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HomeMy WebLinkAboutTR-5451$ J. Krupski, President es 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) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD September 26. 2003 Mr. & Mrs. Robert Schroeder POBox 119 Peconic, NY 11958 Re: SCTM#54-6-4.3 150 Rene Drive Southold, NY Dear Mr.& Mrs. Schroeder: The following action was taken at the Southold Town Board of Trustees Regular Meeting on September 24, 2003. RESOLVED that the Southold Town Board of Trustees grant a One Year Extension to Wetland Permit 5451 for a two story house, garage and swimming pool with option #2 for driveway. However, this determination is not a determination from any other agency. If you have any questions please contact our office at 765-1892 Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK: cie Cc: DEC Building Department P.O. Box 119 Peconi¢, NY 11958 September 9, 2003 Southold Town Trustees P.O. Box 1179 Southold, NY 11971 Re: Robert and Diane Schroeder SCTM #54-6-4.3 - Permit #5451 ~ SEP-9 20~ ~ - I~uthold Town ~o~M of Trustees Dear Trustees: Please extend the above numbered permit for another year, to wit: November 20, 2004. I have enclosed herewith our check in the amount of $10.00 representing your fee to extend same. Thank you. Very truly yours, DIANE SCHROEDER o$- ay 2 24. NO. of SUSpe~s 0Y0N Address (Street NO.. Stceet Name, 81dg NO , Apt. NO , City, State. Zip) 0Small OLarge J S4 EmployerlSchool J 55 fi, ddress eM OF OU 1). 65 Veh. Yr. S. Make 72 Vehicle NOtes BO IONo Status Date 83. Notified/TOT 9 j, z. j$ Albert J. Krupski, President James King, Vice-President Henry Smith Attic Foster Ken Poliwoda BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hail 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 November 27, 200 l Patricia C. Moore, Esq. 51020 Main road Southold, NY 11971 ROBERT & DIANE SCHROEDER 150 Rene Drive Southold, NY SCTM#54-06-4.3 Dear Ms. Moore: The following action was taken by the Board of Town Trustees during a Regular Meeting, held on November 20, 2001, regarding the above matter. WHEREAS, Patricia C. Moore, Esq. on behalf of Robert & Diane $chroeder applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated July 6, 2001 WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and WHEREAS, a Public Heating was held by the Town Trustees with respect to said application on November 20, 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 standard set forth in Chapter 97-18 of the Southold Town Code. WHEREAS, the Board has determined that the project as proposed will not affect the health, 2 safety and general welfare of the people of the toxvn, NOW THEREFORE BE IT. RESOLVED, that the Board of Trustees approved the application of Robert & Diane Schroeder for a Wetland Permit for a two story house, garage and swimming pool with option #2 for the driveway. 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. Permit to construct project will expire two years from the date it is signed. Fees must be paid, if applicable and permit issued within six months of the date of the notification. Fee must be paid, if applicable and permit issued within six months of the date of this notification. Two inspections are required and the Trustees are to be notified when project is started and on completion of said project. FEES: NONE Very truly yours, Albert J. Krupski, Jr. President, Board of Trustees AJIOcjc cc: Building Department Health Department Board Of $outhold Town Trustees SOUTHOLD, NEW YORK PERMIT NO. ~l~i~"'/. DATE: ...~o¥, 20, ...g.001 ISSUED TO .......... ~B..]~RT...~...~):~.~ .~.CH:P,.QED~ER ......................... Aut'horizatiou Pursuant to the provisions of Chapter 615 of the Laws of the State of New Yor~, 1893: and C~apter 404 of the laws of the State of New York 1952; and the Soufhold Town Ordinance en- titled ."REGULATINC~ AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, C~RAVEL OR OTHER MATERIALS FROM I.ANDS UNDER TOWN'WATERS;?. and in accordance with the Resolution of The Bbard adopted at a meeting held on ...~o~.....20.... .2Q~..., and in consideration of the sum of $ "'gO0';O0 ..... paid by · Robert ··.