HomeMy WebLinkAboutTR-4969 (2)
Board Of Southold Town Trustees
SOUTH OLD, NEW YORK
PERMIT NO.
t.f.q~9
DATE:.. Oct, 2l , 1998
ISSUED TO ..Niçl).olas &. Patricia .LaConti
Autl,nrii!utintt
Pursuant to the provisions of Chapter 615 of the Laws of
the State of New York, 1893; and Chapter 404 of the Laws of the
State of New York 1952; and the Southold Town Ordinance en-
titled "REGULATING AND THE PLACING OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS and the
REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN WATERS;". and in accordance with the
Resolution of The Board adopted at a meeting held on Qçt.2L
19 98. , and in consideration of the sum of $ 159,00 paid by
En-Consultants for Nicholas & Patricia LaÇ.o!1ti
f Mattituck N Y d b· t t th
o . .... ..... . . an su lec 0 e
Terms and Conditions listed on the reverse side hereof,
of Southold Town Trustees authorizes and permits the following:
Wetland Permit 114969 to remoVe existing 171'timber bulkhead
an? replac,:(in~place) with C-Lok vinyl bulkhead and replace
(wIthIn 18 )existIng 171'hmber retaining wall landward of bulkhea
BackfiU 18' wine area .h.."inol .hjkhrl w,"h .1.nn c_ f rl""",,, . d
an In accoräãnce Wltlf" Tn-e ð"efll rea-sþeclTlCaflons -a~ p'ï'esen....... IRan
the øricúllilt¡'nCl application.
plant baC"kl1 are'a with Cape American beach grass.
IN WITNESS WHEREOF, The said Board of Trustees høre-
by causes. its Corporat,; S~al to be af~xed, and these P!esents to
be subscribed by a malorlty of the said Board as of this dat.e.
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TERMS IInd CONDITIONS
The Permittee
Nicholas & Patricia LaConti
residing at
part of the
lowing:
176 So. Collier Blvn
consideration for the issuance of
34145
M;:¡rrn T~bnr1 JìT. N. Y.. as
the Permit does undetstand and prescribe to the fol-
1. That the said Board of Trustees and the Town of Southold are released from any and
IU damages, or claims for damages, of suits arising directly or Indirectly IS I result of any oper-
ation perfotmed pursuant to this permit, and the aaid Permittee will, at his or her own expense,
defend any and all such IlUÍts Initiated by thitd pardes, and the aaid Permittee assumes full Iiabllity
with respect thereto, to the complete ""elusion of the Board of Trostees of the Town of Southold
2. That this Permit Is valid for a period of 24 mos. which Is considered to be the
estimated time required to complete the work involved, but should circumstances warrant, request
for an extension may be made to the Board It a later date.
3. l1,at this Permit shouId he retained indefinitely, or as long IS the said Permittee wishes
to maintain the strocmre or project involved, to provide evidence to anyone concerned that autb.·
orization was originally obtained.
4. That the work Involved will be subject to the inspection and approval of the Board or
its agents, and non-compliance with the provisions of the originating application, may be awe for
revocalÌon of this Pennit by resolution of the said Board.
5. That there will he no unreasonable interference with navigation as a result of the work
herein a,,-ûlOrized.
6. That there shall be no interference with the right of the public to pass and rep... aloag
the beach between high and low water marks.
7. That if future OperatiolU of the Town of Southold require the removal and/or alterations
In the location of the work herein authorized, or If, in the opinion of the Board of Trustees, the.
work shall cause unreasonable obstruct1on to free navigation, the said Petmlttee will be requIftd,
upon due notice, to remove or liter this work or project herein stated wilhout expo..... to the Town
of Southold
8. That the said Board ,will he.notified by the Permittee ot the completion of the work auth-
orized.
9. That the Permittee will obtain all other permits Ind consents that _y be required sup-
plemental to this permit which may be subject to revoke upon fallwe to obtain same.
.
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Albert J. Krupski. Presidem
John Holzapfel. Vice President
Jim King
Martin H. Garrell
Peter Wenczel
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ùffice Use Only
Town HaJI _
53095 Main Road
P.O. Box 1179
Southold. New York 11971
Telephone (516) 765-1892
Fax (516) 765-1823
oorn@rnUWŒ!~
SEP 251998 :'"
1-' I
TOWN OF SOUT ¡~:;:j
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
___Codstal Erosion Permit Application
~etland Permit Application
___Grandfather Permit Application
Waiver/Amendment/Chûng~S
~eceived Application: 't ~~/qf
Received Fee:$ ISO ~
~Completed Application
Incomplete
SEQRA Classification:
Type I Type II Unlisted
coordIñãtion:(d~seÎ.t) ----
CAC Referral Sent: 9~F7f9
ate of Inspection: Jd/I'I/W
Receipt of CAC Report:
Lead Agency Determination:
Technical Review:
-- Public Hearing Held: 141~I9I
Resolution:
Address
Nicholas & patricia LaConti
lIb South COlller HOUlevara
Marco Island, FL 34145
~ []
SEP 2 1998
Name of Applicant
Phone Number: (941) 642-7692
Suffolk County Tax Map Number: 1000 _ 123-7-9.2
Property Location: 412 Park Avenue, Mattituck
(provide LILCO Pole #, distance to cross streets, and location)
AGENT:
(If applicable)
En-Consultants, Inc.
Address:
1329 North Sea Road
Southampton, NY 11968
Phone: 516-283-6360
FAX#: ~lb-¿öj-bljb
1
.
. Board
..
of Trustees APPl~c~n
.
GENERAL DATA
Land Area (in square feet):
57,117.45
Area Zoning: R-40
Previous use of property:
residential
Intended use of property:
no change
Prior permits/approvals for site improvements:
Agency
Date
X No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspended by a
governmental agency?
