No InSlIl.l11L'L' COlL·,..I[ll' PILJl'/ffcrf/ a- a- t:I =r- ! ,^" AI ï.;' ~-3 ~"'( .. ---- --.z . u.s. Postil! Service CERTIFIED MAIL RECEIPT ¡Domestic fll.1,1 aI/Iv No fr1SU/.ïllCL' COl CI:)ÇW PIOl'/flem ru ..l a- fT! ..l a- .-'I o fT! o o o ,) /.:..1 'k' '. ~í àt~ t:I ..l ~ Sent To , . _if._ o '--I-.;... .110 Ù . t,u'1VW .-.-.......~_~.u..._31'._.._..._1!....__.._.__....___._.._............_.__.__.....__ ru Slreet, Apt. No.; ~..~. "' ._ ____. t:I o,PO Bo, No, (I),"O~vY Il'':; o hn__nn.__u_....__:iuhU...._....hh_____nh__._ '_____"."__n..__.. _.______. ".... _ ____._ f'- elly,SI.", ·ó \\ill(- Ú 1 \, ~ ~ ¡...., U.S. Po~,t.iI Sc-rvlre CERTIFIED MAIL RECEIPT (DomL'~rIC f1.l,lIl OI1/~ No 1:).';l1I.lIJI~" CPl-,-'! )(/L' P'Ot-,ilCd! f'- <tJ <tJ fT! o BtfilKL Ii. Nt ßJl¡ I 3.85 ê 4~' ;'?"~ta?e S ..l a- ~ ~:~~m~~e\ .~\ rT1 Retur~Re~' c:::::J (EndOl1lemên:~l~ . . c:::::J RestrICtedDel~~~. [:] (EndorsementR~)' ,..), c:::::J Totel pom~.~ F": .;:) " " ..l !' ,.- ~ ~~~/..~~:¡;~mt9~;;t~~-,,-~-:~-~----:n- t:I __hnh_h,__mh'n nmnh_ ["\- Clty,Sr ~~. 2.30 1.75 \ ; __nOh'_"h__ . . NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: ~,,\~ ~¡I\~rAW SCTM#1000- 0 ~'l, _ <0-1 YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to re~uest a Permit from the Board of Trustees to: \?.~GotJ~d- ~lS~lfV6 Jt. 1-:,,< \""~lk1S) , ~ l k./\>t...PQ AtV 2. That the property which is the subject of Environmental Review--Ïs located adjacent to your property and is described as follows: 9-ïo5 '\?)A'(S\...ø~t 'RoAl)) (912.-f''é-Ñ pCðfLS\' 3. That the project which is subject to Environmental Review under Chapters 32, 37, or 97 of the Town Code is open to public comment on: "')_ 1.-2. \07,. You may contact the Trustees Office at 765-1892 or in writing. ìr The above referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal. OWNERS NAME: MAIL! G ADDRESS: h ~ PHONE I: '?''''',... ì1({ _ t> Q...\ IX' Ene.: Copy of sketch or plan showing proposal for your convenience. .s C) z ~ ~ u.J J: U- o u.J U I- o Z . 0) '" ....c:\J - 0 )....0 ...cO=:: I:: \J ._ -0 ~~ 0)1.() ...co.. =0 '-M ~I.() 0) '" 1::= .- 0 OJ: 0) I:: ....c:~ ~.2 ...c . :> 0) è a......c: L.. - 0) o - a.. _Oe ° V) a.. -=:UJI/) UJ .- Z~-= UJ V) 0) >~.s (!)~E 0) >- L.L. U caO I:: o UJou 0=:: '" UJO=::~ J: « L.. O-J. V)ca ~ UJo 0) U-JZ ~O '" 0J:32 Z~o ::::>-= 05 V) V) 1 r .s . . o a:::: o U UJ a:::: u.. o - V) - a:::: UJ Z ~ . -- I/) 0 ãrE "':': '- ~o I:: I:: ~ t2 .S L.. 0) :> ....c: \J - ~ g> 0).- .- L.. > ° .Q~ . . I 1'\ \J 0) V O)....c: - - Z '>~. . . - .S 0 E ~j ~ ~~ ~ Z UJ :> O)\J - I o....c: I:: a:::: ).... - 0 <CUJfu. û"': ~ - 0) 0 0 IJj ~ ~ .~.~~ u.... :::>, I/) I:: 0 :::J \~ a..i ~ .~ ~ co~ u.. I:: 0) 0 ::JfO '-:¡; ~ ~ a.. 0) . - ....c: UJ L..L..- u..o ~ ~ ~ "*~ ~ ~ ~ .