&....Diane--Sehroeder ........................................... : e[ .... $ou. th~l~., ............. . ............. .N.Y. and subiect to the Terms and Conditions I,sted on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: Wetland Permit for a two stor:y house, garage and swimming pool with option # 2 for the driveway. all in accordance with the detailed specifications as presented in the originating application. IN WITNESS WHEREOF, The said Board of Trustees here- by causes ifs Corporate Seal to be affixed, and these p.resents fo be subscribed by a majority of the smd Board as of this dais. , TERMS and CONDITIONS residing ~t 150 Rene Drive. ~nuthc!~, N. Y~ ~ ~ ~ ~, m ~ ~~ of~T~T~~ [or ~don ~y~to ~at a ~ ~ '6. ~t~H~~the ~c ~ ~ m ~ ~ ~ d~ s. ~at ~e~d~dw~i~the~°~e~~~ o~ ~. ~at ~e P~ ~ ~a ,~ ~e~ ~ sad ~ ~ ~ ~ ~ m~ P.O. Box 119 Peconic, NY 11958 May 30, 2001 HAND DELIVERED Southold Town Trustees Town Hall P.O. Box 1179 Southold, NY 11971 Re: Robert and Diane Schroeder SCTM #54-6-4.3 Dear Trustees: We are the owners of the above referenced property. We are most distressed and confused to receive your Notice of Violation dated May 16, 2001 along with Town of Southold Summons #A 1670. We are not in violation of our Trustees Permit. I refer you to your letter addressed to Shepard M. Scheinberg dated July 1, 1999, a copy of which I have enclosed for your edification, wherein it was: "RESOLVED, that the Board of Trustees approve the application of ROBERT & DIANE SCHROEDER to construct a single family dwelling with septic system and well with the condition that there be a 30' setback from the rear pond, ....... " A-1670 Town of Southold Suffolk County, NY The People o! the State of New York vs, COURT COPY ~ gslan DUnk. ~ Non-Hispanic ~Medlum ~ Other Contacts B Small D LargeJ N DCJS-32©5 t2_ 97) "FALSESTATEMENTSAREPUNISNABLEASACRIME. PURSIJANTTOTHENEWYORKSTATEPENALLAW }uiy t6, 2001 COUNTY OF SUFFOLK n~rt J, Oaftr~y Suffolk C~e/&~a~uliva CLARE B. BRADI. EY, iS,D,, M.P.H, CERTIF/ED l~ .RET~ RECEII~ t22 No~th ~: ~ ~f. RIO-~, ~ S~/C Sou~ View Ave & Rene's Drive. S~u~old B~d al:on informatton submttte~t to this Office, t appears that [he e~stmg ne gnbor water supply This i~ format, ion is contrary to that shown o{t the plen approve;[ by the Dep$.rtmenL A guidance document for addressing problems with aeiShboring wells is enclosed for use in mr ev~lt that a redesigns of the sewage disl;)oaal system does ~ot solve thc problem. la ac'~rda~¢ with Article 3, Section 760-305 & 307 of the Suffolk Cou_my Sanitary Code. the above referenced permit to constnlc! ii s~pended until this matter can be resolved. Ii you have 0.qy questions concerning this, plea.se feel h~e to contact me, Since. ely, Royal Rc-ynolds P£ A~sociate l~blic Health Engineer Charles Brigham, WWM Town of Southold Bu2di~ Dcpartmc~t LESLIE KANES WEISMAN, Assoc. AIA Board of Town trustees Town Hall 53095 Main Road P.O. Box 1179 Southold, NY 11971 Dear Trustees, July 19, 2001 2001 I am writing in relation to Robert and Diane Schroeder's Wetland Permit Application SCTM# 1000-54-06-4.6 filed on 6/15/01 for which I received notice as an adjacent property owner. Since I do not want to cause the Schroeder's any inconvenience or unnecessary costs, I would like to inform the Trustees and bring to the Schroeders attention, prior to the scheduled public Environmental Review on July 25, 2001, and before they begin any construction, that their survey incorrectly locates my well as being 115 feet from their proposed leaching pool. My sun,ey by Roderick Van Tuyl dated October 2, 1990, which is on file with the Town Building Department, correctly shows my well at 23 feet from our adjacent property boundary,, which would be 61 feet from the Schoreoder's proposed leaching pool (see the attached copy of my survey). Moreover, my well is not a "deep well" and is vulnerable to contaminants (see the attached printout of the specifications of my well installed in 1989 by Krieger). Although I have been a Professor of Architecture for more than 30 years and am quite familiar with