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Home My WebLink AboutTR-5808 Board Of Southold Town Trustees PERMIT NO. . SOUTH OLD, NEW YORK stOl DATE: u ~~¡:>L ISSUED TO ..........J..J<:~NIJf§R...g,..P.!:ULIP4 .ST ANTON....... l\utqorilation .................. 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 Böard adopted at a meeting held on .5..!m.t,.. Z.¡!;lh. 20Q}....... and in consideration of the sum of $..2{){)AJe-· ... paid by Ep..::.CQ.rl';;.ultants. ..Inc....on..behalf ·of.··Jennifer·..i!t··uPh¡'ip"S~nton of .........$g.\Ü.b.ªmp.ton..... . ....... N. Y. and subject to the Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the foDowing: Wetland Permit to remove existing asphalt driveway and replace with pervious driveway. install drywell, and remove portion of existing bituminous driveway located within 100 feet of tidal wetlands boundary as per surveydsted 3-14-021asl revised 8-7-03 and prepared by john C Ehlers Land Surveyor an In accordance with the detailed specifications as presented in the oñginating application. . IN WITNESS WHEREOF, The said Board of Trustees here- by causes, its Corporat«: ~al to be a~xed, and these P!'esents to be subscribed by a malority of the said Board as of this dat.e. Artie .Foster T",si..s _' .' II_'_'_'_'_'_"~, .___-._....!-_.. ._ _..'è_'-_'-'-_'_-_" > . . . "--' _-_.3 !-_-,,--.-., "- .~- .-. . . . ; .-..-,-,,---- TERMS and CONDmONS Tpnnjfpr .. P¡';l;p åta..tB....,.- J J?le Permittee residiog It 302 Town Creek Lane, Southold. N. Y.. 115 put. of the coosideratioo for cbe isso..oce of the Permit does uødeøcaød and prescribe to the fol- 10wing : 1. 1bat the said Board of Trustees and cbe Town of SoucboId - released £tom U1y and all damages, or claims for damages, of suIa arisiøg direcdy oc iøclitec:dy as a resuh of my oper- ation perfotmed pUnumt to this petmIt. and the said Po· ...~"" wil1, at his oc bet own exper"". defend my oØd all such salts ·/nlH.-I by cbitd puda, and the said 1\. . Ii I.... - £aU JiIbIIiq wiIh respect thereto. to the <1OØIp1ete excIusioo of the Board of TJ:USttCS of the TOWIi of So.od ~ 2. That this PeaaIt is wild for . period of 24 mos. wbkh is ccDti'¡"CCI to be the estimated time· requited to complete the ,.ode inwl'9'C<l, but should ~"""" wøraat, request for 011 exœosion ouy be made to the Board at a Iaœr daœ. 3. 1bat this permit should be rdaiøed indef"udtely, or as long as the said Permittee wishes to ....;....;n the sttueturC 0<1 project involved, to provide evidence to U1yooe ÐOQCeCDCd chat 1UIh- .orizatioo was original1y obtained. 4. That the wodr: involved will be subject to the ïnspectinn and appronl of the Board oc its agents, and OOI1-compIiaoœ with. the pr.msioas of the origi....fI'Ig appliatioa, may be caase foe ccvocatioo of this Permit by resolutioa of the said Board. S. That there will be no unreaSOOlble interference wiIh navigat/oa as a resuh of the 1IOdo: baein ..,ihorized. 6. 1bat there shan be no interference with the right of the pd>Iic to pass and repus ùoog the beach between high and low water marks. 7. 1bat if future opentioas of the Town of Southø1d zec¡aire the remon1 aødjoc aiœndoas in the location of the work herein ..~ or ii, in the opIaIoa of the Board of T~ the wot:k shall canse unreasoøahIe obstrua1OD to free navigadoa. the said p-'.... will be reqairecI. upon due notice, to remove or alter this work or project herein stated wicbout ~. to the Town of Soucbolcl. 8. 1bat the said Boatd will be notified by tbe Permittee o( the . 011'1'" 1/<-. of the wod< III1h- orized. 9. That the Permittee will obtain all other permits and coosePis dIat may be requited ....... pIemental to tWs permit which may be subject to revolce npoo flÚlUt'e to obtain ame. .. . . 