HomeMy WebLinkAboutTR-5813
James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
Bob Ghosio, Jr.
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
CERTIFICATE OF COMPLIANCE
Date September 7,2007
# 0247C
THIS CERTIFIES that the addition to the rear ofthe dwelling, dormers, and sanitary system
At 1895 Leeton Dr., Southold,
Suffolk County Tax Map # 58-2-10
Conforms to the application for a Trustees Permit heretofore filed in this office
Dated 9/29/03 pursuant to which Trustees Permit #5813Dated 10/22/03 and Amended on
5/17/06
Was issued, and conforms to all of the requirements and conditions of the applicable
proYisions of law. The project for which this certificate is being issued
is for the addition to the rear of the dwelling, dormers, and sanitary system.
The certificate is issued to WILLIAM & MARY STEELE owner of the
aforesaid property.
r67.~
Authorized Signature
~~ - ";/16/2""5 -~;~2 ---.6'3.83
STEELE r_
New York State Department of Environmental Conservation
Division of Fish, Wildlife & Marine Resources. Region One
BUre4l1l of HabItat
BuildIng 40 - SUNY, Stony BroOk, New York 11790-2356
Phone: (631)444-0275 . FAX: (631) 444-0297
Website: www,dec.state.nY.U5
Marcli 8, 2005
WilliaD:\ Steele
25 Highgate Drive
Smithtown, NY 11787
"
RE: NYSDEC v William Steele
\ll\\*. 'Ill
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~
ErIn M. Crotty
Commissioner
J have reoeived the plans sent by Robert AI. Steele for the proposed sanitary system for 1895 Leeton
Drivc, Southhold. NY. Two sets of plans for different alternatives were' provided dated February 23, 200S.
One set of plans was for installation_of the sanitary system on the side of the house (Sanitary Plan), and one
set of plans was for the installation of the sanitary system in the front of the house (Sanitary Plan Front of
HouseAltemative)..BY submiltingthe plans prior to ,March 1,2005, you have submitted the plans as ordered
under the Ordcr on Consent signed by you on Deoember 31,2005, and executed on January 18, 200S. Either
plan would be acceptable to the NYSDEC. The Jetter sent by RobertA. Steele to me on February 27,2005,
indicated that the Saoitary Plan FrOnt of House Alternative was YOll1"prefcrreel plan. As that pian would place
the sanitary system more than 100' from the freshwater wetlanel boundary, the Sanitary Plan Front of House
Alternative is also the NYSDEC's preferred plan. The next step in the prooess would be to get approval for
the sanitary system from the Suffolk County Department ofRealtb (SCDIi). Once SCm'I approval has been
obtained, the sanitlll)' system would be able to be installed. The deadline date for installation is June 30,
2005, as per the Order on Consent. Please let me know when you submit the plans to the SCDH in order to
demonstrate progress towards completion of the Order on Consent.
,
Sincerely, fi2J/4J
~dward/Ko~~-
Regional Habitat Manager
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April 27, 2006
25 Highgate Drive
Smithtown, NY 11787
Town of Southold, Board of Trustees
Town Hall, 53095 Main Road
PO Box 1179
Southold, NY 11971-0959
Re: 1895 Leeton Drive, Southold, NY
Dear Trustees:
We are in the closing stages ofthe Building renovation at our Residence at the
above address, and we have been dealing with the D.E.C. with regards to improvements
of our sanitary system; the plans for which have been submitted and approved.
Attached please find a copy of the letter received from Regional Habitat Manager,
Gregory Edward Kozlowski, wherein, he states that our Engineer's plan for the
placement ofthe sanitary system, in front of the dwelling, meets with his approval.
In our attempt to comply with requirements, we made an Application to the
Suffolk County Department of Health and one of the requested bits of information is a
letter from the Town of Southold indicating that there are no objections to our proposal.
Attached please find a copy of our Permit No. 5813, issued by the Town Trustees on
October 22,2003.
We are now formally requesting that you modify our Permit to permit the
movement ofthe sanitary system in accordance with the D.E.C.'s approval expressed in
Mr. Kozlowski's letter of March 8, 2005.
Attached you will find our check for the amendment fee of $50, as well as a copy
of the plans.