reading and drawing surveys, site plans, construction documents and the like, to be sure that my own measurements were correct, I employed the Schroeder's surveyor Mr. Joseph Ingegno in April of this year to set stakes at the four corners of my property and additional stakes at the mid-way mark of the North and East lines (see attached proposal and paid bill from Mr. Ingegno). When my calculations were confirmed by measuring the distance from my well to a line strung between the surveyor's stakes, I called the Department of Health Services and asked them to inspect my property to verify these facts. Mr. Charles Brigham, Senior Public Health Sanitarian, did so, and told me that the DOH would be notifying the Schroeder's in writing that they would be revoking their permit based on this new information and that the Schroeders would have to re-locate their proposed cesspools on a new sur~,ey at a minimum distance of 100 feet from my well before the DOH would grant them a next- permit. Again, I would like to reiterate that I am writing this letter now as a cooperative neighbor who is seeking to discuss and resolve any potential conflicts with the Schroeder's construction plans before, rather than after the fact. Thank you for your attention in this matter. Leslie Kanes Weisman, Assoc. AIA PO BOX 1280, 10720 SOUNDVIEW AVENUE oSOUTHOLD, NEW YORK 11971 PHONE AND FAX ®631 763-187J ,E MA[L: weisman~northfork.com WELL HISTORY 1. °° L. Neme WEISMANN 2. '' F. Name LESLIE 3. Address i PO BOX 1280 5. City SOUTHOLD 6. State MY ?.Zip Co~e l1971- 8. Phone# -765-1873 Well Size 2B~1C ~26' 21 Well Pa=kef 70' 22 We£1 Pump I HP MYERS 1018 24 Well Drop Line1-1/4" X 40' 2 3 Enter LAne # to Change, A to 09:54:31 21 JUN 2001 9B CONT TOT 3275.00 10. Job Neme SAME lA. Job Addr SOUNDVIEW AVE 12. City SOUTHOLD 13. Phone 14. BOH # 16 Driller TOM TROYAN ~? Ma=hine 55 25 Scr Make COOK 26 Scr Size 5X5 27 Scr Slot 10 28 Map Loc 29 Date Comments (line below~ Add, P to Print, D To Delete , or END Joseph A. Ingegno Land 8urveyor P.O. Box 1~31 ~, N.Y. 1t~0t~ Em4~l: tll~g~t~ndsurveyor~J~:~ss.nef ~ W~ism~ $omhold. New Yo~k 11971 Re: ~oc~l~ two corn. s ~ tl~rking wi~ rl~oar nn~ tWO addit~l stak=s O~r ~ for log~i~ two corners ~ ~ ~ N~ ~ ~ l~e would We ~d ~ a ~ ~ Should~you ~av~ a~y q~.s6~o~ mS~rcti~; ~ proposnl, please ~ ~t l'~,sit,.~ to ~ontac~ ' (ei31l 727-2090 (I JosephLand A.surveyorlngegno RO. Box 1931 R~verhead, New York 11901-0965 April 27, 2001 Job#21-259 Leslie Weisman FOR PROFESSIONAL SERVICES RENDERED: Set stakes at the property comers and along two lines of your property at Southold. S.C. tax no. 1000-54-O6-05 Fee: $375.00 Retainer: $187.~9 Total due: $187.50 PAYMENT 'DUE UPON RECEIPT Telephone (6~1) 76~-1592 Tovm Ha.U. 53095 Main Road P.O. Box 1179 Soutbokl, New. York I19"/1. SOUTHOLD TO.bi CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town ConseCvation Advisory Council held Tuesday, July 17, 2001, the following recommendation was made: ROBERT R. & DIANE SCHROEDER 54-6-4.3 to construqt a two-stdry house, garage and swimming pool. 150 Rene's Dr., Southold The CAC did not make an inspection, therefore no recommendation was made. I~'° 13' INCIDEN~ REPORT 24. NO. of Suspects 13. et: .~o ~,~'- 77. RepOrt,mi Office~ S,gnatu,e (Include RanX~.~ J 18 ID ~o 7g Su~,~,'S 5,gnature (Include Rank) SO. ,D No DOS 3205 (2/97) *FALSE STATEMENTS ARE PUNISHABLEASACRIME.PURSUANTTOTHENEWYORKSTATEPENALLAW EL. Albert J. Krupski, President Jame~s King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Route 25 P.O. Box 1179 Southold, NewYork 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application Wetland Permit Application 5/ Major Waiver/Amendm. en~/C h~ages Received Applicati~on: ~'//~"'/O / Received Fee:$ ~/ I' / . Completed AppliCation ') [(V/0 [ Incomplete SEQKA Classification: Type I _Type II Unlisted Coordination:(date sen~~ CAC Referral Sent:. 