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 September 29, 2003 Mr. Rob Herrmann En-Consultants, Inc. 1329 North Sea Road Southampton, NY 11968 RE: SCTM#64-1-12 Jennifer & Philip Stanton 302 Town Creek Lane Southold, NY Dear Mr. Herrmann: The Board of Town Trustees took the following action during a Regular Meeting, held on September 24th, 2003 regarding the above matter. WHEREAS, En-Consultants, Inc. on behalf of JENNIFER & PHILIP STANTON applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated September 2, 2003 WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on September 24, 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, . 2 . 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 approved a Wetland Permit for JENNIFER & PHILIP 8T ANTON to remove existing asphalt driveway and replace with pervious driveway, install drywell, and remove portion of existing bituminous driveway located within 100 feet of tidal wetlands boundary as per survey dated 3-14-02 last revised 8-7-03 and prepared by John C Ehlers Land Surveyor BE IT FURTHER RESOLVED that this determination should not be considered a determination made for any other Department or Agency, which may also have an application pending for the same or similar project. Fee must be paid, if applicable and permit issued within six months ofthe date of this notification. If inspections are required, at a fee of$5.00 per inspection (See attached schedule). FEES: None Very truly yours, b~·j 9- ~'(}. Albert J. Krupski, J r. President, Board of Trustees AJK/cjc cc: DEC . . 0.. .'ii;.' ..~. ~ (.... ...'-~:' ~", ~". ..< '. .". .r:' -.;;",l':':.,. '. . ~~'-._- .. ',- - , fl _ .:c.- . _.. Figure I. Looking north toward existing dwelling and over bituminous driveway to be removed. ..,'.~~ ~,: ~... - ...' ~.:. . . . ...... . .... ct '::: .;.; ,"' -.- - -,;;.-- '" -- ~ Figure 1. Looking west over existing asphalt driveway to be removed und r~ay. . . Telephone (631) 765-1892 Town Hall. 53095 Main Road P.O. Box 1179 Southold. New York 11971 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conser\iation Advisory Council held Tuesday, September 23, 2003, the following recommendation was made: Moved by Bob Ghosio, seconded by Nicholas Dickerson, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH A CONDITION of the Wetland Permit application of JENNIFER & PHILIP STANTON to remove existing asphalt driveway and replace with pervious driveway; install drywell; and remove portion of existing bituminous driveway located within 100' of tidal wetlands boundary. All proposed work (including new porch) located more than 100' from tidal wetlands boundary is beyond Trustees jurisdiction. Located: 302 Town Creek Lane, Southold. SCTM#64-1-12 The CAC recommends Approval with the Condition that hay bales are placed down along the creek during construction. Vote of Council: Ayes: All Motion Carried SUR\lEY OF PROPERTY '5IìUAìE: SOllTHOLD TOWN: SOllTHOLD I =~;;_I~UNìYl NY FEMA ZONE ADDED 12-05-02 HETLAND FLAGS LOCATED 01-13-03 TOPO 4 PROPOSED PORCH 03-IQ-03 AMENDED 05-0Q-03, PROPOSED ACTIONS 017-01-03 SUFFOl.K COUNTY TAX # 1000 - 64 - I - 12 CERTIFIED TO: PHILIP B. STANTON JENNIFBR LAMBBRTS STANTON PBCONIC ABSTRACl', INC. ClTiBANK, N.A. N W*E S PHILIP B LAND NO/'1 OR FORH R STANTON , ~ENNIFER LE. ~ YSEORF c c_ " T::J JI.'~NTOU 1; ,q- V'OOD FENGE , / ~ tP ~ ~ ~ ~/ / tå ~ ~ U? U' .." n "'0 ~:z: -0 ~~ 11; 0 ..; :z:7J ~~ ~ ~í\ ~ ........ ........ -nO ~ '" 11 ....... 111. ," ~ Î\ÍI ""': ........ ? J).... ~.< ];.1 ~........ \P~ 0- ....... ~C) ~ ~ ~,,3,1~ _- ---I-rI _-........ ,n , " ..<:--..... ~ 'IB--~- , '" ',~ cv(lÓ , /", jefOf- I / "'. ,:" - ¿," "- -.-. ./- ~ / ,) ----.:,~/./ / / "/>.,r' '?-/ /." -1"';. í - J' r-.-/ :; // f .¡Z,o_ " ,/1 /,/ -'~/./; ',. )\ / . //.' 'J. / ."¿>" ~ / ., -:~\~\~i~?_ _ _. proposed df""'rvel^\l°Y ."~ / ~~ Q.rlve...ay to- be ..,::emovec:;l --'7_ / "~. /, e, '0' 00. u"<E E-" ...--11___ ~ '- '6~ . ~. /-; --- / ". . .)( ,: -,//" I ' . 1/ / 'N86°51 'OO"W / " 91.70' ., 03' O~ U,,"E E-... / . / 3~ ',''i''- w 1] cr. C' ~, .:)1 \}' - ~ ~ Ç) (Jl , , .... , , , , , '- , , \ .' -:-,r ?'Y' Z--z. ~n ~v '"~ ~- o ~:?- \ííO ?,TJ ~\', \Ie \\"7J 7J'1.. -'" 'y.-jJ 1.' <}J" "'0 ~í\ I,J' U' - 7, "" .., , 0, ",' I ~ ~ ~- \ ~ "'" ....... "........~"'- ........ --- , ~':~" -~- ~- " ........ ,___ t / }.IoJ_ drl"""'",,! t;Q I Þ , 10-.. -r- J¿e !:..e~o\¡ved ':1 '~Ý)I - ~,~ ~ ~ ~1 -q-.. 0, -.. / -"-1...... ----' --- ,,--:-.. -A_ Ftn.-. I -- L ~ f'r;..-CUDz. c". _. -VOì5 ...-0'11; x 7' _ <PNe -'\....... /1--- I E:ð - _.", ' "'- .. - "~D '- . ->¡;;LL ....... ,,~ " ~ --- '0' ""'De "0" '<'6H 1<Fjf'~"0f'·· (."765 "'V¡:,;;:.,. -~ ?Oð ~ ~ ~ o "' ~ ~ '- ~ '- e. Q;E '- -- ~- ~. \Q ,-00 ~ " ~~ NOTES. ,. ",. <~, ."-P"", o _.~, ''''~_" " P'O~ '._ . o CONCRETE MONUMENT FOUND PIPE FOUND STAKE FOUND -','. co"., .A . ',·r ~<,. ,'" .,.- '~',' ,,-. ,-Cpo .--'~. ,--",-~'" FLOOD ZONE AND TOPO LINES REFERENCE USCS NGVD '2Q DATUM AREA = 24.160 SF OR 0.55 ACRES _"",P'O , __0" '"pO .-", ,~., -, - , "" ,.." , . - "~-." 1"=30' JOHN C. EHLERS LAND SURVEYOR 6 EAST MAIN STREET N.Y.S. LIe. NO. 50202 RlVERHEAD, N.Y. [[901 369-8288 Fax 369-8287 REF.I\Hp serverldIPROSI02-129.pro - Albert J. Krupski~ preSident. / James King, Vice-President Henry Smilh I Artie Foster Ken Poliwoda . Town Hall 53095 Roule 25 P.O. Box 1179 Soulhold. New York 11971-0959 Telephone (631) 765-1892 Fex (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Applicatj,l'm _Wetland Permit ApplicatlOn ~ Major Waiver/Amendment!. ges Received Application: 1>. () Ò -Received Fee:$ .;( Completed Application '1/-10:) _Incomplete SEQRA Classification: Type I_Type "_Unlisted _ Coordination:(date sent~~ CAC Referral Sent: 1_?;i!2 b Date oflnspection: / Ill oj Receipt ofCAC Report: Lead Agency Determination: Technical Review: Public Hearing Held: Resolution: qj(}..ý!ø ,- I Name of ApplicantJENNIFER & PHILIP STANTON Address 18 ORCHARD STREET, NO.5, NEW YORK, NY 10002 Phone Number: 212-941-6101 Suffolk County Tax Map Number: 1000 - 64-1-12 Property Location: 302 TDWN CREEK LANE, SOUTHOLD (provide LILCO Pole #, distance to cross streets, and location) AGENT: EN-CONSULTANTS, INC. (If applicable) Address: 1329 NORTH SEA ROAD, SOUTHAMPTON, NY 11968 Minor ¿.¡ \;~ 'ì -. ~~,~ nu~ S.oth Id r.... r at Trustees Phone: 631-283-6360 · Board of Trustees APPlic.on GENERAL DATA Land Area (in square feet): 24,160 Area Zoning: 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 a en X N ~lE~\¥JlE _ r ~ If yes, provide explanation: "'."''1 ."" uthold Town Board 0 rus ee Project Description (use attachments ¡fnecessary): REMOVE EXISTING ASPHALT DRIVEWAY AND REPLACE WITH PERVIOUS DRlVEW A Y; INSTALL DR YWELL; AND REMOVE PORTION OF EXISTING BITUMINOUS DRIVEWAY LOCATED WITHIN 100 FEET OF TIDAL WETLANDS BOUNDARY, ALL AS DEPICfED ON THE SITE PLAN PREPARED BY JOHN C. EHLERS LAND SURVEYOR, LAST DATED 8-7-03. ALL PROPOSED WORK (INCLUDING NEW PORCH) LOCATED MORE THAN 100 FEET FROM TIDAL WETLANDS BOUNDARY IS BEYOND TRUSTEES JURISDICTION PURSUANT TO SOUTHOLD TOWN CODE CHAPTER 97. .Board of Trustees APPlic.on WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: IMPROVE CONDITION, CONFIGURATION, AND MAKE UP OF EXISTING