Thank you for your attention to this matter.
Very truly yours,
./;,~ / /~.
L /~~si~//
APR 2 8 2006
WRS:dd
Encls.
CC: Gregory E. Kozlowski, D.E.C. Regional Habitat Manager
James F. King, President
Jill M. Doherty, Vice-President
peg~. Dickerson
Dave Bergen/
". ~ Holz~fel
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Southold Town Board of Trustees
Field InspectionIWorksession Report
Date/Time: t; 113/0 '""
.
Name of Applicant: Yt<:.<= (c..
Name of Agent:
Property Location: SCTM# & Street
Brief Description ofpr9Rosed action: 1... 5 f- f!
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Se"l~
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Type of area to be impacted:
~Saltwater Wetland .,K..Freshwater Wetland _Sound Front _Bay Front
Distance of proposed work to edge of above: t Z)' I
Part of Town Code proposed work falls under:
_Chapt.97 _Chapt. 37 _other
Type of Application: _ Wetland _Coastal Erosion _Amendment _Administrative
_Emergency
Info needed:
(\0..."
Modifications: i'"\ '" ., ~
Conditions: A- (\ . C)' k
f
"Present Were: _I.King ~~Doherty _P.Dickerson $.-D. Bergen_I.Holzapfel
Other:
..
Mailed!Faxed to:
Date:
.
.
James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
John Holzapfel
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
May 17, 2006
William and Mary Steele
25 Highgate Drive
Smithtown, NY 11787
RE: 1895 LEETON DR., SOUTHOLD
SCTM# 58-2-10
Dear Mr. and Mrs. Steele:
The following action was taken by the Southold Town Board of Trustees at their Regular
Meeting held on Wednesday, May 17, 2006:
RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to
Permit # 5813 to install a sanitary system on the landward side of the existing dwelling as
depicted on the plans prepared by Robert A. Steele last dated May 17, 2005.
This is not a determination from any other agency.
If you have any questions, please call our office at (631) 765-1892.
Sincerely,
/.:: 0<7
James F. Ing
Presiden , Board of Truste ' s
JFK/hkc
PRDJECT NAME
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1 STORY
DWaLlNG
DISTRICT I 000
SECTION 058
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INVERT ELfYA110NS .
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STEELE RESIDENCE ADDITION
1895 LEETON DRIVE SOUTHOLD, NY I 1971
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DISTRICT I 000
SECTION 058
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DRA"'ING TITLE
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SUfFOLK COUNTY TAX MAP
DISTRICT I 000
SECTION 058.00
BLOCK 02.00
LOT 010.000
ROBERT A. STEELE
PROFESSIONAL ENGINEER
2G ROlliNG AVENUE
MILLER PLACE. NY I I 7G4
SANITARY PLAN
FRONT OF HOUSE ALTERNATE
NOlES:
1. SEE GRADING PlAN FOR PROPOSED
GRADES NOT SHOWN.
APR 2 8 2006
7.80
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TEST BORING
NO. 1
DA TED: 3/18/05
TeST HDLE BY
HCDDNALD GEOSCIENCE
BOX 1000, SDUTHDLD, NY
11971
(631) 765-3677
SCALE DATE
D"'G. No.
AS SHOWN 5/ I 7/05
S.IA
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4- PVC PIPE
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INV 7.38.
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TYPICAL INLET
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1. CONCRElE 4000 PSI II 28 OA YS
2. REBAR ASlM A-615 GRADE 40
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4. DETAILS OF INSTALLATION TO BE IN
ACCORDANCE WITH SCDHS FlG.1.
5. SEPTIC TANK SHALL BE WAlERPROOF
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WIN.
