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Home My WebLink AboutTR-5630 .-- ---- - --:- - -:.... "-t ---- . . . . , . . . . , , TERMS and CONDmONS .. '~ .... .,.- ~, .. .. The permittee Donald VazQ\1ez residing at ?~()n NQ....tr 5""~ DriH~, Sç'ltQ.Qlg, N. Y., as pan of the coosideradoo for the isSuance of the Permit cIoa uødcncaod aad prescribe to the fol- lowing: 1. That the oaid Board of Trustees aad the Town of SouthoId - released from any aad aU damages, oe claims fo< damoges. of auks arisiøg directly oe indirecdy as a !aUk of any oper. ation perfom>ed panuaøt to this penaIt. aad the IIid ro· ¡...... will, K his oe her owa. e.t'[w. defend any and aU such suics' Jaidued by thhd parties, aad the said 1'>. ¡".-....- fultliØllity with respect theteto, to the complete udusion of the Board of T.- vi the Towa. vi ~ 2. That this Pem>it is 'f&Üd for a period of ?A mos. wbich is ",ad' ,..t to be the estimated time· required 10 complete the work iøvohed, but should cin'uØisÞøca warnøt, œquest for an extemioo may be made to the Board at a 1_ daœ. 3. That this permit should be retaiøed iødefiaite1y. or as loag as the oaid Permittee wishes to m.jn,.;n the stIUcture or project iøvolved, to provide evidence to anyone cooœmecI that auth- orizadon W2S originally obtained. 4. That the work ïøvolved will be subject to the iøspertinn aad approval of the Board or ilS ageølS, and non-compliance with the provisioDS of the origiøadag applicadoo, may be cause foe revocadoa of this Permit by resoludon of the...id Board. 5. That there will be ao uøreasoo.h1e iøcerfereoce with aavigadoo as a result of the "IVOIk baeiø aUthorized. 6. That there shall be 110 iøterfereoœ with the right of the pøbW: to pass aad repass aIoag the beach betweeø high and low water marks. 7. That if future operatioos of the Town of Southold requúe the rea>OYal aad/oe alteradoas iø the locadoo of the work herein .,.thorized, or if, iø the opiøioo of the Board of T~ the work shall cause unreasooab1e obsttuCÞOl1 to free aa~ the oaid Permittee will be rec¡aIred, upon due DOÚce, to remove or alter this work or project beteiø stated without ....peasa to the TOW11 of Southold 8. Thar the said Board will be aodfied by the Permittee 01 the ~ of the wad< ...m- orlzed 9. That the Permittee will obtaia all other permits aad c:ooseoCS that may be required sup- plemental to this permit wbich ma1 be subject to revolœ upoa failure to obuiø woe. _____.....oMI........_"""'~....-----~- ~~~!!"'--~ ' . .. . . . . ........ ".......... -.- Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson eq . Town Hall 53095 Route 25 P.O. Box 11 í9 Southold, New York 119í1-0959 Telephone (631) í65-1892 Fax (631) í65-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD October 8, 2002 Mr. Rob Herrmann En-Consultants, Inc. 1329 North Sea Road Southampton, NY 11968 RE: SCTM# 54-5-1 Donald Vazquez 2300 North Sea¡j.-ive Southold, NY Dear Mr. Herrmann The following action was taken by the Board of Town Truslees during a Regular Meeling, held on September 25, 2002, regarding the above matter. WHEREAS, En-Consultants, Inc. on behalf of Donald Vazquez applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated August 29th, 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 September 25, 2002 at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, . 