1 ! (, t 0 ! Date of inspection: ~ [ {~"'[ 0 ! Receipt of CAC Report: Lead Agency Determination: Technical Review: Resolution: Minor Name of Applicant Address fl 7~-,~/~7 Phone number:(~ Suffolk County Tax Map Number: 1000- Property Location: (provide LILCO Pole #, distance to cross streets, and location) 1 AGE NT: (If applicable) Address: Phone: Bo~ard of Trustees Application~ GENERAL DATA Land Area (in square feet):. Area Zoning:. Previous use of property:_ Intended use of property: Prior permits/approvals for site improvements: _f~ Agency __ 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 Description (use attachments if necessary): Bo~ard of Trustees ApplicatioW WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: 7-~ ~We~ [A] Area of wetlands on lot: square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: 75- feet a,t ~./~#070t/~- 7~ ~'~-~) Closest distance between nearest proposed structure and upland edge of wetlands: feet 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 Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: 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 by reason of such proposed operations (use attachments if appropriate): ~oard of Trustees Application~ COASTAL EROSION APPLICATION DATA Purposes of proposed activity: -tv ~t~(./ r.~,,OSN~,- 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 bom implementation of the project as proposed. (Use attachments if necessary) NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEESt TOWN OF SOUTHOLD In the matter of applicant: YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: ~-~/~ StN6~b-~tLJ 2. That the property which is the subject of Environmental Review-is located adjacent to your property and is described as 3. That the project which is subject to Environmental Review under Chap~erst32~ 37, or 97 of the Town Code is open to public comment on. '~/~/_~ You may contact the Trustees Office at 765-1892 or in w~iting. 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: ~/~ ~d~/~/~ MAILI,~._G~ ADDRESS: . PHONE ~: '7d~- Enc.: Copy of sketch or plan showing proposal for your convenience. Bo~ard of Trustees Application' County of Suffolk State of New York Di,q'A~ ,.q~ 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(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 REVIEW OF THIS APPLICATION. Signature SWORN TO BEFORE ME THIS /3 D^YoF ,,20 ~otary Public PAT~ICIA CO~ Bo~of Trustees Application AUTuOP~IZA'£±ON (where the applicant is not the owner) (print owner of property) residing at (mailing address) do hereby authorize (Agent) to apply for per~it(s) from the Southold Board of Town Trustees on my behalf. (Owner's signature) IPROJECTI.O, NUMEER 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 Proiec[ sponsor) 1. APPLiCANT/SPONSOR I 2. PROJECT NAME 7. AMOUNT OF ~ND AFFECTED: SEC WIL' , ROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? $ L~ No If No, describe t3rlefly ; .~ ParklFores~'Ooen s~ace ~ Other . OOES ACTION INVOLVE A PERMIT APPROVAl_ OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY ~FEDERAL, STATE LOCAL)? ANY AaPECT OF THE ACTIOI,I HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [] NO if yes, list a@e~cy name and permiUaooroval I CERTIFY THAT THE INFORMAT]CN PROVIOED ABOVE IS TRUE ~O THE BEET OF MY KNOWLEDGE ¢, 147¢/ If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this as_...~essment OVER I PART II--ENVIRO~,[ME;'ITA' 'S~ PART III--OETE.~MINAT1CN CF SiGNiFICANCE ~To be completed by Agency) INSTRUCTIONS; For eec.'1 aqverse etfect icienll[ied score, determine wned~er it is substantial, large. [rncor~n[ or odlerw~se $igllJ tic. E=-cn effect snouJd De assessed in connection w~t ~ts (a) Setting (i.e. urban or rural); (b) prolaaDility at occ.~-~ng; (.c) duration: ;rrevers=bHity; ',e) geographic so,ce; an(3 (r~ magm[uoe. I[ ~ecessary, ad(3 attachments or re[erence sup[3or~ing maledals. Ensure exelana[icns contain sutficien[ QetaH !0 $llow [hat all re!avant actverse irnoac[s have been i(3entif|e(3 an(3 adequately aC~ressec. --- Cheek ;his ~ox if you have identified one or more ;o[entJa[J'/ large or significant a~verse imoac:$ which h~A'? occur. Then 3rcceed direc,'ty ~o :ne FULL EAF and/or prepare a positive' declaraticn. ----' Check ,,his :ox !f you have de',ermmeo, based on [he information and analysis above and any SUDDOrti~C~ documentation, :~a[ :he pro(aosed Ac;ion WILL ,'lOT result in..