The URL can be used to link to this page

Home My WebLink AboutTR-4966 o� �jif�l Michael J.Domino,President S0Town Hall Annex John M.Bredemeyer III,Vice-President54375 Route 25 .� P.O.Box 1179 Glenn Goldsmith T Southold,New York 11971 A.Nicholas Krupski COQ Telephone(631) 765-1892 Greg Williams �ly`, Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1520C Date: October 9,2018 THIS CERTIFIES that the replacement within 18" 113' of existing bulkhead with c-loc vinyl, constr. 16+' of westerly return using same sheath,• remove and replace inkind/innlace 5'x12' stairs to beach and approximately 45 cy of sand trucked in from upland source for backfill and area between two bulkheads be maintained as buffer with non turf,non-fert buffer; At 6760 Peconic Bay Boulevard,Laurel Suffolk County Tax Map#1000-126-11-3.1 Conforms to the application for a Trustees Permit heretofore filed in this office Dated March 1, 1999 pursuant to which Trustees Wetland Permit#4966 Dated March 24, 1999,was issued and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the replacement within 18" 113' of existing bulkhead with c loc vinyl constr. 16+' of westerly return using same sheath;remove and replace inkind/inplace 5'x12' stairs to beach and approximately 45 cy of sand trucked in from upland source for backfill and area between two bulkheads be maintained as buffer with non turf,non-fert buffer. The certificate is issued to THOMAS MASTRO owner of the aforesaid property. Authorized Signature Mary F.Jeffrey and John R.Jeffrey,Jr. 55 Grandview Circle,Manhasset,NY 11030 (516) 728-7306 October 1, 2018 Town of Southold Board of Trustees Attention: Ms. Diane Disalvo 54375 Route 25 Southold, NY 11971 Re: 6760 Peconic Bay Blvd, Laurel NY 11948 D: 1000 5:126.00 B: 11.00 L: 003.001 To Town of Southold Board of Trustees, You are hereby authorized to enter our property located at 6760 Peconic Bay Blvd, Luarel, NY 11948 in order to conduct the necessary inspection so that we may obtain a Town of Southold Board of Trustees Certificate of Compliance. Many thanks. John R.Jeffrey,Jr. M ry F.Jeffrey Michael J.Domino,President ��OF S0UTyO Town Hall Annex John M.Bredemeyer III,Vice-President �� l0 54375 Route 25 P.O. Box 1179 Glenn Goldsmith Southold,New York 11971 A. Nicholas KrupskiG Q � O Telephone(631) 765-1892 Greg Williams �OOU O Fax(631) 765-6641 � NT`I,�� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: I't)A/r r - Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction % constructed VProject complete, compliance inspection. INSPECTED BY: 6. cold'srn I COMMENTS: OK go C oy C 804 ►n c�cc or�csn ce �• ��r�, CERTIFICATE OF COMPLIANCE: NI P---W-- N 1111111171111-11.0 W Mm : Board Of -Southold Town Trustees SOUTHOLD, NEW YORK DATE: .3/24/99 PERMIT NO. 'Y ISSUED TO ...... THOMAS MASTRO. 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 3141/99..... 150.00 19 99, and in consideration of the sum of $ paid by En-Coxisultants-Inc. ,. for THOMAS MASTRO of ...... Laurel... . N. Y. and subject to the Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: Wetland Permit to replace within 18" 113' of exist. blkhd. with c-loc vinyl, constr. 16+' of westerly return using same sheath. remove & repl. inkind/inpl. 5'X12' stairs to beach and approx.. 45 c sand rucke frn e al area ,g�and spurf enfor ba aliW In III In accor4ance wkqhe speci Ica 16 s as pri betw two fhe originating application.blkhds. be maint. as buffer with non- turf, non-ifftVft4g§'WHEREOF, The said Board of Trustees here- by causes its Corporate Seal to be affixed, and thesegesents to be subscribed by a majority of the said Board as of is date. .. . .......... rust s . ......... gUFFO(� A C z, Town Hall Albert J. Krupski, President ylhy� GGy n 53095 Main Road James King,Vice-Presidentc < P.O.Box 1179 Henry Smith w Z Southold, New York 11971 Artie Foster Ken Poliwoda q y� \� r' Telephone(516) 765-1892 Q! y �.