- 0) 0) I- 0 §-g ~ u _~ 0) ':": ...c UJ yv >01/) o > ..., UJ ....c: 0 0 CO -<.l:> O)\J :::> <j :S"'S ~ C ~ V) ~ I- ~ ,=....c: ê U._ .- I/) ....c::> ~...c '", " ~r ' ~ ~~ t~ N <>- ex:> ..- I I.t) '0 I'.. - ..- M '0 - * o .....J o ::r: I- :::> o V) u.. o z ~ * V) w W l- V) :::> a:::: I- u.. o o a:::: « o cc . . NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: SCTMitlOOO- OZ)"l,_<O-¡ YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: \2. ~ Go ~ ~\Å<..t ,<--~lc;'tlfV6 jt t:"'-( \ u \:-.\ t.J Ç) , €'. \ IV~L AcE AIIj 2. That the property which is the subject of Environmental Review.--is located adjacent to your property and is described as follows: 8--105 'bA. '\51.,Jø ~t 'Ro~j)) (8/¿f?'é N pCùa..5\· 3. That the project which is subject to Environmental Review under Chapters 32, 37, or 97 of the Town Code is open to public comment on: You may contact the Trustees Office at 765-1892 or in writing. The above referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal. OWNERS NAME: W ~ \ k w "',Ð r? A. u--~ MAILI~ ADDRESS: n~?I ~ eII:& l-A""-' ù \)Q..\u{' h. -\-ð '" W\I> 0 g6 ::'4 "- PHONE If: '?l">r..... /ì({ _ .., IS~R' Ene.: Copy of sketch or plan showing proposal for your convenience. s . . PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: ST ATE OF NEW YORK COUNTY OF SUFFOLK , residing at , being duly sworn, deposes and says that on the day of ,20_, deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at Ihe 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 Ihe current assessment roll of the Town of South old; thai said Notices were mailed at the United States Post Office at ' that said Notices were mailed to each of said persons by (certified) (registered) mail. Sworn to before me this Day of ,20_ Notary Public · . Board of Trustees Application ><" County of Suffolk Stale of New York W '" I \C, «- \)J p.. rr!? 1\1..) S BEING DULY 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 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 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 REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REYJEW OF TIllS APPLICATION. SWORN TO BEFORE ME THIS ()E) DAY OF NðV4'1-cLu ,200. ') ~ ~9 Notary P~ ic CD(I7(V71 "sIC:>1 - e><-¡) Ite" 8"1 (sl Z-UD c. . . (j COASTAL CONSULTANTS Waterfront Planning. Permitting & Engineering P.O. Box 1149, Madison Squore Station, NY, NY 10159-1149 Fax 212/460-5667#99, Emoil raycOQch@rcn.com, Phone 212/777-0083 Walter Wappaus ::/.705 Bayshore Road Greenport, NY 11944 See. 053 Blk 6 Lot 1 ADJACENT PROPERTY OWNERS To NORTH: Town of Southold Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971 Phone: (631) 765-1889 To SOUTH: Carol Ruroede 2875 Bayshore Road Greenport, NY 11944 -.... BO. of Trustees APplication. x: AUTHORIZATION (where the applicant is not the owner) .' I, W fI.