X No Yes
If yes, provide explanation:
Project Description (use attachments if necessary):
SEE ATTACHED
,
.
.
.
.
PROJECT DESCRIPTION
NICHOLAS & PATRICIA LaCONTI
412 PARK AVENUE
MATIlTUCK, NY
SCTM #1000-123-7-9.2
Remove existing ±171 timber bulkhead and replace (in-place) with C-LokT" vinyl bulkhead.
Backfill a ±12' wide area with approximately 100 cubic yards clean sand to be trucked in froman
upland source & plant backfill area with Cape American beach grass (AmmoDhila brevili!!Ulata).
r.e..-U\SQó \ 01 \ I q ð'
4IÞBoard of Trustees APPlica~n
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: To maintain stabilized
embankment.
Area of wetlands on lot:
o
square feet
Percent coverage of lot:
o
%
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: n/a feet
Does the project involve excavation or filling?
No
x
Yes
If yes, how much material will be excavated? n/a
cubic yards
How much material will be filled?
iOO
cubic yards
Depth of which material will be removed or deposited: n/a
feet
Proposed slope throughout the area of operations: nla
Manner in which material will be removed or deposited:
Clean sand to be trucked in and dumped landward of bulkhead as
backfill.
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 consists of a replacement of an existing bulkhead
adjacent to unvegetated tidal waters and thus will have no
adverse impact on Town waters/wetlands.
3
.
.
NOTICE TO Þ~JACENT PROPERTY OWNER
BOARD OF TRUSTEES, TOWN OF SOUTHOLD
In the matter of Nicholas & patricia LaConti
SCTM#lOOO-123-7-9.2
YOU ARE HEREBY GI"ÝEN NOTICE:
1. That it is the intention of the undersigned to request a
?ermit from the Board of Trustees to: remove existing ± 171
timber bulkhead and replace (in-place) with C-LokTM
Backfill a +12' wide area w2th a proX2mate y 0 cu
sand to be trucked 2n rom an up an source & p an
Cape American beach grass Ammoph2 a reV2 2gU ata ,
2. That the proper~y which is the subject Environmental Review
is located adjacent to your property and is described as
~ollows: 412 Park Avenue. Mattituck
3. That the property which is subject to Environmental Review
under Chapters 32,37.or 97 of the Town Code is open to public
comment. You may contact the Trustees Office at 765-1892 or in
Nriting.
The above referenced proposal is under review of the Board of
Trustees of the Town of Southold and dose not reference any
other adjacent that might have to review same proposal.
OWNERS NAME: Nicholas & patricia LaConti
MAILING ADDRESS: 176 South Col12er Boulevard
Marco Island. Flor2da 34145
?HONE #: 941-642-7692
Enc.: Copy of sketch or plan showing proposal for your
convenience"
,
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1) Purpbse: Erosion control
2)Datum: ALW
3)New sheathing to be C-Lok.... vinyl,
4)Approxima1e1y 25 cubic yards
clean sand to be trucked in
from an upland Source
5) Property location: 412 Park Aw.,
Mattituck; SCTM #1000-123-7-9.2
") Adjacent owners:
1. Holman
2. S'-han
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PROPOSED BULKHEAD REMOVAL &
REPLACEMENT (IP) WITH C-LOKTM
VINYL BULKHEAD FOR NICHOLAS
AND PATRICIA LACONTI ON GREAT
PECONIC BAY, MATTITUCK,
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SHEET 1 OF 1 9/15/98 9/30/98
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1) Purpóse: Erosion control
2)Datum: ALW
3)New sheathing to be C-Lok- vinyl.
4)Approximately 25 cubic yards
clean sond to be trucked in
from an upland source
5) Property locotion: 412 Pork Aile.,
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") Adjacent owners:
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PROPOSED BULKHEAD REMOVAL &
REPLACEMENT (IP) WITH C-LOKJ"M
VINYL BULKHEAD FOR NICHOLAS
AND PATRICIA LACONTI ON GREAT
PECONIC BAY, MATTITUCK,
SUFFOLK CO., NY
SHEET 1 OF 1 9/15/98 9/30/98
PARK AVENUE
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.. 1) Purpose: Erosion coontrol
Z;¡j:tum: ALW
3)Ne., sheathing to be C-lok- vinyl.
4)Appl'Oximately 25 cubic yards
clean sand to be trucked in
from an upland source
5) Property location: 412 Park Ave.,
Mattituck; SCTM #1000-123-7-9.2
") Adjacent owners:
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GREAT PECONIC BAY
PROPOSED BULKHEAD REMOVAL 8&
REPLACEMENT (IP) WITH C-LOI{I'M
VINYL BULKHEAD FOR NICHOLAS
AND PATRICIA LACONTI ON GREAT
PECONIC BAY, MATTITUCK,
SUFFOLK CO., NY
SHEET 1 OF 1 9/15/98
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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) 765-18!t2
Fax (516) 765·1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
BOARD OF TRUSTEES: TOWN OF SOUTHOLD
-----------------------------------
In the Matter of the Application
of
foLiC-Hi¿ '-A-S_ _ _ b!l_ _Cf¿ ¡t):rz __
COUNTY OF SUFFOLK)
STATE OF NEW YORK)
AFFIDAVIT OF POSTING
fì - !-I ~I: EN·CONSIIlTMITS INC
I, ¡úJß6((;T t;~1\rJ rJ, H:s~d-L119 at 1323 N(1RTH 3EA f1!). .