��Y Fax(516) 765-1823 T � BOARD OF TOWN TRUSTEES TOWN OFSOUTHOLD March 26 , 1999 En-Consultants Inc. Roy Haje 1329 North Sea Road Southampton NY 11968 Re : THOMAS MASTRO SCTM #126-11-3 Dear Mr. Haje, The following action was taken by the Board of Town Trustees during a Regular Meeting, held on March 24 , 1999 , regarding the above matter: WHEREAS, THOMAS MASTRO, applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated March 1, 1999 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 March 24 , 1999 , 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, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approves the application of THOMAS MASTRO to replace within 18" 113+' of existing timber bulkhead with C-loc vinyl bulkhead, construct a 16+' westerly return using same sheathing, remove and replace inkind/inplace 5 ' X 12 ' stairs to beach and approx. 45 c .y. of clean sand will be trucked in from upland source for backfill and area between the two bulkheads be maintained as a buffer with a non-turf non-fertilized area. Located: 6760 Peconic Bay Blvd. , Laurel . 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 of this notification. Two inspections are required and the Trustees are to be notified upon completion of said project . FEES : None Very truly yours, oa Albert J. Krupski, Jr. President, Board of Trustees AJK/djh CC . DEC Dept . of State .ite La �og�FFOur�o • 0 9 Town Hall, 53095 Main Road P.O. Box 1179 Telephone � O-`-Ol � �. Southold, New York 11971 (516) 765-1801 ZpI SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Tuesday, March 23, 1999 the following recommendation was made: Moved by Richard Smith, seconded by Bret Hedges, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL of the Wetland Permit Application of THOMAS MASTRO 126-11-3.1 to replace (within 18") +/- 113 linear feet of existing timber bulkhead with C-Loc vinyl bulkhead. Construct +/- 16' westerly return using C-Loc vinyl sheathing, and remove and replace (inkind/inplace) 5'X 12' timber stairs to beach. Approx. 45 c.y. of clean sand will be trucked in from an upland source and used for backfill. 6760 Peconic Bay Blvd., Laurel Vote of Council: Ayes: All Motion Carried i • 1329 North Sea Road Southampton, New York 11968 �v. 516-283-6360 E N- CONSULTANTS, INC. Fax:516-283-6136 E-mail:encon@peconic.ne[ ENVIRONMENTAL SERVICES IE if February 26, 1999 u E K* I X999 Town of Southold TOWN OF SOUTHOLD Board of Trustees Post Office Box 1179 Southold,New York 11971 Attn.: Diane Herbert Re: Thomas Mastro 6760 Peconic Bay Boulevard, Laurel SCTM 41000-126-I1-3.1 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 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 (1) set of site photographs. 7. Application fee of$150.00. 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. Sincerely, Robert E. Herrmann Coastal Management Specialist /khs Enc. eP� 0�vO. • Suft3 •A•m Map 25 G In P�GpNN EaiEt OLD \\ Awrnrar 6 6 to 9amacr i \ Notes: ,e a I 1)Purpose:Maintain existing 6 144 erosion-control structure a 2)Datum:ALW CA)NOLIC R.uc"rERS 3)New timber to be CCA treated or AMERICA 4)New sheathing to be C-Loc- 1 5)Property location:6760 Peconic Bay Blvd., TE Kl Southold:SCTM#1000-126-11-3.1 °" m 6)Adjacent owners: N I.Lawrence A.Holfelder2.Gubs t` ApproxInc. 'f058'/5 �Appro P " 45 C.Y.clean gond to be trucked in from upland land source and used as backfill p� CREAT PECOBAY , , I 0 ul `1 I 1. z W11 " 61 S' Z J �C Lp,v%"�We �� i m % J G04k 'AZ ?a R— J O yvx�i x W J o 11'G J V \/ � W UAN, Livounhi 3d U U rx N T- 20 20 KO �I J e�Py � ti j 5 vWALc� v / _ o SrR RS �f•t' N' 6 TIMBER'fikb,NC �p9l69. 