TYPICAL SANITARY LEACHING
NlS
STEELE RESIDENCE ADDITION
1895 LEETON DRIVE SOUTHOLD, NY I 197/
PROJECT NAME
DRA\(ING TITLE
SCALE DATE
D\(G. No,
ROBERT A. STEELE
PROFESSIONAL ENGINEER
2G ROLLING AVENUE
MILLER PLACE, NY I 17G4
SUFfOLK COUNTY TAX MAP
DISTRICT I 000
SAN IT ARY DET AI LS SECTION 058.00
BLOCK 02.00
FRONT OF HOUSE ALTERNATE LOT 01 0.000
AS SHOWN 2/23/05
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PRDJECT NAME
DRAWING TITLE
ROBERT A. STEELE
FROFESSIONAL ENGINEER
2G ROLLING AVENUE
MILLER FLACE. NY I 17G4
STEELE RESIDENCE ADDITION
1895 LEETON DRIVE SOUTHOLD, NY 1 197/
GRADING PLAN
FRONT OF HOUSE ALTERNATE
SUFfOLK COUNTY TAX MAP
DISTRICT I 000
SECTION 058.00
BLOCK 02.00
LOT 0' 0.000
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NOTES:
1. APPROX. 108 (;( OF OFFSITE FILL
REQUIRED TO Mffi SCDHS GRADING
STANDARDS
2. GRADING SHALL MAINTAIN A 5"
MAXIMUM SLOPE FOR A DISTANCE OF
20' FROM PROPOSED SANITARY
SYSTEM.
SCALE DATE
DWG. No.
AS SHOWN 5/17/05
S.3A
Board Of Southold . Town Trustees
SOUTHOLD, NEW YORK
PERMIT NO. . 5EJ.3J ...... DATE: ºçJ<?Þ~.r m~.?,..2003
ISSUED TO .n..n...~~~~.I.II:~.n.~,.~II:!:l.y'...?!~~L~..'..."'hn"'.h'"..... ..h.h.···
l\utQori;rutiott
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 Yorlc 1952~ and the Southokl 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· W A TERS:!~. and in accordanc:e with the
Resolution of The BOard adopted at a meeting held on "'?~~'~~"'':'h.22, .
. 2.o.º.~., and in consideration of the sum of $h.?~gh·"~O. .... paid by
.h...\\'.igi,9c"'...&...M.9cry...!?JêêJe......... ........... .... ..................h.............n.......h.....
of ..h..h.~9..~~.þ."'1.<:l.m...h.hmh.h.hh.hm ..h' N. Y. and subject to the
Terms and Conditions lined on the reverse side hereof,
.of Southold Town Trustees authorizes and permits the foDowing:
Wetlana-Permit for a 12'X 28' expansion to the rear of the
existing dwelling and to change the roof contour to provide
full dormers. and as depicted on the site plan prepared by
Robert A. Steele, dated September 4, 2003.
aU in accordance with the detailed specifications as presented in
. the originating application. .
IN WITNESS WHEREOF, The said Board of Trustees here-
by causes its Cor >Orat~ ~al to be a~xed, and these presents to
be subscribed by a maJority of the said Board as of this dat.e.
¿~&.~::~
a¿..... .(J 0J'J,'Jn~
. A~ie~q.oster"" Absent
rrtlslter
i.
TERMS and CONOmONS
William 8< Mary. Steele
The Pennittee
residing at 25 Highgate Dr., Smith town N. Y.. as
pan. of tbc coosidetatioo for che is$>"OVT of die Permit does .,,_i--ul.nd and pteSaibe to the fol·
1owiøg:
1. 'l1w tbc said Board of rrusues and the Town 01 SoucboId _ Ideased from any and
all cIamoges, or cIaJms foe cIamoges, of suiø adsiøg diI:cctIJ ot' iDcIirecdy as a malt of any ope<-
atiou peáom>ed pUnuaat to Ibis pemit. and die said 1'--. "¡'t"" will, It his oc her own bi ¡-.
defead any and all such IUlU·/oM...... bJ d1hd patties, and tbc said p.. III,t .- fall JàbUitr
with R5pect thereto, to the ~ .~ of tbc Board 01 Tmstta Πtbc TO'IIIi. Π~
2. That Ibis Permit is' w1id f« . period of.24 IDOS. wbich is CIODÀ!~red to be the
estimated time· required to cocnpleœ tbc work iavohe<l, but ihoaJd å.rœiistmces warnat, ~
for an exteDSion may be made to the Boud at a later daœ.