\ kIlL \}\J~ti"US (print owner of p erty) residing at \ ì\ 2.g t-I'tee.. (mailing address) lAuJU \)Q... f¥:.k6~ \Aù do hereby authorize CO~~~ \ (Agent) C')~Sù I+-A¡\J~ to apply for permit(s) from the southold Board of Town Trustees on my behalf. 8 . . U·!6-4 (2/87)-7ex( 12 I PROJECT I.D. ,"uMaE." 617.21 Appendix C State Environmental QuaJity Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I-PROJECT INFORMATION ¡lo be completed by ADplicant or ProleC[ soonsor) SEa I.IS I 2. ?ROJEC7 ,\lAr.1E fo\US J. PRO...;ECT LOCATION: Municfpality '\O~~ C,:¡un¡y Su 4. PAEC:SE LOCATION ($Iree! aadress ana road inlersec:Jons. ;¡romlnent landmarKs. :IC.. ,jr ;:¡rOYloe :nap) 9-105 ~ ¡C\ '( 5 $ e..E:. 12..o~o I (Ón...eeAJ ~O(L-"T 5. IS PROPOSED ,1.CTION: o New 0 ExpansIon Ò. DESCRIBE PROJECT SRE~LY: \2..eco)'-<;. þct" Je~'\ vJ',\--h +~ ~djficatjOnlaJteration ~e (1¥:e.IV\EoJ7 \10 't-\0D ) ~-eL 0 CL pJ ~l~ U\u-((, 04~Aj-£ 5:)1 I\.'- 13. I I I i 9 , . '. AMOUNT OF !....J.NL¡::ECT=~: Initially . \ 3.cres Ultimatelv L, \ ac~es WIL!... .-QO?OSE:J ~C-:¡ON CaMPI..':' WITH ËXJSiïNG ZONING OR OT¡';E~ EXISTING ~~w USE ~E5ïMrC7¡CNS" ~es ~ ,'10 If ~o. cescrlbe :Jnefty 'Nti', :5 PRE3ËNT LAt~G 'J::c: iN 'IIC:NIT':' ,J;:: :;L:;OJECT? ~eS,den!lal r--:.!ncuS'tlal ~ ":.:.mm~!Clal Om"oe <)\~q(e ~~ L..: .:..gncullure --.!. ?3rKIForeSIICoen scace _Other '{QS \. .oe 1\..1",\ I ~ (.. 10. DOES .J.C710N INVOLVE A ?'=.RMIT J,PPROVAL. OR .;:iJNo!r~G. .'tOW OR ULj"!MAiEL':' :=;:¡Or.1 ANY OTHER GOVEMNME~ïAL AGENCY iF::ùERAL. SõAT~YesLOC';LI?U"o If yes. ,'\C:;""C~ 1.VS,í\{)<-(Cd-1 "^~~"')I -i{J Ye ,- !is! agencYIS! ana oermitfaocrovals \....J ''\ 'V 1 y ~ ",7 I- ""', \ ~'( ç Ofê.- - 11. DOES ANY A.¥'~CT OF THE AC,lor~ HAVE A CURRENTLY VALID PERMIT OR APPROVAL? o YeS ~¡o II '/P.S. list agency name and permll1approval 12. ..\5;" RESUL:- ~OPOSED AC7!ON 'NIL!... S(ST!NG PERMITIAPP'10VAL .=iEOUIAE .\100IFIC':'1 ¡ON? DYes Li No n. 1 CEiiT!FY THAT 7HE INFOAMATICN PROVIDE!) AeOVE IS TRUE:-O THE 3ESï OF MY KNCWl=.CGE _ j Do<eo2 {" ;Jlo ¡J4..WUw2-- .I('" ApplicantlS;:Jonsor SlgnalUre: If the action is in the CO¡Jstal Area, and ¡OU are a state açency, complete the Coastal Assessment Form before proceeding with this a?..~essmeni OV::R ·.-'\-'1- ':;'11 C. I J ~e '-:8r::¡e~e'~ J'I ~:;;e::c ;., ~C'::::::..C. ,':'.\1 :;........~;;.'-' ':",'~Y . ,.:~. 7¡....=.2~r.CLJ 'r~ '5 'F':;::.:::. .;J :.'::.7 5: ì .:~ ~ J ~S. . ::::crClna!9 :ne '"~V'r!'N :;r::ce5.3 ,¡nc '.lsa :r·e .=:";L:... ::~... ,:)':";:,1 ;1_~N'/IFi.C~J~.~E~rj"~· f"lS .'~o ::! NIL:" :..C7:CN .:tE·:::';'¡~ ::CP':::I0i..:.'<::J =ìE"/IE'N":'S ,::::::C'JICE=J =.:;::; 'J~LS7~J ,:,:::,;ÇNS N 3 .'PC:=R, :Jo),;;, ';::-.37 I ,'c. .3 .