4 Z EX.S'NSTiMXCR STAIRS w -ro IiE REMD evED AN .6 ftErwceD FOR?I68,C.- 6 GKfIP� F"`�-rn•'�;i„aa �C I\Jln.. BLKND. WITHIN 18^ Of Ex.TIMBER BLKHD. K b w= Snllil`"t+l.,` •; A.}. li5tic PRbr I�b�'+.C..-Eac 516-ZA< f�.il•(i R(; ^1 PROPOSED BULKHEAD REPLACEMENT WITHIN 18" FOR GREAT PECONIC BAY TOM MASTRO ON GREAT PECONIC BAY, LAUREL, SUFFOLK CO., NY SHEET 1 OF 1 2/23/99 SURVEY OF PROPERTY N CERTIFIED TO: 51TUATE: LAUREL THOMAS MASTRO TOWN OF SOUTHOLD MORA MASTRO SUFFOLK COUNTY, NY W E SURVEYED 02-10-99 AMENDED 02-18-99 SUFFOLK COUNTY TAX # 1000 - 126 - II - 3.1 � \0 . \•/ O 0 0 K �w Pew P� O I ew5 � 4 6 � � CD I �•1 C a r a e�. G a ppp� oc / I SFr p ° ��,2� NOTES: V ■ MONUMENT FOUND QF NE(� STAKE FOUND hP�� C•E/y�� RR RR M I� 9 HEDGE LINE L5 LS U _L5��1 co AREA = 32639 SF OR 0.75 ACRES LMARI 1999 i nF .50202 ,�'� Albert J. Krupski. President ~p�� 00 'Z. Town Hall John Holzapfel. Vice President '_� ya .� 53095 Main Road Jim King ` y x P.O. Box 1179 Martin H. Garrell `O Southold, New York 11971 Peter Wenczel �'j1p 4 ¢� Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use OnlLTE0W=N07FSQU1HQ—Coastal Erosion Permit ApplicatioWetland Permit ApplicationGrandfather Permit Application_Waiver/Amendment/Changes Received Application:Received Fee:$ Completed Application - - - Incomplete SEQRA Classification: Type I Type II Unlisted Coordination: (date sent) CAC Referral Sent: Date of Inspection: - Receipt of CAC Report w Lead Agency Determination: Technical Review: Public Hearing Held: ,? - MAR I - X99 —Resolution: Name of Applicant Thomas Mastro 24 Wright Avenue Address Malverne, New York 11565 �... Phone Number: ( 5i6j 599-0388 Suffolk County Tax Map Number: 1000 - 126-11-3 .1 Property Location: 6760 Peconic Bav Boulevard Laurel (provide LILCO Pole #, distance to cross streets, and location) AGENT: En-Consultants Inc. ( If applicable) 1329 North Sea Road Address: Southampton New York 11968 Phone: 516-283-6360 FAX# : 516-283-6136 1 Board of Trustees Application GENERAL DATA Land Area ( in square feet) : 32 , 639 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) : Replace (within 18" ) ±113 linear feet of existing timber bulk- head with C-LocTM vinyl bulkhead. Construct +16 ' westerly return using C-LocTM vinyl sheathing, and remove and replace ( in-kind, in-place) 5 ' x 12 ' timber stairs to beach. Approxi- mately 45 cubic yards clean sand will be trucked in from an upland source and used for backfill. 2 Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Maintain existing bulkhead. Area of wetlands on lot: 0 square feet Percent coverage of lot: 0 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? 45 cubic yards Depth of which material will be removed or deposited: ±1 ' behind bulkhead. feet Proposed slope throughout the area of operations: n/a Manner in which material will be removed or deposited: Approximately 45 cubic yards clean sand will be trucked in from an upland source and dumped 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) : This maintenance project will not result in any adverse impacts to Town waters , and there are no vegetated wetlands present along this shoreline. 