SOUTHAMPTON, N.Y. 11968
being duly sworn, depose and say: 516.283.6360
That on the ''"It'day of Oc...\.. ,¡99<:6", ersonally posted the
property known as It.. 'PM~ k. Ç..c...!:..
by placing the Board of Trustees fficial poster where it can
easily be seen, and that I have checked to be sure the poster
has remained in place for seven days prior to the date of the
pUþlic hearing. (date of hearing noted thereon to be held OC-7. rf/..I IP,r
Ml.. (J/f.. ,41.10«7 ?: u) 1..+1. '
Dated:
(sign )
Sworn to bef9~ me this
.,.2 ¡kday of U¿of- 199 J>
ICIoI H. STEPHENS
<l1IIIIIIJ PlrblJo.8l11te .r New Yod!
COmmlaalon No. SOIS9J1
Qualified In .. . SuIId
CDuntl.. Q
CC::-:ITÜaion Ex ires A'J ust 2 I
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.
.
I\PPLICI\NT
TRI\NSI\CTIONAL DISCLOSURK FORH
The Town of Southold's Code of Ethics prohibits conflicts of
interest on the parL of town officers and employees. The
.l2.!!.!.pose of this form is to provide information which can
alert the town of possible conflicts of interest and allow
it to take whateve action is I cessar to avoid same.
h-I'l- ¿, ~. ¡j/1 (;ff~/A ¡if.
YOUR HAHRI L ri [- v,dJ "f J-
Last name, first name, m ddle initial, unless
you are applying in the name of someone else or
other entity, such as a company. If so, indicat..
the other person's or company's name.)
NATURR OF I\PPLICI\TION. (Check all that apply.)
Tax grievance
variance
Change of zone
I\p'p~oval of plat
Ex..mption from plat or official map
Oth..r
(If "Other," name the activity.)
Do you p..rsonally (or through your company, npoun.., sibling,
par..nt, or chIld) have a r..lationship vith any officer or
..mploy.... of the ''ovn of Southold1 -Relationship- includ..s
by blood, marriag.., or busin..ss int..r..st_ -nusin..ss
interest- means a businens, including a partnership, in
vhich the tovn officer or employee has even a partial
ovnership of (or employment by) a corporation in vhich
the tovn officer or employee ovns more than 5% of the
shares.
IRS
NO V
If you ansvered -YES,- complete the balance of this form and
.lat.. and sign vh..r.. indicat..d.
name of person employed by the Town of Southold
Titl.. or position of that person
Describe the relationship between yourself (the applicant)
and the town officer or employee. Either check the
appropriate line 1\) 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).
1\) 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
corµocation),
c) an officer, director, partner, or empleyee of the
applicant, or
D) th.. actual applicant.
DESCRIPTION OF RELATIONSHIP
Submitted this ____day of
Signature
199ý
'prlnt name
1",¡.--r¡ê1é1rl µ< ¿rt~~
t(, C.h,,1-t4 s d. 4 <
.
.
PROOF OF MAILING OF NOTICE
ATTACH CERTIFIED MAIL RECEIPTS
.. J --Name:
Address:
Bud G. Holman
c/o Kelly Drie
101 Park Avenue
New York, NY 10178
Elizabeth Sheehan
63 West 89th Street
New York, NY 10024
STATE OF NEW YORK
COUNTY OF SUFFOLK
doing business En-Consultants, Inc.
Robert E. Herrmann , í<èf§Mj5ikJ at 1329 North Sea Road
Southampton, NY , being duly sworn, deposes and says
that on the 21st day of September ,19~, deponent mailed
a true copy of the Notice set forth in the Board of Trustees
Applicat~on, 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 Southampton , that said Notices
~:Ii..ailed to each of 'aid p='o= !J.-::;J:í' <_
R~rmann
e me this ..:J (~
~ ,19~Y
I'
<I Not":.
C:-. _. c. ;;)'L':~ ~j
Qualif'o: ... . Suffolk
Countiu
Comm;ôsion E irn Au It '!l
6
.
.
..
l-k ~ ):;..c d'¿ ,
Z 228 765 811D
I~ J<w: ohs
Z 228 765 879
us Postal Service
Receipt for Certified Mail
No Insurance Coverage Provided.
Do not use for Intemational Mail See reverse
Restricted Deivery
"'
m Retum Receipt
- Whom & Dale Dei
." Retum ReceipI Showrg
~Date&_·s
a
i TOTAL Postage & Fees
('I') Postmarlt or Date
E
æ
en
a.
." ReI1JmR"""
~ Date.&
a
~ TOTALPostage&
(I') Postma~ or Dale
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, 4-16-4 (2I87)-'T.xI 12
I PROJECT I.D. NUMSER
.
.
.
61 7.21
Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART I-PROJECT INFORMATION (To be completed by Applicant or Project sponsor)
SEQR
1 . APPLICANT /SPONSOR NICHOLAS & PATRICIA LaCONTI I 2. PROJECT NAME
BY EN.{;ONSUL TANTS,INC.
3. PROJECT LOCATION:
Municipality MATInuCK Counly SUFFOLK
4. PRECISE LOCATION (Street address and road int.....ctlon.. prominent landmarks, etc., or provide map)
U2 PARK AVENUE, MATIITUCK, NY - SCTM#IOOO-123-7-9.2
5. IS PROPOSED ACTION:
~N.w o expansion o Modification/alteration
8, DESCRISE PROJECT SRIE~L V:
SEE ATIACHED
7. AMOUNT O~ LAND A~~ECTED:
Inl!ally 1.31 acre. Ultimatety 1.31 acre.