2 . WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town. NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approved the application of Donald Vazquez for a Wetland Permit to construct on a piling foundation a Iwo story, one family dwelling with attached garage, porch and deck with drywells and gutters clean an area up to 50' from the freshwater wetland boundary, and establish a 50 foot wide non-disturbance fertilization buffer to remain natural and undisturbed adjacent to the wetland boundary erect a shed connect to public water service, placement of250 cubic yards offill, installation ofa septic system pervious driveway and drywells. BE IT FURTHER RESOLVED that this determination should not be considered a determination made for any other Department or Agency, which may also have an application pending for the same or similar project. Fee must be paid, if applicable and permit issued within six months of the date ofthis notification. If inspections are required, at a fee of$5.00 per inspection (See attached schedule). FEES: $10.00 Very truly yours, a!.tL' I !J. Albert J. Krupski, r:. President, Board of Trustees AL,;'~ 9"-,,. AJKlcjc cc DEC Building Department , . . Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Telephone (516) í65-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: Rn C:nn!::.l11t::¡ntc: Tn,.. nn hph;tlf nf f)nn::¡lr1 V;:¡'7.'111P7. .. Please be advised that your application, dated August 29th, 2002 has been reviewed by this Board, at the regular meeting of ~",pt";,:,~r,'"}~r~: ~P9f and the following action was taken: , ( ---X... ) 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: Two Inspedion @$5.00 each \ð~ \J\ \G TOTAL FEES DUE: $ 10.00 BY: ~ t). 1&... ,?.t' 9, ~IDENT' BOARD OF TRUSTEES ~~ ----- SIGNED: CLERK, BOARD 4/98 Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson . . Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) í65-1892 Fax (631) í65-1366 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. VaL. 'b ve. &. INSPECTION SCHEDULE V Pre-construction, hay bale line 1 st day of construction 112 constructed ¡,/ Project complete, compliance inspection. . . ~ EN-CONSULTANTS, INC. 1329 North Sea Road Southampton, New York 11968 631 -283-6360 Fax: 631-283-6136 E-mail: encon@peconic.net www.enconsultants.com ENVIRONMENTAL SERVICES ~ June 7, 2002 .. Albert Krupski, Chairman Board of Trustees Town of Southold 53095 Main Road Southold, NY 11971 SEP 3 0 -"~II Re: Donald Vazquez. 2360 North Sea Drive. South old c~--·- Dear Mr. Krupski: Pursuant to Artie Foster's recommendation during the September 25th public hearing on the captioned permit; the surveyor's recalculation of the fill volume needed for the septic system; and my subsequent conversation with Mr. Foster, please fmd enclosed (3) copies of a site plan, which has been modified to indicate that approximately 250 cubic yards of fill will be required for the septic system. By copy of this letter and revised site plan, I am notifying the New York State Department of Environmental Conservation of this change. Should you require any additional information before a permit can be released, please let me know at your earliest convenience. Respectfully yours. ,..