3 ':.16-4 0671—Text 12 FPROJECT I.D.NUMBER 61 7.21 S E Q R 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) 1 .APPLICANT/SPONSOR THOMAS MASTRO 2.PROJECT NAME Y EN-CONSULTANTS.INC. 7 PROJECT LOCATION: Municipality LAUREL County SUFFOLK 4.PRECISE LOCATION(Street address and road intersections.prominent landmarks,etc.,or provide map) 6760 PECONIC BAY BOULEVARD.LAUREL.TOWN OF SOUTHOLD.NY- SCTM#1000-126-11-3.1:MAP PROVIDED 5.IS PROPOSED ACTION ®New ❑Expansion ❑Modification/alterauon 6.DESCRIBE PROJECT BRIEFLY' SEE ATTACHED 7.AMOUNT OF LAND AFFECTED. Inbially 0'75 acres Ultimately 0.75 acres S.WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ®Yes ❑No If No. describe bnefly 9.WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ®Residential ❑Industrial ❑Commercial ❑Agriculture ❑Park/Forest Open space ❑Otner Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING,NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL. STATE OR LOCAL)? ®Yes ❑No If yes.list agency(s)and permiVapprovals NYS DEC Article 25, COE Sections 10 6 404 11 DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? 11,as ®No If yes. list agency name and permit/approval 12.AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? 1:3 yes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicam/sponsor n RID T E.HERRMANN,COASTAL MGMT. SPECIALIST Data FEB. 26. 1999 Signature' If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment nvs=R PROJECT DESCRIPTION THOMAS MASTRO 6760 PECONIC BAY BOULEVARD LAUREL,NY SCTM#1000-126-11-3.1 Replace(within 18')+113 linear feet of existing timber bulkhead with C-Loc,vinyl bulkhead. Construct+16' westerly return using C-Loc'vinyl sheathing,and remove and replace (in-kind, in-place)5' x 12'timber stairs to beach. Approximately 45 cubic yards clean sand will be trucked in from an upland source and used for backfill. 0 NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES , TOWN OF SOUTHOLD In the matter of Thomas Mastro -CTM#1000- 126-11-3 .1 YOU ARE HEREBY GIVEN NOTICE: i . That it is the intention of the undersigned to request a Permit from the Board of Trustees to: SEE ATTACHED 2. That the property which is the subject Environmental Review is located adjacent to your property and is described as follows: 6760 Peconic Bay Boulevard Laurel 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 writing. 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: Thomas Mastro MAILING ADDRESS: 24 Wright Avenue Malverne, NY 11565 PHONE # : 516-599-038 Enc. : Copy of sketch or plan showing proposal for your convenience. gP� 6�v 1w Havamm Map 25491 014, OL \ t � Wr"rW a. msnr.cr s B \ Notes: ,e s I b 1)Purpose:Maintain existing s Ms erosion-control structure '+ 2)Datum:ALW CATHOLIC OIUCHURS 3)New timber to be CCA treated OF AMERICA 4)New sheathing to be C-Loc- 1 TE 5)Pr'op"location:6760 Peconic Bay Blvd., !tl Southold;SCTM#1000-126-11-3.1 °' m 6)Adjacent owners: N I.Lawrence A.Holfelder t` 2.Subs Inc. YO —lT— 7)APProx.45 c.y.clean sand to be trucked in from upland source and used as backfill 6KE41r FE!_o $A Y JV am Q N 1- z' w } J X Pr'ans row I 171 � t r'rDadi V, O y� /1.9 Z 3 0LUo WQ Noi,/yil�I N3d U U In � f=EET r, A o 20 yo 10 I' w l� / Ns x$ wFm J� IIMBEK }p�� /dVl'ci E �'? x WICK} �� .45 . liMBER GAbrN�ri� 7EZ S'rAlRS fjc.j N�=TiMdER STAIRS BeMcQK/IP�vtb AND r LKW6. W17741HRePE Ris y N'CONSULTANTS INC. - l ' ! NORTH SEA RD. Pk oFEx. TrnBERBtxHD K ' _ ;C.:S;i'IGN N, Y. 11968 w= .-2d:t-�3o0 POP )&'C-LOC Kmow PROPOSED BULKHEAD REPLACEMENT WITHIN 18" FOR GREAT PECONIC BAY TOM MASTRO ON GREAT PECONIC BAY, LAUREL, SUFFOLK CO., NY SHEET 1 OF 1 2/23/99 Hoard of Trustees Application 0 County of Suffolk State of New York JO( RA G. MAS(/, 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 BOARDOF 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 AP= ,I:A ON, I :Dp.EBY AUTHORIZE 'i'HE TRliSTcES, THEIR AGENT( S) OR RE PRESENTATIVES(S) , TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. ,y Signature SWORN TO 3E.ORE ME THLS _DAY OF •J 2 r 10� AN CARMELA m eCASELLA NewNotary P:,1.3 Sate of New Ypk l:�.37.4754693 Qu3ffi,�in NCw York County r Dy_C Come- Cspires,Dec.31, 19!