8. WILL PROPOSED ACTION COMPL V WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
~Ves o No If No, d..cribe briefly
9. WHAT IS PRESENT LAND USE IN VICINITV OF PROJECT?
~ Resident.1 o Industrial o Commercial o Agrlcutu,. o Park/Forest/Open .paoe DOt..,
Describe:
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR ~UNDING, NOW OR UL TIMATELV ~ROM ANV OTHER GOVERNMENTAL AGENCV (~EDERAL,
STATE OR LOCAL)?
~V.. ONo If Y.', list agency(s) and permit/approvals
DEC, COE, AND DOS
11. DOeS ANY AspeCT cpr TH! ACTION HAVI!!: A CURRI!NTLY VALID PI!RMIT OR APPROVAL?
DYes 181 No If yes, list agency name and permttfapproval
12. AS A RESULT", PROPOSED ACTiON WILL EXISTING PERMIT/APPROVAL REQUIRE MOCI~ICATION?
OVes ~No
I CERTIFY THAT THE INP;ORMATION PROVIDII!!D Al!iOVe: IS TRUe TO THE I!iI!:ST 0,. MY KNOWL!!DOI!:
Applicant/sponsor name: ROI ERT E. , COASTAL MGMf SPECIALIST Date: SEPT. 18, 1998
Signature: v:!¡J ~< ~
'-' ,
If the action is in the Coastal Area, and you are a state agency, complete the
Coastal Assessment Form before proceeding with this assessment
nVFR
.
.
..
PROJECT DESCRIPTION
NICHOLAS & PATRICIA LaCONTI
412 PARK AVENUE
MATIlTUCK, NY
SCTM #1000-123-7-9.2
Remove existing ±17l timber bulkhead and replace (in-place) with C-Lok'" vinyl bulkhead.
Backfill a ±12' wide area with approximately 100 cubic yards clean sand to be trucked in from an
upland source & plant backfill area with Cape American beach grass (Ammoohila brevilil!Ulata).
r
4IÞoard of Trustees APPlica~n
County of Suffolk
State of New York
P~TJ((!'~t1 ¡J. L¡q. ÚO/.f 1/ ~
~ IC...hclJts 3. ~T·I 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
Þ..RISING UNDER OR BY VIRTUE OF SAID PERLolIT ( 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 WI ~ OF THIS
APPLICATION. -. J;.~,
/
SWORN TO BEFORE ME THIS
q~
DAY OF
,19.91.
No-;:ar
,~;¡.,:'!;:;.;;:< MARLENE MARTELL
!.;~,., MY COMMISSION' CC 638215
",'. ,., EXPIRES' Apnl 7 2001
'<~.;;" '" eOllClldThIU" "'*~ Un"_"
..........
4IÞBoard of Trustees APPlic~on
AUTHORIZATION
(where the applicant is not the owner)
I, MI!--!II)!'F; 9--/}¡¡¡;(!/iJ ¿,([;"ii77"' residing
(print owner of property)
at ~/J.- /?'Æf !'οI¿
(mailing address)
{fit ftf¿,(! If /~ /19'5- 'Z.--
do hereby authorize
- (j Ie..--- ---
/:¡.¡' tP¡JSO (HK(5,li.f{'·
(Agent)
to apply for permit(s) from the
Southold Board of Town Trustees
~':d ~~
~~AJ_ ¥6J'
(Owner's signa~ure)
on my behalf.
.......
·
1-"J-",'¡'-:""-:~>~
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·-_:_·-':";-'-:_~T';',J]_¡JI
-.
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 15161 765-1812
Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
May 27, 1999
Mr. Robert E. Herrmann
En-Consultants, Inc.
1329 North Sea Road
Southampton, NY 11968
Re: David & Ann Corieri
SCTM#123-7-9.2
Dear Mr. Herrmann:
The following action was taken at the Southold Town Board of
Trustees Meeting on May 26, 1999:
RESOLVED, that the Southold Town Board of Trustees grant the
request to Transfer Permit #4969 from Nicholas & Patricia
LaConti to David & Ann Corieri to remove existing 171' timber
bulkhead and replace (in-place) with C-Lok vinyl bulkhead and
replace (within 18") existing 171' timber retaining wall
landward of bulkhead. Backfill 18' wide area behind bulkhead
with 100 c.y. of clean sand and plant backfill area with Cape
American beach grass, and, an Amendment to Permit #4969 to
construct two 10' returns to the primary bulkhead. The returns
will be located inside the western and eastern property lines
and will terminate at the seaward face of the landward retaining
wall and the elevations of the returns will be equal to grade
level and that of the primary bulkhead.
However, this does not constitue approval from any other
agencies.
If you have any questions, please call our office at 765-1892.
Sincerely,
~ >1 /~ f)-..
Albert J. Krupski, Jr.
President, Board of Trustees
.
.
Albert J. Krupski, President
James King, Vice-President
Henry Smith
Artie Foster
Ken Poliwoda
,,~ÚfFDl.t ~
~"~.~
~~~ ~
, u:I ~
~ I:!
~. ~-.;:
~Q./ . i-'ð~
Town Hall
53095 Main Road
P.O. Box 1179
Southold, New York 11971
Telephone (516) 765-18q2
Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Mr. Robert E, Herrmann
En-Consultants, Inc,
1329 North Sea Road
Southampton, NY 11968
October 22, 1998
Re: Nicholas & Patricia LaConti
SCTM#123-7-9,2
Dear Mr, Herrmann:
The following action was taken by the Board of Town Trustees
during its regular meeting held on October 21, 1998 regarding
the above matter:
WHEREAS, EN-CONSULTANTS on behalf of NICHOLAS & PATRICIA LA
CONTI applied to the Southold Town Trustees for a permit under
the provisions of the Wetland Ordinance of the Town of Southold,
application dated September 25, 1998, and,
WHEREAS, said application was referred to the Southold Town
Conservation Advisory Council for their findings and
recommendations, and,
WHEREAS, a Public Hearing was held by the Town Trustees with
respect to said application on October 21, 1998, 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 37-18 of the Southold Town Code,
.