3. That Ibis Permit should be maioed iadef"UJitdy, or' as loog as tbc said PermIttee wisba
to· ....¡....in tbc sttuctur. or' project iavolved, to pt'OYide nideDœ to anyooe a>oc:em<od that auth-
.orizatioa ..... origina11y obuiaed.
4. That the wode úm>loed wID be subject totbc ïospectioa and appron1 oi tbc Boud or
ia agents, and noo..oo...pu........ with. tbc prOYisioas Πtbc or1g1....fI..g appIiatioa, may be couse for
rewatiOC1 of Ibis Permit by ~tioa oi tbc said Board.
s. That there wID be no uareuo..ab1e iaterfereøoe with na'fi&adon as a malt Œ the wcdc
herein outborized. .
6. That there shall be 110 iaterference with the right of tbc pubIJc to pass and repus a10ag
tbc beach between high and low water marks. .
7. That If future opendons Πthe Town of SoadIpId reqake the. ftIDOftI and/ot: a1teratioas
Ia. tbc Iocaâo<1 oi tbc work herein met.<,. t iI, 0 r iI. ia tbc opIøJaa Œ the Board Œ T.-. tbc.
work shall cause W1IeIsoaahIe obstrucl1Oll. to free naYigadon. the said p., .ltt~ wID be required,
upon due notice, to runove or alter Ibis work or project herein stated wiIboat ~s to tbc Town
. ΠSoud1old.
8. That the said Board wID be notified by the Permittee at die ~. Of the worIc auth-
orized.
9. That the Pe<mittee wID obtain all ocher pemúts and coaseniS d>at may be required sap-
plemental to Ibis permit wbId1 _y be subject to revolre upoII failure ro obtain -.
·'
.
.
Albert J. Krupski, President
James King, Vice-President
Artie Foster
Ken Poliwoda
Peggy A. Dickerson
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTH OLD
October 22, 2003
Mr. & Mrs. William Steele
25 Highgate Dr.
Smithtown, NY 11787
RE: WILLIAM & MARY STEELE
1895 LEETON DR., SOUTHOLD
SCTM#58-2-10
Dear Mr. & Mrs. Steele:
The Board of Town Trustees took the following action during its regular meeting held on
Wednesday, October 22, 2003 regarding the above matter:
WHEREAS, WILLIAM & MARY STEELE applied to the Southold Town Trustees for a
pennit under the provisions of Chapter 97 of the Southold Town Code, the Wetland Ordinance of
the Town of Southold, application dated September 29,2003, 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 22, 2003, at which time all interested persons were given an opportunity to be heard,
and,
WHEREAS, the Board members have personally viewed and are familiar with the premises in
question and the surrounding area, and,
WHEREAS, the Board has considered all the testimony and documentation submitted
concerning this application, and,
WHEREAS, the structure complies with the standards set forth in Chapter 97 ofthe Southold
Town Code,
2
.
.
WHEREAS, the Board has detennined that the project as proposed will not affect the health,
safety and general welfare of the people of the town,
NOW THEREFORE BE IT,
RESOLVED, that the Board of Trustees approve the application of WILLIAM & MARY
STEELE for a l2'X 28' expansion to the rear ofthe existing dwelling and to change the roof
contour to provide full donners, and as depicted on the site plan prepared by Robert A. Steele,
dated September 4, 2003.
Pennit to construct and complete project will expire two years from the date the pennit is signed.
Fees must be paid, if applicable, and pennit issued within six months of the date of this
notification.
Inspections are required at a fee of$5.00 per inspection. (See attached schedule.)
Fees: None
Very truly yours,
£th.$? ~'0"
Albert J. Krupski, Jr.
President, Board of Trustees
AJKllms
.
.
Telephone
(631) 765-1892
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
CONSERVATION ADVISORY COUNCIL
TOWN OF SOUTHOLD
At the meeting of the Southold Town Conservation Advisory Council held Tuesday,
October 14, 2003, the following recommendation was made:
Moved by Don Wilder, seconded by Drew Dillingham, it was
RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH
A CONDITION of the Wetland Permit application of WILLIAM & MARY STEELE for a
12'X 28' expansion to the rear of the existing dwelling and to change the roof contour to
provide full dormers.