\" Robert E. Herrmann Coastal Management Specialist Enclosures cc: Jean and Don Vazquez Karen Westerlind c/o George Hammarth, NYSDEC ~ š Isl ;!~III ~il i~1 i. AI ~ !l1I1i s~~ ili· P- ~ ¡!I, ~ü Ii tit .t: i I 0 I ê i ~~ i t ~ ~ ~ ;~ -' ~ I; ~I .~ ~ <0 I i I ~ ~ ~ i~ CO..J 1 ~ ~I~ ~ ~ i ~ ~i ¡;;- '" '" ... ~ - 3~ z >- ôc¡> "§!:"i E-t ->-U')o Bca.. ~ L.....I ...JWw ,., ...J ~ I 01 .. gj to :: )ooIoot 0L.I.J...,. atoa...(/). O"............:I:z "'001"'00 :r O~~t- J.....-lac:r::wØ!. I:t:: .......::>.OIl.G:i..~..,g "<::100>-0, :!"'oG:i~o i0oi-4 ~ ::r: tf) I- 0 -- o~ tk:: Ill.... t....; Z - Cl:o ....II'! .. 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"''''0lIl 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 Southold Town Conservation Advisory Council held Monday, September 23, 2002, the following recommendation was made: Moved by Drew Dillingham, seconded by Bob Ghosio, it was RESOLVED to recommend to the Southold Town Board of Trustees DISAPPROVAL of the Wetland Permit Application of DOMAtD VAZQUEZ to construct on a piling foundation a two-story, one-family dwelling with attached garage, porch, and deck; clear an area up to 50' from the freshwater wetland boundary; and establish a 50' wide non- disturbance/non-fertilization buffer to remain natural and undisturbed adjacent to the wetland boundary. Located: 2360 North Sea Dr., Southold. SCTM#54-5-1 The CAC recommends Disapproval of the application because the area is a valuable wetlands resource. Vote of Council: Ayes: All Motion Carried ~y~V 'f~ ~ 1'Juw~ 4r+ .8'r ¡}-roiL . . 1329 North Sea Road Southampton, New York 11968 631-283-6360 Fax: 631-283-6136 E-mail: encon@peconic.net www.enconsultants.com ~ EN-CONSULTANTS, INC. ENVIRONMENTAL SERVICES August 26, 2002 Town of South old Board of Trustees Post Office Box 1179 Southold,NewYork 11971 Attn.: Lauren Standish Re: Donald Vazquez 2360 North Sea Drive, Southold SCTM #1000-54-5-1 Dear Ms. Standish: In regard to the above referenced property, enclosed are the following for the Board of Trustees review: 1. Three (3) Wetland Permit Applications, ( including Notice and Proof of Mailing to adjacent owners). 2. Three (3) Short Environmental Assessment Forms. 3. Three (3) copies of authorization & disclosure forms. 4. Three (3) work plans. 5. Three (3) copies of survey. 6. One (I) set of site photographs. 7. Application fee of $200.00. I trust this information shall allow you to process our permit request. Should any additional information be required, please do not hesitate to contact our office. S1t(L Robert E. Herrmann Coastal Management Specialist /khs Enc. . ~ '" '" '" <.J ~ :<;V1 a:::...... :':Ig z >- oc¡> >:5 '- >-", 00"- C"""" 0 0 --IWW. e:: -'0>, ","-:gt== ~ 0>... Ø)Qa..VJ . Q",~Q:t:~"'O~~¡¡¡8R". O,,<:~!:; .óìf -~"-'i2~g ~~Oo>-o, :!"'o~¡::o - ¡¡,;¡::r:: [/) I- 0 - o~ '" '!ij; ~c..... Z-"''''O>N~O .... """ u..:J ..J~0"'0 O~~ 00 Ò"'ON",O" ...., ZUL ~ N '0 U V1-"'N ,,\ ~ U 0 _ ¡¡ >-t;:)[()Z X O~O<O.. .-, ~ :.:: ... '" N N - O.....J..... W.>- :> 0 "'0--' .... 1-... '"~:o ~ ....... (.) W""") ....... u... > >- ...,J :) en 0« UJ [/) Z'" '" i g ~ ~ : ~~ ; 9 ~~~ i ~ 1;' §~§!c; ~ ~~! ~ ~ ' f I ~15; ~ C/¡ ~ . II' : l5~g : ~ ~ ~ .,., ~ ~·15 " ~ 1...° ili e· a a '~ h~~I~~~~ 0 ~i OJ e~ ~... If 4 ¡-!it· §1 ;I~ ~ h i ~i !~~ ~ 25 v; ~IIII ~ ~ ~ I ! ~= § :~: i I!¡¡ t: I! ~ I !! I I . !i~ ~¡ ~ ~1~ J h III ~ ; ë ~ a ~ ~ ~hi! ~~~ ã 15~ lib I, I II .111 !!! I ;¡ ¡¡Ii i! ~~ .