.
WHEREAS, the Board has determined that
will not affect the health, safety and
people of the town,
the project as proposed
general welfare of the
NOW THEREFORE BE IT,
RESOLVED, that the Board of Trustees grant a Wetland Permit to
NICHOLAS & PATRICIA LA CONTI to remove existing 171' timber
bulkhead and replace (in-place) with C-Lok vinyl bulkhead and
replace (wi thin 18 ") existing 171' timber retaining wall
landward of bulkhead. Backfill a 18' wide area behind bulkhead
with 100 c.y. of clean sand to be trucked in from an upland
source and plant backfill area with Cape American beach grass,
and,
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 and complete 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 oLthis
notification.
Two inspections are required and the Trustees are to be notified
upon completion of said project.
FEES: NONE
Very truly yours,
t2t.L.-I 9 /~~. 9,
Albert J. Krupski, Jr,
President, Board of Trustees
AJK/lms
cc: DEC
Dept. of State
ACE
.
.
Telephone
(516) 765-1801
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, October 19, 1998, the following recommendation was made:
No. 1594
RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL
of the Wetland Permit Application of NICHOLAS and PATRICIA LaCONTI
123-7-9.2 to remove existing +/-171' timber bulkhead and replace (in place)
with C-LOK vinyl bulkhead and replace (within 18") existing +/-171' timber
ret::lining wall landward of bulkhead; backfill a +/-18' wide area behind
bulkhead with 100 cubic yards of clean sand to be trucked in from an upland
source and plant backfill area with Cape American beach grass (Ammophilia
Breviligulata) .
412 Park Avenue, Mattituck
Vote of Council: Ayes: All
Motion Carried
.
IO)r[r,.
In,
l1U ¡ OCT 2
I
EN- CONSULTANTS'ctNC.
.
~,'- --;-~.:------,
1. I, r·,
o 'I', _
~ ; ! i ~
! . I· . 1329 North Sea Road
199 f' ~ .
8 i:. ~øuthampton. New York 11968
¡.~ . 516-28'3-6360
J Fax: 516-283-6136
._;_~:-'.~_;:::; 1" l~jlil~~'~ E-mail: encon@peconic.net
~
ENVIRONMENTAL SERVICES
September 30, 1998
Mrs. Carol Farkas
Division of Environmental Permits
NYSDEC
SUNY, Building 40
Stony Brook, NY I 1790-2356
RE: NICHOLAS & PATRICIA LACONTI. #1-4738-02055/00001
Dear Mrs. Farkas:
The captioned permit, which was issued 22 September 1998, authorized replacement of an
existing timber bulkhead with a vinyl bulkhead in the same location. As the permittee now
wishes also to replace (within 18") the existing retaining wall landward of the bulkhead, I have
attached (4) copies ofa revised project plan and respectfully request that you issue an amended
permit or a letter of non-jurisdiction pursuant to 6 NYCRR Part 66 I.4(b )(ii) for work landward
of the existing, functional, + I OO-foot long timber bulkhead constructed prior to 20 August 1977.
I would appreciate if you could confirm the bulkhead's presence on the Department's infrared
Tidal Wetlands Map No. 708-538, as the shoreline is obscured by shadows on the microfiche and
the oldest land survey available is dated 18 June I 980 (copy enclosed).
The existing timber retaining wall will be replaced (within 18") by a CCA-treated timber
retaining wall, and the area of backfill and plantings will be extended to 18' to incorponite the
disturbed area landward of the retaining wall.
By copy of this letter, I am similarly notifying the Southold Trustees of the revised project
proposal. Should you have any questions or require further information, please do not hesitate to
contact me at your earliest convenience.
Respectfully yourii¡
/1
\1:JJt~,,-~
'~....J .--J
Robert E. Herrmann
Coastal Management Specialist
Attachments
.1/
FROM ENCONSULTANTS, INC.
411rHDNE NO. 5162836136
411rP' 30 1998 06:36PM P1
1329 North Sea Road
Southampton, NY 11968
Phone: (518) 283-8380
Fax: (518) 28M138
~U: enc:on@peoonJc.net
I
Fax
I En-Consultants, Inc.
~QD.~
11M Dianne Herbert
._ Rob Henmann
Fmc 7«15-1823
p..-= 3
...... 785-1892
.... September30,1998
... LaContJ
CCI
D ...... " F4w "4;. _ C "TAT. ~'ILULL." [] .....-.pIy
o ~R.op"
. Comments: Dianne: I am sending a hard c:øpy d the foIlowng correspondence through
the mail, but I wanll!ld you 10 get this today so that a complete project description can go inID
the paper morrow.
Complete project description should now read:
"Remow uiatIng :!:171' timber ÞuIkt-.d & rIIpI8ce (In p&.œ) with c-t...ok1M và1yI buIkheIId and
røpIaœ (within 18") existW1g ±171'1imber I8IIIirWIg wall ~ d bulkhead. BøådiII a ;!:18'
wide area behind ÞuIkhe&d with 100 a.ö: yanis d cIesn ~ 10 be trudœd In from an
up¡.nd IOUI'C8 n pIIInt backfill .... with c.pe AtnericM bMch !/'as (Amrnop/'Ih
breviligulata). .
Any questions, just call. Thanks, Rob.
-
-
FROM
ENCONSULTANTS.INC.
~ONE NO. : 5162836136
.P.
30 1998 06:37PM P2
~
EN- CONSULTANTS, INC.