Located: 1895 Leeton Dr., Southold. SCTM#58-2-10
The CAC recommends Approval of the application with the Condition that no
construction should take place, which reduces the distance to the wetlands.
Vote of Council: Ayes: All
Motion Carried
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.
.
Albert J. Krupski, President
James King, Vice· President
Henry Smith
Artie Foster
Ken Poliwoda
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
Office Use Only
_Coastal Erosion Permit Application
........wetland Permit Application ............Major _Minor
_ Waiver/Amendment/Changes
_-1feceived Application:~
_ ~ceived Fee:$ J.-OO....
~ompleted Application '/~'J/03
_Incomplete
_SEQRA Classification:
Type I_Type II_Unlisted_
_Coordination:(date sent) SEP 29 2003
..RAC Referral Sent: ~
-f1ate of Inspection: ¡OJ ISI~ ..... '1M
_Receipt ofCAC Report: IoaI1l limn.
_Lead Agency Determination:
Technical Review:
.A"ublic Hearing Held:-LCY~.3)Q3
_Resolution: .
Name of Applicant Úd~<',' oL )n ~ .dr ð ~ . ~
Address ( J- S- JI /~ ;91, s., / )'p'ð'U'-'\, hþlnT!J / : c¡ j ~ /)~
S~ h/t PhoneNumber:f~ &t,O-J~17 ( J/JUb.;-lJ¡t-7/tPf'-/'J.-Fj)
Suffolk County Tax Map Number: 1000 - 5lÇ -é} - I 0
Property Location /%9j ;(~ ~ S~. h).
')
~~I
~~~1
~\
(provide LILCO Pole #, distance to cross streets, and location)
~
AGENT:
(If applicable)
Address:
Phone:
.
.
Board of Trustees Application
GENERAL DATA
LandArea(insquarefeet): ~~¿;/"Zr7J Sr~-_L ~ð7
Area Zoning }.-f-1-7 1/1, ~ A £(cE i-I I )
/ /-,/2.': Á ... ~
Previous use of property: ~ J.' /j.J
-
,.o~
Intended use of property: d.{ t' eM· 7J
Prior permits/approvals for site improvements: '*'
f\gency
Date
.,
_ 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):
lv/x
I
~~
t-?'- ~
~~-
)tf
.
.
Board of Trustees Application
WETLANDfIRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: W~.;",-, r ~. ð}' ~
Area of wetlands on lot: JT,ðDC) square feet
~
Percent coverage of lot: l¡o %
Closest distance between nea~est existing structure and upland
edge of wetlands: þ¿) feet
Closest distance between nearest proposed structure and upland )
edge of wetlands: þ"" feet (tL~~-
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):
~
.'
14·~6-J. 12!8i1- 'p.xt 12
,. PROJECr I.D. NUMBE"
.
.
/
SEa
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 Project sponsor)
T. APPt.ICANT /SPONSOR
uJ ¡¿¿Ol-m
I 2. PROJEC7 NAME
'¥ #1/4-"11..(
3. PROJECT LOCATION" / __
Munlclpall!y !?' o¡ S- l..J:::, E--¡;; ¡..) County S ò J71e; LlJ. /.j /
4. PAEC:SE LOCATION (Street at1Qre=ss and road inlersectlons. prominent landmarks. elc_. .Jf .::IfOvlOe mapI
/19'5' L..6E7ðAl ¡)I!../ý£,
3C¡¡/17ft;U;¿ /l Y -
5.
o MOClificationlalteratfon
6.
/,.-1(' ~//~ a.T~. /bl><2$~
~~~~~~
'.
IniliaHy
acres
Ullimatefv
7Jb 5 P
acres
3. Vb(( FRQ?IJSEiJ ACTION COM~LY 'NITH 8<J$TING lONING OR OTHER EXISTING '-.AND USE :=!ES7rtIC7tQN$?
"Yes 0 No [f No. describe briefly
9. '/~H.'jT 1$ ?RE3ENT LAND uSë IN VICINITY ~F PROJECT?
Ll. ;::¡es¡denllal [j.~n<Justrlal C C.Jmmercia
aesc~'be;
U .:.gncUlture
~ ParK/Forest/Ooen space
L..; Qlher
10. DOES ACTION INVOLVE A ?EFlMIT APPROVAL OR FUNDING. NOW OR ULTlMATELf ~ROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL,
STATE OM lOCAL)?