~n'/ significant adverse environmental imcac:.~ AND 2rov~ce on =~;[ac,~ments as necessary, the reasons suGcorting tn~s determination: P~int or Type: IOffice use only File #:__ Permit #: TOWN OF SOUTHOLD HIGHWAY DEPARTMENT PECONIC LANE PECONIC, NEW YORK 11958 PERMIT & BOND APPLICATION FOR ACCESS THROUGH TOWN OWNED PROPERTY 1) 2) (Name of Applicant) (Address) (Name & Address of Contractor Involved) 1000- - - (Project Location) (S.C.T.M. #) : (Name of Road or Town Property Involved) (Hamlet) (Brief Job Description) Starting Date: Completion Date: 3) 4) 5) 6) 7) 8) Estimated Cost of Proposed Work: 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 Insurance Company: Insurance Agent Name & Telephone # : D. Policy # : E. State whether policy or certification is on file with the Highway Department: (If no, Provide a copy with Application) (yes/no) (Signature of Applicant) (Date) To be completed by the Bond Amount Required: Superintendent of Highways: (Signature) P~int or Type: 1) ACCESS CONSENT FORM FOR ACCESS THROUGH PRIVATE PROPERTY JOffice File #: Permit use Only #: 2) (Name of Applicant) (Address) (Name & Address of Contractor Involved) 3) : 1000- - - (Project Location) (S.C.T.M. #) 4) : (Name of Road or Private Property Involved) (Hamlet) S) (Name & Address of Homeowners Association / Property Owner) 6) (Brief Job Description) 7) s) g) Starting Date: Completion Date: Estimated Cost of Proposed Work: Insurance Coverage: A. The coverage required to be extended to the Property Owner: Bodily injury & Property Damage; $300,000/$500,000 Bodily Injury & $50,000 Property Damage. B. Insurance Company: C. Insurance Agent Name & Telephone # : D. Po]icy # : E. State whether policy or certification is on file with the Trustees Office: (If no, Provide a copy with Application) (yes/no) (Signature of Applicant) (Date) To be completed by the Property Owner: I/We the undersigned, fully understand the nature of Work referenced above and have no objection to Applicant to cross My/Our Property to do the work. the Proposed allowin9 the (Signature of the Property Owner ordulyauthorizedrepresentative) Albert J. Krupski, President 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) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD OTHER POSSIBLE AGENCIES YOU MIGHT HAVE TO APPLY TO N.Y.S. Dept.. of Environmental Conservation (DEC) SUNY, Bldg. 40 STONY Brook, NY 11790-2356 444-0295 Suffolk County Dept. of Health Services County Center Riverhead, NY 11901 852-2100 Army Corp. of Engineers New York District 26 Federal Plaza New York, NY 10278 212-264-3912 N.Y.S. Dept. of State Coastal Management 162 Washington Ave. Albany, NY 12231 518-474-6000 ~A~TIONAL DISCLOSURE -- The Town of Southold's Code of Ethics prohibits conflicts interest on the part of town officer~ and employees. Tile purpose of this form is bo provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is nece.ssary to avoid same. YOUR NAME~ (Last name, first name, middle initial, unless you are applying in the name'of someone else or other entity, such as a company. If so, indicate the other person's or company's name.) NATURE OF APPLICATIOII~ (Check all that apply.) Tax grievance Variance ~/ Change of zone Approval of plat Exen%ption from plat or official map Other (If "Other," name the activity.) Do you personally (or through your company, spouse, sibling, parent, or child) have a relat~onship with any officer or employee of the Town of Southold7 'Relationship" .includes by blood, marriage, or business interest. 