1329 North Sea Road
SouII1amplon. New VOrl< 11968
516-283-6360
Fax: 516-283-6136
E-mail: encon@peeonlc.nQt
ENVIRONMENTAL SERVICES
September 30, 1998
Mrs. Carol Farkas
Division of Environmental Pcnnits
NYSDEC
SUNY, Building 40
Stony Brook, NY 11790-2356
HE: NICHOLAS & PATRICIA LACONTI. #1-4738-02055100001
Dear Mrs. Farkas:
The captioned permit, which was issued 22 September 1998, authorized replacement of an
existing timber bulkhead with a vinyl bulkhead in the same 10catiOIL As the permittee now
wishes also to replaœ (within IS") the existing retaining wall landward of the bulkhead, I have
attacl1ed (4) c:opies of a revised project plan and respec:tÍÌ1lly request that you issue an amended
permit or a Jetter of non-jurisdiction pursuant to 6 NYCRR Part 661.4(b Xli) for work landward
of the existing, functional, + 1 OO-foot long timber bulkhead c:onstruc:ted prior to 20 August 1977.
I would appreciate if you c:ould c:onfinn the bulkhead's presence on the Department's inti-ared
Tidal Wetlands Map No. 708-53S, as thc shorelinc is obscured by shadows on the microfiche and
the oldest land survey available is dated lS1une 1980 (c:opyenclosed).
The existing timber retaining wall will be replaced (within 18") by a CCA-treated timber
retaining wall, and the area ofbacldill and plantings will be emended to 18' to inc:orporiÏte the
disturbed area landward of the retaining wall.
By copy oftlüs letter, I am similarly notifying the Southold Trustees of the revised project
proposal. Should you have any questions or require funher information, please do DOt hesitate to
contac:t me at your earliest c:onvenience.
Respectfully yours,
I
I
~!
"'---
Robert E. Hcmnann
Coutal Management Specialist
Attachments
çç: Albert Krupski, Southold Trustees'/
FROM: ENCONSULTRNTS, INC.
llllltes; ,
1) Purpose: Erosion cøntrol
Z)Dcrtum: AI.W
3)New cMathing to be C-lAk-Ili"l'1 .. __...
4)Approotimøtwly 25 abic yards
clean sand to be tnlCked in
fro", an upland source
5) f'ro¡.orty Iocøtlon: 412 Park A....
MIIttl'IUck: SCTM #1000-125-7-9.2
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PROPOSED B1JLKIŒAD RJœOVAL .
REPLACEMZNT (II') wITH c.LOJCI'M
.V1KYL BULKI'1P.o\D FOR NICHOLAS
AND PATRICIA LACONTI OK GUAT
PZCONIC BAY, MATTJTUCK,
SUFFOLK CO., BY
SHEET 1 OF 1 9/15/98 9/30/98
.
.
~.
S~etnber 18, 1998
EN- CONSULTANTS, INC.
œG~-~J'¡
TO'^'~ OF ,..." ., , . ~
'IV nl ,-, ! I ;_!, ;1 I
.. u_·_~: I .......¿ i.
1329 North Sea Road
Southampton, New York 11968
516-283-6360
Fax: 516-283-6136
E-mail: encon@peconic.net
~
ENVIRONMENTAL SERVICES
Town of South old
Board of Trustees
Post Office Box 1179
Southold, New York 11971
Attn.: Diane Herbert
Re: Nicholas & Patricia LaConti
412 Park Avenue, Mattituck
SCTM #1000-123-7-9.2
Dear Ms. Herbert:
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 adjacentownen).
2. Three (3) Short Environtnental Assesstnent 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 ofS150.00.
I trust this infonnation shall allow you to process our request for pertnit. Should any additional
infonnation be required, please do not hesitate to contact our office.
Robert E. He
Coastal Management Specialist
.
Ikhs
Ene.
·Alben J. Krupski. President
John Holzapfel. Vice President
Jim King
Martin H. Garrell
Peter Wenczel
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Town Hall _
53095 Main 'Road
P.O. Box 1.179
Southold. New York 11971
Telephone (516) 765-1892
Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
. fZQ.0l'Sed IN' ) Q8'
ùffice Use Only
___Codstal Erosion Permit Application
___Wetland Permit Application
___Grandfather Permit Application
___Waiver/Amendment/Changes
Received Application:
Received Fee:$
Completed Application
Incomplete
SEQRA Classification:
Type I Type II Unlisted
CoordIñãtion:(d~sent) ----
CAC Referral Sent:
Date of Inspection:
Receipt of CAC Report:
Lead Agency Determination:
Technical Review:
Public Hearing Held:
Resolution:
Name of Applicant
Nicholas & patricia LaCont~
lib South COll~er Houlevara
Marco Island, FL 34145
Address
Phone Number: (941) 642-7692
Suffolk County Tax Map Number: 1000 _ 123-7-9.2
Property Location: 412 Park Avenue, Mattituck
(provide LILCO Pole #, distance to cross stree~s, and location)
AGENT:
(If applicable)
En-Consultants, Inc.
Address:
1329 North Sea Roaa
Southampton, NY 11968
Phone: 516-283-6360
FK{#: ~lb ¿~j bLjb
1
Board of Trustees Application
-
WETIJIND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: To maintain stabilized
embankment.
Area of wetlands on lot:
o
square feet
Percent coverage of lot:
o
%
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: n/a feet
Does the project involve excavation or filling?
No
x
Yes
If yes, 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: n/a
feet
Proposed slope throughout the area of operations: n/a
Manner in which material will be removed or deposited:
Clean sand to be trucked in and dumped landward of bulkhead as
backfill.
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 consists of a replacement of an existing bulkhead
adjacent to unvegetated tidal waters and thus will have no
adverse impact on Town waters/wetlands,
3
.