DYes ¡t No !f yes. [ist agency(s) and permit/approvals
'r
11. DOES ANY ASPECT OF THE ACTlor~ HAVE A CURRENTLY VAUD PERMIT OR APPROVAL?
o Yes' ~ No It y<!!s, list age(lcy name and permIt/approval
12. AS RESULT OF PROPOSED ,;CTlON WIL!.. EXiSTING PERMIT!APPI:10VAl FJEOUtRE .\100lFICATlCN?
Y~s 0 No
I CEiiTlFY THAi ïHE INFORMAT!ON PROVIDED AeOVE IS TRUE -0 iH: 3ES7 OF MY KNCWL:;;iJGE
Applicant/sponsor
Oðle:
9i»/ö 3
Signature:
If the action is in the C02stal Area, and '{au are a state ac;ency, complete the
Coastal Assessmen: Form betore proceeding with this a~~essmen:
OVé:R
.
.
Albert J. Krupski, President
James King, Vice-President
Artie Foster
Ken Poliwoda
Peggy A. Dickerson
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971..0959
Telephone (631) 765-1892
Fax (631) 765..1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
~le ,~¡ ~: :3E ~
BOARD OF TRUSTEES: TOWN OF SOUTHOLD
---------------------------------------------------------------
In the Matter ofthe Application
of
Southold Town
Board of Trustees
_....l).1l~~~~~_S:..~[ll-~..~..~~l~----------..--..
COUNTY OF SUFFOLK)
ST ATE OF NEW YORK)
~~~
I, )r¡~ J~
AFFIDAVIT OF POSTING
. residing at ;2!:>- ¡},c/-r j}¡. ~-./I-ð./f?¥(
being duly sworn, depose and say:
.../"'-
That on the 6 day of OcTo&/.., 2003, I personally posted the property known as
! '8 c¡:;- U::e\ÕrJ D ILl II f" So ¡}Thc'\'.. D, N. 'i -
by placing the Board of Trustees official poster where it can easily be seen, and that I have
checked to be sure the poster has remained in place for eight days prior to the date of the public
hearing. Date of hearing noted thereon to be held ~. ðt.~ ~ r3 I
- Ot'\. or db O..l:t 1'):-00 "" .
Dated: o.JÓ~ ç- )ÔrJ3
(
Sworn to before me this.sTï
day ofJJ"<t<-oI. 200 ~
~
~4' ý'
ßí;;; AoÞ~
~ ¡/:z:::-r
Notary Public
DANIEL P. IRWIN
NOTARY PUBLIC. State of New York
No.OIlR5037815
Qualified," Suffolk County _
CommISSion Expues Jan. 1. ~_
"'Db I
Boa. of 'l'rustees Application .
, .
County of Suffolk
State of New York
N I+¡tY Sit;;; eLc=-
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. ~
77~fl-~'
si ature
DAY OF ~é?7.
BEING· DULY SWORN
SWORN TO BEFORE ME THIS
c.-fÍ
).1
19 }...-Od.3
'-
~I~~
Nota y Public
LINDA J. COO!'~R
Notary Public. State of New York
No, 48.225ñ3',Sulf~l.k c,·"nty .élfJ 0 h
Terr.-~ ~:j.(pl;-G5 D03C'8¡1'!L'~. '" ¡. ~
7
.
.
,
PROOF 011 MAILING OF NOTICE
ATT ACII CERTIFIED MAIL RECEIPTS
Name: Address: // J.
/11-~ tJ.-,...6'~ ...:i'~k/~ á..æ,~Tc.tP7h,l1ð/07o/
f)~ - iL~//~d....&· //¡j/c/-3.Pd .