ìe>:;:>.t:'/a :~C:."":=' Tla'f :Je su::ersece,= :.y :.nc(:":er .r\Vclvea a-;ency. I C. -::ULD .:.c-:-;cr :J.r=.5UL~ N .J,NY ,.J,ovE:::Sê: :;::==::::·:;73 .l.S::CC;;.72:J ,'JI7~ ---2 =:L:":"NI.~G. .':"n5',oJers -:-:ay::e ~;¡¡nCWrll:e". I e:;I::let :1. :::'tlSill'Ig 1\t :uaJlt'(. 5unaC2 Jf ~rOl.:naware~ =uall!v ;r ,::t.:anfJ1y. .1Ct$e e'1~IS. =,:s.mq '~<>¡~ic ;;af:er~s. ::C!lC ,vasie ::r;;:c(.:c:;:::1 Jr ~fs::::: ~Ofen¡aJ ~C~ erOSõQn, ::r:¡unaça vI' :ioocmq ;;roc¡~ms? ="~clam Jrlerly: ':'~s . ;-IQ C2. .l.¿stne!tc. Jçrlc:;lIuraL 3.~c:;aèoloqICJ.L ,lls.or:ç. .Jr JtMer l.a[:..If31 Jr r.:.Jlrt:r:lI ·~sourç~S: Jr ::::Immunlty Jr :-:elç:1cct:1coa c:-:;;rac:er? :::"~claln ~ '/eo;o:!al!on ::If ·auna. ·Isn. ~r.elrfisn Jr 'Nllati'e ~¡jec:es. 51çmiicanr ."aoliat:;. ::r ::l(-=3r~~ea :::r ~ncançerea .;::c:e5? :::"-:'CI.HO )rlany: c~. ~ c::mmunlt.,·s ¿xls;:nq ;:)Ians or ioals.aS ol/[c:all,:, 3.QOCleð. Qr a cnange in use or intensllY I)r I,;se 01 lana or ':Jt:"Ier natural resourcss.? =;I;ptaln :;: -c 3rQwlh. ~uoseCl.:ent :::e...eloomen!. ~r retatea ac::vltles likelV ,0 ::Ie Inducee 'Y ~ne :rccosea aC:lcn: ::..:(::lIa,n Jr:edv. :3. '_cnç ·arm. ;;:10r. :er~. ;:.;rr.UI.;t;·¡e. Jr )tnf;!r :rTec:s ,lot ,cenl!!iea ,n C~--:.s? :::-::lIaln Jnerl'f· :t;;~~ moac::> Inc:..Jc:nç ::-:anç-=s ,1'\ 'Jse Jf ~~t:'1er :Jllararty .,r "¡¡:;e :H ='l¿~çy¡1 ="-;::¡I¿,ln :r:-=II'I. j. S -7-!E=::. :R S -:-::?~ _.:<'2:"":' -C 3E.. :~~IT::¡cvE.=S·( ~E:...A, 2:1 -0 =CH-:::,{,',:,:", .:.:\, ::.~S2 :':·I'¡I~CN,'J1E.·,ï':'L ..·.~F-.l.C7".3'? _ ·~=s _,'/0 .f ·:'-=s. ~:c::!aln ::rrerlv ?ART !I1_DETE?:MINAïJCN OF SiGNIr=¡CANC::: ¡70 Je c:Jrnotered -:J1j Ä.çenc'!) !NS7nUC":-¡ONS: ,=or ~3C:1 adverse ~ffec= :dennfie(] atcve. determIne whether!t is sut:stantial. íarge. ;mcorrant orOrnerNlse signific. =3C:-! ~ifec: silould :Je 3ssessed in c::mnec:ion 'Nun Its {al setting [La. urcan or ;uraO; it:} ;¡rabamlity af occ:;¡""-Wq; (CI duration' irre'terslbllity: :.e qeoqr3cnic 3c::ce: ana (f) maqmtuce. It .'1ecessary, acd atIaC:lments or reference sUDDoning materials. ::1sure ~xclanat!cns c;:nfaln sutfic:ent Jer31i to snow ¡M,t 30[1 ~e~e'/ant adverse impacts ;'lave been identifiea ana adequatelY ac:cressec. C~eCK ;hls :::cx ;f '.IOU r'a'le 'Centifiea cne 'Jr :r.ore :::oten[aH'I l2.rçe or significant .2.C'iersa ;mD2c:S '.\Ihic:1 ,'.1';"':' oc::...:r. ïhe~ JrCC~8tJ círec:!'l ~o :he '=UL~ =..:...r= 3.nC/or ¡::reaare 3. positive· Gedaraticn. !=~e-::{ :his ::cx 'r ¡OU :lave rje!ermlnea, JaSed on the infcrmatian and analysis above and any siJooon:ir:ç .:oc:..::r.:enr'H!Cr.. :héH :r,e Jrooosea ac~jcn I,"JlLL ~~Oï result In"";:;1:'I significant acverse anvlrcnrr.enta[ ¡mcac~: AND JrC'lICe :n 3..-::aC:1ments 35 necessarv, :he ;easons :3u¡::coning thIS ae1ermtnarion: ......,"~. lr ..:~ù ~,;",,,,(.,, ....'n!)' .