~
. -
NOTICE TO ~~JACENT PROPERTY OWNER
30ARD OF TRUSTEES, TOWN OF SOUTHOLD
In the matter of Nicholas & Patricia LaConti
SCTM#1000-123-7-9.2
YOU riRE HEREBY G¡'VEN NOTICE:
1. ~hat it is the intention of the undersigned to request a
?ermit from the Board of Trustees to: remove existing ± 171
timber bulkhead and replace (in-place) with C-Lok™ vinyl bulkhead.
Backfill a ±12' wide area w~th a rox~mate y cu ~c yar s clean
sand to be trucked ~n rom an up an source & p an ac ~ area with
Cape American beach grass Ammop ~ a rev~ ~gu ata ,
2. ~hat the property which is the subject Environmental Review
is located adjacent to your property and is described as
follows: 412 Park Avenue, Mattituck
3. That the property which is subject to Environmental Rev~ew
~nder Chapters 32,37,or 97 of the Town Code is open to public
comment. You may contact the Trustees Office at 765-1892 or in
~ri~~ng.
The above referenced proposal is under review of the Board of
Trustees of the Town of Southold and dose not reference ~~y
ather adjacent that might have to review same proposal,
OWNERS NAME: Nicholas & patricia LaConti
MAI~ING ADDRESS: 176 South Coll~er Boulevard
Marco Island, Flor~da 3414~
?HONE ~: 941-642-7692
Ene.: Copy of sketch or plan showing proposal for your
=~nvenience.
tl!!!g:
·1) Purpose: Erosion coontrol
2)Datum: ALW
3)New Sheathing to be C-Lok- vinyl
. 4 )Á~'O"ilntl'l8ly 2!1 cubic yards .
cleon sand to be tnlcked in
from on upland source
!I) Property location: 412 Park Aile.,
Mattituck; SCTM #1000-123-7-9.2
') Adjocent owners:
1. Holman
2. S'-hon
PARK AVENUE
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GREA T PECONIC SAY
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PROPOSED BtrLKHEAD REMOVAL 81
REPLACElIrIENT (IP) WITH C.LOI[I'M
VINYL BULKHEAD FOR NICHOLAS
AND PATRICIA LACONTI ON GREAT
PECONIC BAY, MATTITUCK,
SUFFOLK CO., NY
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PROOF OF MAILING OF NOTICE
ATTACH CERTIFIED MAIL RECEIPTS
Name:
Address:
Bud G, Holman
c/o Kelly Drie
101 Park Avenue
New York, NY 10178
Elizabeth Sheehan
63 West 89th Street
New York, NY 10024
STATE OF NEW YORK
COUNTY OF SUFFOLK
doing business En-Consultants, Inc.
Robert E. Herrmann , ~~~~ at 1329 North Sea Road
Southampton, NY , being duly sworn, deposes and says
tha~ on the 21st day of September ,19~, deponen~ mailed
a true copy of ~he No~ice se~ forth in the Board of Trustees
Applica~~on, direc~ed ~o each of the above named persons a~ ~he
addresses se~ opposi~e 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; tha~ said Notices were mailed at the United
Sta~es Post Office at Southampton , that said No~ices
~:i;.mailed '0 each of .aid persons ~d) '...........
RObert~~ '~rmann
Swor:l t~o efo¡;oe!\le ~his ...:J r..oÆ
day of _dJ/'C-':x.. ,19 ~y
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Z 228 765 879
Z 228
CertifIed Fee
(115.2
3.,)
I y;
Special Delivery Fee /
"
Special Delivery F8! . _", .\ ,A r:. ~.
Restricted DeNvery Fee
on
m Return Receipt 5howi1g to I 0
- Whom & Da.. DaU,.,red _ . !
'ë Ratum_~" . ',.
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g TOTAL POSIege...... $ õP' ,;¿
CD
M Postm8lk or Date
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! TOTAL POSIego & Faa. $_.£ :2.
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14-16-4 (2187)-Text 12
. \ PROJECT I.D. NUM!ER
617.21
Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
FDr UNLISTED ACTIONS Only
PART I-PROJECT INFORMATION (To be completed by Applicant or Project sponsor)
1 . APPLICANT ¡SPONSOR NICHOLAS & PATRICIA LaCONTI 12. PROJECT NAME
BY EN-CONSUL TANTS. INC.
3. PROJECT LOCATION,
Municipality MATITIUCK County SUFFOLK
4. PRECISE LOCATION (Street addre.. and road Intersection" prominent landmark., etc.. or provide !'NIp)
SEQR
. ,
~12 PARK AVENUE, MATITIUCK, NY - SCTM #1000-123-7-9.2
5. IS PROPOSED ACTION,
~ New 0 I!!:xpan.ion 0 Modification/alteration
6. DESCRI!E PROJECT !RIE~L V,
SEE ATIACHED
7. AMOUNT O~ LAND A~~ECTED,
Inlially 1.31 acre, Uftlmtltety 1.31 acre,
8. WILL PROPOSI!!:D ACTION COMPLY WITH I!!:XISTING ZONING OR OTHI!!:R I!!:XlSTING LAND US!!! Rf!STRICTIONS?
~Y.. 0 No if No, d..cribe briefly
9. 'M-IAT IS PRESENT LAND use IN VICINITY Opr PROJI!!:CT?
~ Re,identlal 0 Industrial 0 Commercial
Describe:
o Agricuture
o Park/Pore,t/Open .pace
o Otha,
10. DOES ACTION INVOLV! A peRMIT APPROVAL, OR FUNDING, NOW OR UL. TIMAT!LY FROM ANY OTHI!!R GOVeRNMeNTAL AGENCY (prI!!CI!!RAL,
STAT! OR LOCAL)7
rg Yes 0 No If ye" list agency(.) and permit/approval.