~~ d .41 '-:7;:; +- M· ~ (? .::H A~ ¡ A.J.y//c¡ 7/
- ¿j ~ ~ / 'l/ð 0ß~e.,.,·· ~/ ~
'7:i1.æ::',¿/~ - /éJ £/ßð/ /A//e/ J1vu#;'¿..l/ /;~.//F7/
7l" r ~ .s/~ /~/~,hð/y'r;,5
c?'¿:v1'¿"·L- /~ - .r (; Þ1re, ~ tt..du-r-9.).Y-; ICJ7tJ7
1'1~ i. c<_.µ,JX;A~ Þ"""'1i ';fJd.,..) "
STATE OF NEW YORK
COUNTY OF SUFFOLK
, ,rcsidingat /j?9S~~"
Þ...:;¡¡¡:,::{:,;¡ h ~9 7/ ,being duly swom, deposes and says that on the
)'IP day of ~. r ,20 Ó;, deponent mailed a true copy of the Notice
set forth in the Board of Trustees Application, directed to each of the above named
persons at the addresses set opposite there respective names; that the addresses set
oppositc the names of said persons are the address of said persons as shown on the current
assessment roll of the Town "f Southold; that said Notices were mailed at the United States Post
Offi~e_ at ;f:..~ ¿P~ h-1" that said Notices were mailed to each of said persons by
(certlhed) (regIstered) mal\. .
7;( /; ::£9 ~
V
Swom to before me this ~ 1
Dayof~'2~ ,20~
" ) .,....
J£¿ /
r /t
.¿ "-" L C,?¿L'l ~
/ Notary Public
~T1IIC1A CORWIIt
ND13IY Public, Stall of New Yorl<
No. 01005017852
Oualified in Suffolk Coun~J -
Commiss~n Expires SepllJ, MCJ
.
J\.rpLtCJ\.NT .
TRANSACTIONAL DISCLOSURE FORH
Tha Town of Sou~hold'a Code of Bbhlcs toh1blbs confllcbs of
nterest on bhe part of town off cers and employees. The
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 11eceSSary to avoid same.
f}(
~~ :i~¿lf&~~~~\
. ~ , .
tOUR HJ\.HE.
-'r~.
Last name, first name, n tal, unless
you are applyln~ in the someone else or
Qther entity, such ~B a company_ If so, indicate
the other persohls or company's name.)
...
;-:'~~'A:' :::~~.:..:~f,'·:··!::'
HATURE OP APPLI~J\.TI0H. (check all bhab applY·)
Tax gdavance
Variance
Chang. of zone
Ap'p~pNal of plab ~
Exa~pblon from plab or offlclal map
other ç> ~/1~a1
(If "obher," name bhe actlvHy.) Í¡~I""'- -:-1'~~~ ~
Do you pereona11y (or through ~our cOMpany, øþOtlde, blbllng,
parent, or child) hove B relationship with Dny officer or
employee o~ the Town of Southold1 ·Relationship· includes
by blood, .arriage, or business interest. -Business
1nberest. Means s buslness, in<!lud1ng a parbnership, 1n
vh1ch ~he tovn officer or employee has even a partiai
ovnership of (or eMploYMent by) a corporablon 1n vhich
the ~ovn of ricer or e~ployee ovnø more than 5% of ~he
sh"ares. /'
TBS HO V".
,~
If you answered ·!89,M. complete ~he bà1ance nf ~hl. tor. and
date and olgn vhere indicated.
Hams of psrson employed by bhe Town of Soubhold
TibIe or positlon of bhat paroon
Doecrlbe bhe rolatlonehlp bebwaen youroalf (bho apþlicanb)
and the town officer ør employee. Ei~her check ~hø
appropriate line ~) through D) and/or. describe in ~he space
provided.
-
The bown offlcer or omployee or hh or her spousa, sibling,
parent, or chlld is (check all bhab apply).
~) bhe ownor of greaber bhan 5% of bho shares of the
----- corporabe sbock of bhe appIlcanb (when bhs appllcant·
ls a corporatlon),
_____B) the legal or beneflcial owner of any inberesb In a
noncorpor8~e'enti~y (when ~he aþplicant is not a
corpora~ion) r
_____C) an offlcer, dlrector, parbner, or employse of bhe
appllcanb I or
_____D) bhe a<!tual appllcent.
.,
..
."~' ~
DESCRIPTION O~ REL~TIONS"tP
" .",
..,
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, ; ~,.~..
.. ....._- .
sub,.i Hed
slgnature.
·prlnt na..e
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