'Business interestw means a business, ~ncluding a partnership, in which the tow~ officer or employee hag even a partial ownership of (or employment by) e corporation in which the town officer or employee owng more then 5% of the chares. YES ~/ NO If you answered "YES," complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position Of that person Describe the rela~ionsh~p between yourself (the applicant) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in ~he 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 applicant (when th~ applicant' is a corporation): __.B) the legal or beneficial owner of any interest in a noncorporate mntity (when the applicant is not a corporation); C) an officer, director, partner, or employee of the applicant; or __D) the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this ay of Sign.trite __lgg~ The Town of Southold's Code of Ethics prohibits conflicts or interest on the part of town officers and employees. Tho purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. (:asr name, first name, you a~e applying in the name of someone else or other entity, such as a company. If so, indicate the other person's or company's name.) NATURB OF APPbICATIoN~ (Check all that apply.) Tax grievance Variance Change of ~one App~fwal of plat ~xemption ~rom pl~t or' official map Other (I~ "Other." name the activity.) parent, or ~htld) have a relationship vitb any officer or employee DE the Town DE Southold? 'Relationship- includes by blood, ma~riage, or business interest. 'Business interest' means a business, including a partnership, in which the to~n officer or employee has even a partial ovnerehip of (or employment by) a corporation in ~hich the town officer or employee owns more than 5% of the shares. NO le you anevered 'YEs,#. complete the balance o~ ~hie ~orm and date and sign ~here indicated. Name of person employed by the ToWn of Southold Title or position of that person Describe the relationship between yourself (the applicant) and the town officer er employee. Either check the appropriate line A) through D) and/or describe in the space provided. The town parent, __A) e) __c) officer or employee o~ his or her spouse, sibling, or child is (check all that apply), the owner o~ greater than 5% of the shares of the corporate stock of the applicant (when the applicant· is a corporatlon)~ the legal or b&neficial owner of a,y interest in a noncorporate'entity (when the applicant is not a corporation}~ an offtcer~ director, pa~tner, or employee of the applicant~ or the actual applicant. DESCRIPTION OF RELATIONSIIIP submitted this'"_ ,'..day o~,': ..'.j' .199_ Signature . 'Print ~-,~- ' ' § 58-1 NOTICE OF PUBLIC HEAP. lNG § 58-1 Chapter 58 NOTICE OF PUBLIC HEARING § 58-1. Providing notice of public hearings. [HISTORY: Adopted by the Town Board of/he T~wn of Southold 12-27-1995 as L.L. No. 25-1995. Amenchnents noted where applicable.] § 58-1. Providing notice of public hearings. Whenever the Code calls for a public hearing, this section shall apply. Upon determining that an application is complete, the board or commission reviewing the same shall fix a time and place for a public hearing thereon. The board or commission reviewing an application shall provide for the giving of notice: A. By causing a notice giving the time, date, place and nature of the hearing to be published in the official newspaper within the period prescribed by law. B. By requiring the applicant to erect the sign prey/dod by the town, which shall be prominently displayed on the premises facing each public or private street which the property involved in the application abuts, giving notice of the application, the nature of the approval sought thereby and the time and place of the public hearing thereon. The sign shall be set back not more. than ten (10) feet ['rom the property line. The sign shall be displayed for a period of not less than seven (7) days immediately p~eceding the date of the public hearing. The applicant or hie/her agent shall file an affidavit that s/he hae complied with this prey/sion. C. By requiring the applicant to send notice to the owners of record of every property which abuts and every property which is across from any public or private street §58-1 SOUTHOLD CODE §58-1 from the property included in the application. Such notice shall be made by certified mail, return receipt requested, posted at least seven (7) days prior to the date of the initial public hearing on the application and addressed to the owners at the addressee listed for them on the local assessment roll. The applicant or agent shall file an affidavit that e/he has complied with this provision. ri'