~~ I~I!!!!¡¡ I ;1 ~!!u U ~ ~.. ,~ I~ Ñ~ . f: O>N oW ~s . .. .> ~ z v¿~ j :!IV'J ¿ 0/ JC (;;> _ lnos ::10 N/v\Ol OlOH O~VOg S:¡:¡lsmll ::10 -~ .'.', r-'\Jdd\f . I...~... a / / / / ~~~ '/ ~ <t.,\)~ 'ì",'ì.:t~ ~ ~. c:t <? ->,'t ;- ~>: '.., .s><i>.'¡""'<.~ .s>.%-'>.s>-Q. ~ ~.s>:+:s ~ ~O+ '1-,þ" ."' % 4>¿,.'* <þ .. '>- ~ 0.... '''OJ ~ ~ r~o (leY; ¡ v ",'t . '. . .' . . . '. . - -. I . I. II ~, .~ II ~ d II Ii .i ~ I !ê ¡ ~~ ~ ~I~ f._:a.a ~'I¡n ~i lu P.H~~; ..: "" 044ot1 .. ç b-¡ ; I" . Iii I ¡¡ '·1 ! I ! ~q i !i!II!¡ i ~ 1~li;1 ~1~I;fil ~Ililec & .¡alal ~1,.ØI ~Ilim! ,-i¡¡~~.!~ -~ .,¡,.¡ ." .. I' I~ 2¡~ Iii 5i: :;;t !~:I~~: ¡e: I~~ ! i; It; eel ell I~' ~I~ I~,h L, ~~119: Îia!m m ~ I ' J ~ i ~~ ~ I ~ ~ ~i ~ i ~ ~I ~ ~ <0 I ii j fi ~ ~ª ! I "~,, I ~ ~ )0- " .J J ~ ~ I~ 51 ~ ¡ ~ ~i ~ ? <?~;;:\ ¥ ... <t. A<l.~...)' 0" r;,\~¿~ +\(;~# A+ii "'v.v ~ ~v ,').!i / ALbert J. Krupski, President .. James King, Vice-President r Henry Smith Artie Foster Ken Poliwoda ., Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fex (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit APPlic:;,n _Wetland Permit Applicatton' Major - Waiver/Amend~T;:rf;s J Received Applicatio : -y Received Fee:$ "' Completed Application V _Incomplete SEQRA Classification: Type I_Type II_Unlisted COOrdination:<date11lzn . CAC Referral Sent: Date of Inspection: ./ Receipt of CAC Report: Lead Agency Determination: Technical Review: I -Public Hearing Held:--Ø /1(1,,)7' -Resolution: ' , Name of ApplicantOONALDVAZQUEZ Address 46 ROUNDABOUT ROAD, SMlTHTOWN, NY 11787 Phone Number:63I )724-7859 Suffolk County Tax Map Number: 1000 - 54-5-1 Property Location: 2360 NORTH SEA DRIVE, SOUTHOLD (provide LILCO Pole #, distance to cross streets, and location) AGENT: EN-CONSULTANTS, INC. (If applicable) Address: 1329 NORTH SEA ROAD, SOUTHAMPTON, NY 11968 Minor )I rA\~( Phone: 631-283-6360 ~~rd of Trustees APPlica~AIÞ GENERAL DATA Land Area (in square feet): 24,822.79 Area Zoning: R-40 Previous use of property: VACANT LAND. Intended use of property: SINGLE FAMILY RESIDENCE. Prior penn its/approvals for site improvements: Agency Date X No prior pennits/approvals for site improvements. Has any penn it/approval ever been revoked or suspended by a governmental agency? X No Yes If yes, provide explanation: Project Description (use attachments if necessary): Construct on a piling foundation a two-story, <HIe-family dwelling with attached garage, porch, and deck; clear an area np to 50' &om the freshwater wetland boundary; and establish a 50' wide non-<listurbanœ/non-fer1ilization buffer to remain natural and Wldisturbed adjacent to the wetland boundary, aU as depicted on the site plan prepared by Joseph Ingegno, last dated July 26, 2002. Erection of a shed; connection to public water service; placement of 100 cubic yards of ftll; instaUation of a septic system, pervious driveway, and drywells; and associated improvements located more than 100 feet ftom the wetland boWldary are beyond the jurisdiction of the: SOUTHOLD TOWN TRUSTEES PURSUANT TO CHAPTER 97 OF THE TOWN CODE. 4Ito4ltd of Trustees APPlicat~ WETLANDITRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: IMPROVE VACANT RESIDENTIAL PARCEL. Area of wetlands on lot: +/- 1,493 square feet Percent coverage oflot: +/- 6 0/0 Closest distance between nearest existing structure and upland edge of wetlands: N/ A feet Closest distance between nearest proposed structure and upland edge of wetlands: 75 feet Does the project involve excavation or filling? No x Yes rfyes, how much material will be excavated? N/A cubic yards How much material will be filled? 