¡;<:: '-'.,10.. JI ~.',;jcn;.OI<:: ·~I!I.:~r <l _.....0 -~...".:, .I!I<:: :;Ir ..:....'oon\'o'<:: ,jlrlcer ,,\;,'..>Il.:'::' J ,,"<cen',c<!!' ':'t·I':~r·n ~"'Ja ~.;..ncv '.',<"<i:'-"'~ )1 ...·~~.!l..r Ir _I<:e:..n! .r<:>m '<::~OO""OI" Jrr,en' J~lC . . , Print or Type: ACCESS CONSENT FORM FOR ACCESS THROUGH PRIVATE PROPERTY ~ ~ \ ~ \J..J!>o ~~U-S \::::I1Z4 ~LA\JJJ.J Oil. fkh~ 'fAQ (Name of Appl icant) (Address) "2b~6 ( Office use File #: Permit #: Only 1) 2) 3) (Name & Address of Contractor Involved) (1-\05 ~S;Jn> tL'ë: T2...:L b1.e.~ Ah-( ~: 1000- 1)"3> - 6 _ I. (Project Loca ion) I'-"-'-' (S.C.T.M. #) d:::)n S ~~'íS h!Ð'<Le. ~. ~YLDtr< t (Name of Road or Private Property InvJlved) (Hamlet) 4) 5) (Name & Address of Homeowners Association / Property Owner) \2. e (J[) \ll..ç t-~d-- , u t:..lN 0 / \!J (Jl,.. ~Ce. (Brief Job Description) f 6) ~ '(l& \-\f0 6 ~¿ t't'-\ 7) Starting Date: Completion Date: 8) Estimated Cost of Proposed Work: 9) Insurance Coverage: A. The coverage required to be extended to the Property Owner: Bodily injury & Property Damage; $300,000/$500,000 Bodi ly Injury & $50,000 Property Damage. B. Insurance Company: C. Insurance Agent Name & Telephone # D. POlicy # : E. State whether policy or certification is on file with the Trustees Office: (If no, Provide a co ) (yes/no) .;¿.r .J~'--~ (Dat e) ------------------------------------------------------------------ To be completed by the Property Owner: I/We the undersigned, fully understand the nature of the Proposed Work referenced above and have no objection to allowing the Applicant to cross MY/Our Propert to do the wo k. (Signature of t roperty Owner or dUly authori ze representative) >r . . Office use only File #: Permit #: TOWN OF SOUTHOLD HIGHWAY DEPARTMENT PECONIC LANE PECONIC, NEW YORK 11958 Print or Type: PERMIT & BOND APPLICATION FOR ACCESS THROUGH TOWN OWNED PROPERTY 1) \.1J-~~~L \NAOP"U.S \112-9 ~e.L",,\.JU/U ~~. l\:..h:1z>u IIIlÙ W~Io( (Name of Applicatt) (Address) 2) .tJ\e.\\U>S(: ~(l.\/,Je t;oo ~btI0Sl)10 '£<O<'\ð,6a.ee)\. ~Mf .kJ'{ II'1Ql{ (Name & Address of Contractor Involved) 3 ) ?-- to 5 V:> A. I( S Hi') QÆ \2-.d.. ~fLee V'- ~: 1 000- 5~- b - I (Project Location) (S.C.T.M. #) 4) 'd-Io5 (6~y!.¡...(C>Q.t. ~. 6fl...~potL-r- (Name of Road or Town Property Involved) (Hamlet) 5 ) \2. 'éCD V'-Ç., f-n..u..c.:t- i U CIU () I \ I\J Q (, "\ci (Brief Job Description) ~ ~IS 1ì\'\.I6 J é l ,'< Start ing Date: Completion Date: work:${ t\ ~Ö, óU 6 ) 7) 8) Estimated Cost of Proposed Insurance Coverage: A. The coverage required to be extended to the Town: Bodily injury & Property Damage; $300,000/$500,000 Bodily Injury & $50,000 Property Damage B. Insurance Company: C. Insurance Agent Name & Telephone # D. E. Policy # : State whether policy or certification is on file with the Highway Department: (If no, Provide