/ •ard of Trustees Applicat AUTHORIZATION I , �h0iK4G.NIAs7Qo - -r yyp�sesiding at RIUN-( VFNJE (pr�nt owner of property) (mailing address lISZS^ do hereby authorize Fw (Agent) / to apply for permit( s) from the Southold Board of Town Trustees on my behalf . ( wner ' s signatu � � Albert J. Krupaki, President �0gpFF0j f Town Hall h�0 Gy 53095 Main Road James King,Vice-President o P.O. Box 1179 Henry Smith cc = Southold, New York 11971 Artie Foster W Ken Poliwoda y� O�� Telephone(516) 765-1892 Fax(516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD ----------------------------------- In the Matter of the Application of THOMAS---A S T2 6 ------ COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POST G !-CONS(I(_TANTS INC. I, 2hp� YIsWEO>_lftM-,j, reslg ,* 1329 NORTH SEA RD, SOUTHAMPTON, N.Y. 11968 being duly sworn, depose and say: 516-283-6360 That on the n1— day of H" , 1999, I personally posted the property known as (.-7(,r) kr_ 7-tN 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 seven days prior to the date of t1je public hearing. (date of hearing noted thereon to be held &J OA) OK. A- 0r ] : /SP.,i, . Dated: (sig e) Sworn to before me this Zyy"Iday of (-`` 1995 N ary Public - - - - - - - - - - - - - - - - - - - - - - KUIiti STEPHl Notary Publlo•State of Now York r-- No. 50159:1 (�.1«�•--,.mac , .•_ 'folk �•,S..m c p 3, ISkl APPLICANT TRANSACTIONAL DISCLOSURE FORM The Town of Southold ' s Code of Ethics prohibits conflicts of merest on the part of town officers and employees . The purpose of this form is to provide information which can alert Elie town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: _ MAs1RO M019A GOCiG/I`I M4�fiv Ito~-s 3', ( Last name , first name, m delle initial, unless you are applying in the name of someone else or other entity, such as a company. If not indicate Elie other person ' s or company ' s name . ) NATURE OF APPLICATION: (Check all that apply . ) Tax grievance Variance Change of zone Appoval of plat Exelption from plat or official map Other ✓ ( If "Other, " name the activity . ) Sou"\l TI 1, Z5 Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or business interest. "business interest" means a business, including a partnership, in which the town officer or employee has even a partial ownership of (or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. 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 KA-(FILE b671M0nJC Title or position of that person QL. Pkv - A < < s ort- Ir-[-Describe the relationship between yourself ( the applicant ) and the town officer or employee. Either 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 ) e A) the owner of greater than 5% of the shares of the corporate stock of the applicant (when the applicant is a corporation ) ; the legal or beneficial owner of anv interest in a noncorporate entity (when the applicant is not a corporation) ; C) an offt"r, director, partes.- , cr empi3yee Of the applicant ] or D) Elie actual applicant . DESCRIPTION OF RELATIONS111P 51S(E� OF APPLICANT Submitted this 10l day of -Jc,.,. 1999 Signature 1�119L1I - ��(1L1 L10rvt�� Print name MOM G MlOrr� -rj�xD-k,-: YW�s� F51 REY OF PROPERTYATE° LAUREL CERTIFIED TO: N OF SOUTHOLD THOMAS MASTRO OLK GOUNTY, NY W ✓ E MOIRA MASTRO r SURVEYED 02-10-qq AMENDED 02-18-qq SUFFOLK GOUNTY TAX # S 1000 - 126 - II - 3.1 Ym CO V _ N � . 0 °� G Z O ° I 40 N O a N O P Pw^e I K w e S � a e o e i r r pp •q�p ev H e< J ly Ode C O 6 O � �c • V f gal oc e --yo O -Q S J � ) 2 c IS- NOTES: 2 NOTE ° �� . � Qj � I • MONUMENT FOUND - STAKE FOUND OF NES, f i HEDGE LINE 't�� O-EH� �' -• AREA = 3263q SF OR 0.'I5 ACRES �F 50202 �Q n. J 1 J i