100 cubic yards Depth of which material will be removed or deposited: +/-3 feet Proposed slope throughout the area of operations: 5% Manner in which material will be removed or deposited: CLEAN SAND WILL BE TRUCKED IN FROM AN UPLAND SOURCE, DUMPED AND GRADED IN AREA OF PROPOSED SEPTIC SYSTEM IN ORDER TO ACHIEVE REQUIRED VERTICAL SEPARATION OF 2' BETWEEN GROUNDWATER AND BOTTOMS OF CESSPOOLS. Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): THE PROJECT ENTAILS THE IMPROVEMENT OF A VACANT RESIDENTIAL PARCEL IN A MANNER CONSISTENT WITH THE SURROUNDING COMMUNITY. THE PROPOSED SANITARY SYSTEM IS LOCATED MORE THAN 100' FROM THE ADJACENT FRESHWATER WETLANDS AND THEREFORE BEYOND THE TRUSTEES' JURISDICTION; AND THE NEED FOR FILL FOR THE HOUSE WILL BE OBVlA TED BY THE USE OF A PILING FOUNDATION. THROUGH THE ESTABLISHMENT OF A PERMANENT 50' NON-DISTURBANCE BUFFER ADJACENT TO THE WETLAND BOUNDARY; THE USE OF A SYSTEM OF LEADERS, GUTTERS, AND DRYWELLS; THE INST ALLA nON OF A PERVIOUS DRIVEWAY; AND THE PLACEMENT OF STAKED HA ¥BALES AND PROJECT-LIMITING FENCE ALONG THE LIMIT OF CLEARING DURING CONSTRUCTION, THE PROJECT WILL HAVE NO SIGNIFICANT ADVERSE IMPACT ON THE ADJACENT FRESHWATER WETLANDS. Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT For UNLISTED ACTIONS Only PART I-PROJECT INFORMATION (To be completed by Applicant or Project sponsor) .. I .. ~ . -14-16-4 (2I97)-Texl t2 I PROJECHD. NUMBER 617.21 SEQR FORM 1 APPLlCANT/SPONSORDONALD VAZQUEZ BY I 2. PROJECT NAME EN-CONSUL TANTS, INC. 3 PROJECT LOCATION: MunJdpallly SOUTHOLD County SUFFOLK .4 PRECISE LOCATION (Street addreøa and road intersections. prominent landmarks, etc, or provide map) 360 NORTH SEA DRIVE, SOUTHOLD, SCTM #1000-54-5-1; MAP PROVIDED ÖS PRoposED AGTB . ~ Modification/aKeration _ ~11SIOn 8 DESCRIBE PROJECT BRIEFLY: Construct on a piling fOlmdation a two-story, on<>-family dwelling with attacbed garage, porch, and deck; clear an area up to 50' from the ITeshwater wetland boundary; and establish a 50' wide non-disturbancelnon-fertilization buffer to remain natural and undisturbed adjacent to tbe wetland boundary, all as depicted on tbe site plan prepared by Joseph Ingegno, last dated July 26, 2002. Erection of a shed; connection to public water service; placement of 100 cubic yards of fill; installation of a septic system, pervious driveway, and þells; and associated improvements located more than 100 feet from the wetland boundary are beyond the jwisdiction of the: Southold Town Trustees pursuant to Chapter 97 of the Town Code. 7. AMOUNT OF LAND AFFECTED Initially 0.57 ""'" Ultimately 0.57 .... B. WIll PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? []vel ~NO If No, de8Cribe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ~ Residential D Industrial o Commercial o Agriculture D Park Forest/Open space OOIl1.r Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDNG, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR lOCAL)? ~y..s DNa If yea, list