a copy with Application) (yes/no) "ZðIJ1-z---- ----------------------------------------- ----------------------- To be completed by the Superintendent of Highways: Bond Amount Required: ,.... (Signature) " . . e. I\.PPLICI\.NT TRI\.NSI\.CTIONhL DISCLOSURE FORM The Town of Sou~hold's Code of Ethics prohibits contlicbs of interest on the part of town officers and employees. The purpose of this form is to provide informabion which can alert the town of ossible conflicts of interest and allow it to bake whatever aclion s necessary to avo d same. YOUR "/\.HR. " '". : /0".: ~I~~I':'" \ I . -'., ';\~",t,.~,. ::-~,:..,,-jIoI.'.':::\ , ,. ,. . ,., ..' "',~..: ,. u.S Lasl nam firsl name, n b al, unless you are applying in lhe someone else or olher enlity, such ~s a company. If so, indicale lhe obher person's or company's name.) NI\.TURB Or I\.PPLICATIONt (Check all that apply.) ;. . . '. .~~.\S:~. : :.~.' "i~~ . :;~:;.'., '!."1~' Tax grievance Variance Change of zone ^p.pJ¡p.1Jal of plat . . .t. Exe~plion from plat or official map n~e~other," name the activity.) \.u<1.:\-\AtJo)tn-u.<;.kLA",~ç, Þt..~i Do you personally (or through your Cb~pa"y, spouse, siblin~, parent, or child) have a relationship with any officer or employee of the Town of Southold7 -Relationship- includes by blood, marriage, or business interest. MDueineee interestM Meane a busineos, including a partnership. in which the tovn officer or employee has even a partial ownership of (or employment by) a corporation in vhich the town of ricer or employee owns more than 5% of the shares. '!. YES NO 1-- ".:..!,'., If you answered Ø~ES,· complete tlte balance of ~hiø form and date and sign vhere indicated. Name of person employed by the Town of Soubhold Title or position of lhat person Describe the relationship belween yourself (the applicanb) and the town officer ør employee. Either check the appropriate line ~) through D) and/ur describe in the space provided. The town officer or employee or his or her spouse, sibling, parenl, or child is (check all that apply), ^) the owner of greater than 5% of the shares of lhe corporate stock of lhe applic~nt (when the applicanl' is a corporation), B) the legal or beneficial owner of any intarebt in a noncorporate'entily (when the applicant is nob a corporation) , c) an officer, director, partner, or employee ot th~ applicant, or D) the açtual applicant. . ,,' DESCRIPTION 01." ItEL^TI0NSII!P ", . ... .:~;:' " ., . jj... ". ,.! ,- '... ~.. ;,.~~:' ., . ,..., . ~ " '" . , ,.. ,'.. . '.<. I,.","..I",u ~ sublnit: ted signature 'Print nam -\- ,",',' ,", ," ..:,~;;¡·}....i·;~ .:...L<~ . .~",~. ~. """'W' .. ..·.f"·, - ......"'~~"'..~,."'.......~.;.:: " " ::1! ¡II:. ',. ! ·ll~~I·:!U ~ I ~ II' ~ '.J.~ ~L Iol,!bþ ',..J .... . . :~;j~r~t