DEC. COE. AND OOS
11. DOeS ANY ASP!CT OprTH! ACTION HAV! ACURRI!NTLY VALID PI!!RMIT OR APPROVAL?
Dyes ¡g¡ No If yes, list agency name and permit/approval
12. AS A RESULT Of' PROPOSED ACTION WILL EXISTING PI!!RMIT/APPROVAL REQUIRI!! MODIFICATION?
o V.. gNo
I CERTIFY THAT THI!! INFORMATION PROVIDeD ABove IS TRue TO THI!! B!ST Opr MY KNOWLeDGE
J
Applicant/.pon.or name: ROi; ERT E.
0~+
. COASTAL MGMT SPECIALIST
Date:
SEPT. 18. 1998
Slgn.ture:
-.;
If the action is in the Coastal Area, and you are a state agency, complete the
Coastal Assessment Form before proceeding with this assessment
nVFR
· .
PROJECT DESCRIPTION
NICHOLAS & PATRICIA LaCONTI
412 PARK AVENUE
MATIlTUCK, NY
SCTM #1000-123-7-9.2
Remove existing ± 171 timber bulkhead and replace (in-place) with C-Lok'" vinyl bulkhead.
Backfill a ± 12' wide area with approximately 100 cubic yards clean sand to be trucked in from an
upland source & plant backfill area with Cape American beach grass (AmmoDhila breviligulata).
- -'
Board of Tr~s~ees Application
Coun~y of Suffolk
State of New York
j) L /{ ~
r~-r;2(C'It1 ¡J. /1- UC'~( 1/
~ \4clA-s 3. ~I'I
DEPOSES AND AFFIRMs THAT HE/ SHE IS THE APPLICANT FOR THE ABOVE
DESCRIEED 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
J>..RISING UNDER OR BY VIR1"UE OF SAID PERI1I'I! 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 WI ~ OF TH!S
APPLICATION. _. ~~.
l
BEING DULY SWORN
Sign
SWORN TO 3EFORE ME =~:S
g-tl
DAY OF
,19~
No ":.,a,r" ,. i ~ ,....
..~\'!i.';';í¡;., MARLENE MARTELL
l.r ,:. "'i;, MY COMMISSION' cc 6362IS
w~.¡"j EXPIRES, AI11 7. 2001
·";¡;nr"r,-.'t..,· IlIIIIdIcI Thru NOCIry PuÞlg UndllWl'illtI
~
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Board of Trustees APPlication
AUTHORIZATION
(where the applicant is not the Owner)
I, ¡J,e/II.'L,~<; 9-~-¡¡;è'¡ L"'([.'",A.TT7'
(print owner of property)
residing at 7f¡).. /?,,ef' I'lt-E
(mailing address)
t1n-7=¡;!í,cff It //9'" 'Z--
do hereby authorize
- (j ¡--- -
¡;- ¡.(- Ip¡t/Se.' InK ($ ,I de; .
(Agent)
to apply for permit(s) from the
Southold Board of Town Trustees
~·X~~
C¿¿;L¿~ cff6J'
(Owner's signa~ure)
on my behalf,
.........
~:
1) Purpose: Erosion coontrol
2)Datum: ALW
3)New sheathing to be C-Lok.... vinyl
4)Approximately 25 cubic yards
cleon sand to be trucked in
from on upland source
5) Property locotion: 412 Park Aile..
Mattituck; SCTM #1000-123-7-9,2
") Adjocent owners:
1. Holman
2. SMehon
PARK AVENUE
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PROPOSED BULKHEAD REMOVAL &
REPLACEMENT (IP) WITH C-LOK£M
VINYL BULKHEAD FOR NICHOLAS
AND PATRICIA LACONTI ON GREAT
PECONIC BAY, MATTITUCK,
SUFFOLK CO., NY
SHEET 1 OF 1 9/15/98
--- --~------
APPLICANT
TRANSACTIONAL DISCLOSURE FORH
The Town of Southold's Code of Ethics prohibits conflicts of
interest on the part of town officers and employees. The
E.J!£pose of this form is to provide information which can
alert the town of possible conflicts of interest and allow
it to take whateve action is lecessar to avoid same.
Lr,ÛT7' i 'í ¡@1;';/1 ¡rj .
YOUR NAHRI (,' ~ '(J,d¿.¡ j.
Last name, first name, m ddle nitial, 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.)
NATURR OF APPLICATION. (Check all tha t apply,)
Tax grievance
variance
Change of zone
Ap'p~oval of þlat
Exemption from plat or official map
other
(If "Other," name the activity.)
Vo you personally (or through your company, spouse, sibling,
parent, or child) have a relationship vith any officer or
employee of the "'ovn of Southold1 -Relationship- includes
by blood, marriage, or. business interest. -nusiness
interest- means a business, including a partnership, in
vhich the tovn officer or employee haB even a partial
ovnerBhip of (or employment by) a corporation in vhich
the tovn officer or employee ovns lIore than 5" of the
shareR.
YES
NO ~
If you ansvered -YES,- complete the balance of this form and
,late and sign vhere indicated.
Ilame 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 or employee, Either check the
appropriate line A) through 0) 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),
0) the legal or beneficial owner of any interest in a
noncorporate'entity (when the applicant is not a
corporat ion) ,
C) an officer, directo~, partner, or employee af the
applicant I or
0) the actual applicant,
DESCRIPTION OF RELATIONSHIP
Submitted this ____day of
199i
signature
_ I~J----rJ¡"-'JI /0-(, f,''flf:.~
·,'rlnt name J{,~¡'¿l-{'IS --I. 1 < , ,