agency(s) and permit/approvals DEC, SUFFOLK COUNTY DEPARTMENT OF HEALTH 11. DOE~ANY A~~~GI 0, TH~ACIION HAVE ACURRENrlY VALID PERMIT OR APPROVAL? DYe. ~No If yes, list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? Dyes ~NO I CERTIFY T T THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name ROBm . HERRMANN, COASTAL MGMT. SPECIALIST DATE AUGUST 26, 2002 .., 'J ~ Signature: ~ ~ If the action is in the Coastal Area, and YDU are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER ·. .. . NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of apPlicant:DONALDVAZQUEZ SCTMnooo- 54-5-1 YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: Construct on a piling foundation a two-story, one-family dwelling with attached garage, porch. and deck; clear an area up to 50' ftom the fteshwater wetland boundary; and establish a 50' wide non-disturbancelnon-fertilization buffer to remain natural and undisturbed adjacent to the wetland boundary, all as depicted on the site plan prepared by Joseph Ingegno, last dated July 26, 2002. Erection of a shed; connection to public water service; placement of 100 cubic yards of fill; installation of a septic system, pervious driveway, and drywells; and associated improvements located more than 100 feet from the wetland boundary are beyond the jurisdiction of the; SOUTHOLD TOWN TRUSTEES PURSUANT TO CHAPTER 97 OF THE TOWN CODE. 2. That the property which is the subject of Environmental Review-is located adjacent to your property and is described as follows: 2360 NORTH SEA DRIVE, SOUTHOLD 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: SEPTEMBER25,2002 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 Southald and does not reference any other agency that might have to review same proposal. OWNERS NAME: DONALD VAZQUEZ MAILING ADDRESS: 46 ROUNDABOUT ROAD SMITHTOWN, NY 11787 PHONE *: 631-724-7859 Enc.: Copy of sketch or plan showing proposal for your convenience. 5 Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda . . .., Town Hall . 53095 Route 25 P.O. Box llí9 Southold, New York 119íl-0959 Telephone (631) í65-1892 Fax (631) í65-1366 BOARD (".., ~~n____ TOW BOARD OF TRUSTEES: TOWN OF E ---------------------------- In the Matter of the Applica of -~-,j~-- COUNTY OF SUFFOL~I ¿1 STATE OF NEW YORK) AFFIDJ'. I, ¿'~t f.teM1.1e¡ ..'" , -res4 u~~ nr ~?-(1J ~ )r-V ~ ~ ~1.J. I"Þ I 0 ý frY ~V --... ....... SOUTHAMPTON N V 11Q66 being duly sworn, depose and say: 631-283-6360 That on the Ib1Jl- day of '5e,1f. , 2002-, property known as r¡ by placing the Board of Trustees official oster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of~e-l __ Rublic hearing. Date of hearing noted thereon to be held~~ ;)fl ~ h o--r ~ '70 ~ ~ / Dated: Sworn to befo~e me this ~-,:>-h..day of~~,...t.. 200..2.- , ~~I~ ~ tv o r Public .j7 '" . ......./II._A ......~"'""t... ;;~rl-',:- t( - -..... to. - ; I ~. . :::~ta (ot .. >\0:. ~ « ~,',A ("::::".' _~.:':1 No. f¡'):: I ~ '. . t ~ -:: ~.:' ." . .., _- ,,\ .. " ::;:/ ~_"h'.' ð'Í 4. -. Cc::-:mí&s!.:J".Exj?ires August 2. :..-_ "'" "-~ _ _ _ _ .... J ð ¡¡.. ........... ttr............ "-' - ,ß.' .. .. PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: HELEN & JOHN CHlHLAS Address: 2250 NORTH SEA DRIVE SOUTHOLD, NY 11971 JAMES J. MURPHY 3617 JOHN STREET WANTAGH, NY 11793 IRENE & JOHN MOUSIADES 11943 SOUNDVlEW AVENUE FLUSHING, NY 11354 STATE OF NEW YORK COUNTY OF SUFFOLK ROBERT HERRMANN doing business atEN-CONSULTANTS, INC. 1329 NORTH SEA ROAD SOUTHAMPTON,NY 11968 , being duly sworn, deposes and says that on the 26TH day of AUGUST .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 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 ere mailed at the United States Post Office at SOUTHAMPTON , that said Notices were mailed to each of said persons y (certified) ~) mail. Sworn to before me this 26TH d~O' ?" *>000 ~; !. _ "",L ~/ ~ Notary Pu~lic -V,..fV'~ ~ =-~ l' &4'1." ~ P~~'-""è1 ~ KIM H. STEPHEN3 r:~'. lIotory PutJio-Slate of ':::;','!o,k . "L"~"r Comrr.,.,lon 110. 6'1.,,1 \J!\ ,..;.---: 1"I1,..","od I... ""f'o" ïi!:-':-"'~:·7"''',"·1I'' . ..........~ '"!ë":Y Cour.~.. 0' <It -. Cc:;;m!SSIDn E Irea Au uet 2,.2.- ..... . .. . Boa.f Trustees Application . .. County of Suffolk State of New York ))ONf+L.b J dJtJ.. TeAAJ t.. V/tZQUEl..- 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 HIS/HER KNOWLEDGE 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 ( 5), 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 REVIEW OF THIS APPLICATION. þ¿""_~____ (l.è;J~~ ~t~~/~:r' SWORN TO BEFORE ME THIS (¡¿~ DAY OF -(I óì./'-{~ , 1"5. ~ ------ - - ~~~~~~ KIM II. STEPHENS ~ Notary Publlo-Slatil of NO':I Y::k ~ Commission No. 60159.;1 ~~. Qualified In . ~,nolx . . Countios ..~~ ~ ~ Cyc:~s~l~n :,I~O~ ~Jiu~t ~.µ~ ......... , J ...... . ~. . . APPLICANT TRANSACTIONAL DISCLOSURE FORK The Town of Sou~hold's Code of E~hics prohibi~s conflic~s of in~eres~ on the ar~ of ~own officers and em 10 ees. The ur ose of ~his form is to rovide information wh ch can alert the town of poss ble conflicts of interest and allow it to take whatever ac~ion is necessary to avoid same. YOUR NAKE I ))(7 N I+Lb J. i.. 0 e.¿¡ (). C!., V;; 7'..(; tJ E 7- (Las~ name, first name, middle ini~ial, unless you are applying in ~he name of someone else or other entity, such as a company. If so, indicate ~he o~her person's or company's name.) - NATURE OF APPLICATION. (Check all that apply.) Tax grievance Variance Change of zone ^p'p~oval of þla~ . Exemption from Pt~ or official map Other ~ '__1_ (If "Other," name ~he activity.) J"\ñIeeS ~J.~t1I~ ~I.·r Do you personally (or through your company, Spouse, sibling, parent, or child) hav9 a relationship with any officer or employee of the Town of Southold? RRelationshipR includes by blood, marriage, or business interest. RDusiness interestR means a business, including a partnership, in which the town officer or employee has even a partiai ownership of (or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. YES NO -K If you answered ·YES,R complete the balance of this form and date and sign where indicated. Name of person employed by ~he Town of Southold Title or position of that person Describe ~he relationship be~ween yourself (~he applicant) and the ~own officer or employee. Ei~her 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 owner of any interest in a noncorporate'entity (when the applicant is not a corporation) , c) an offi~~r: d{r@ctor, par~~g~~ c: c~pl~ya6 of tha applicant, or D) the actual applicant. DESCRIPTION OF RELATIONSHIP .;;"F)~ SUbmitted this day of~ Signatu~1J~~~ Print nam~I'JI1l-D 'IJec¡í) (! - !¡;.7dìLlb-z.-.