DRIVEWAYS. Area of wetlands on lot: +/-1150 square feet Percent coverage of lot: +/-5 0/0 Closest distance between nearest existing structure and upland edge of wetlands: +/-102 feet (STOOP) Closest distance between nearest proposed structure and upland edge of wetlands: +/-104 feet (poRCH) Does the project involve excavation or filling? X No Yes (fyes, how much material will be excavated? N/A cubic yards How much material will be filled? N/A cubic yards Depth of which material will be removed or deposited: N/A feet Proposed slope throughout the area of operations: N/A œ lG; --_.. 0 I,:' 1h I' "'" ~: m....., , I' 1,- : ,-. . Manner in which material will be removed or deposited: n -'I "1)' ¡ N/A ~", !:¡ }I ~ ULf IS """"'010 IOwn BOJrd of Trwf;>es Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): THE PROJECT ENTAILS THE COMPLETE REMOVAL OF AN ASPHALT DRIVEWAY, AND THE REPLACEMENT OF ANOTHER WITH PERVIOUS STONE. THE PROJECT WILL HAVE A POSITIVE IMPACT ON THE ADJACENT TIDAL WETLANDS AND WATERS OF THE TOWN, AS IT WILL REDUCE COVERAGE BY IMPERVIOUS SURFACES AND REDUCE POTENTIAL RUNOFF. 14-18..... {2/87)-Texl t2 PROJECT I_D. NUMBER 617_21. SEQR Appendix C State Environmental Quality Revi_ SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I-PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1 APPLlCANTISPONSOR: I 2. PROJECT NAME JENNIFER & PHILIP STANTON BY EN-CONSUL T ANTS, INC. 3 PROJECT LOCATION: -ty SOlITHOLD County SUFFOLK 4 PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc, or provide map) 02 TOWN CREEK LANE, SOlITHOLD, SCTM # 1000-64-1-12; MAP PROVIDED 5. IS PROPOSED ACë]N D Modificationlalteration ~ - Expansion 6 DESCRIBE PROJECT BRIEFLY: REMOVE EXISTING ASPHALT DRIVEWAY AND REPLACE WITH PERVIOUS DRIVEWAY; INSTALL DRYWELL; AND REMOVE PORTION OF EXISTING BITUMINOUS DRIVEWAY LOCATED WITHIN 100 FEET OF TIDAL WETLANDS BOUNDARY, ALL AS DEPICTED ON THE SITE PLAN PREPARED BY JOHN C. EHLERS, LAND SURVEYOR, LAST DATED 8-7-03. ALL PROPOSED WORK (INCLUDING NEW PORCH) LOCATED MORE THAN 100 FEET FROM TIDAL WETLANDS BOUNDARY IS BEYOND TRUSTEES JURISDlcnON PURSUANT TO SOUTHOLD TOWN CODE CHAPTER 97. 7. AMOUNT OF lAND AFFECTED Initially 0.55 acres Ultimately 0.55 acres 8. WIll PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ~es DNo If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ~ Residential D Industrial o Commercial DAøriculture o Park forestlOpen space DOther Describe, 10. DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNI:JNG, NOW OR UlTtMATElY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR lOCAL)? 181 V.... DNo If yes, list agency(s) and permit/approvats Ò IE ~ IE ~ ~ IE ~. DEC 11. DOES ANY ASPI::CT OF THE ACTION HAVE A CURRENTLY VAUD PERWT OR APPROVAL? j SEP DYes 181 No If yes, list agency name and pennitlapproyal - SOllttmld Tawn 12. AS A RESULT OF PROPOSED ACTION Will EXISTING PERMIT/APPROVAL REQUIRE M FICA o. > Dyes ~o I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name a BERT E. HERRMANN, COASTAL MANAGEMENT SPECIALIST DATE AUGUST 28, 2003 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 OVER . . NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In t:he mat:t:er of applicant::JENNIFER&PHlLlPSTANTON SCTMJtlOOO- 64-1-12 YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: REMOVE EXISTING ASPHALT DRIVEWAY AND REPLACE WITH PERVIOUS DRIVEWAY; INSTALL DRYWELL; AND REMOVE PORTION OF EXISTING BITUMINOUS DRIVEWAY LOCATED WITHIN 100 FEET OF TIDAL WETLANDS BOUNDARY, ALL AS DEPICTED ON THE SITE PLAN PREPARED BY JOHN C. EHLERS LAND SURVEYOR, LAST DATED 8-7-03. ALL PROPOSED WORK (INCLUDING NEW PORCH) LOCATED MORE THAN 100 FEET FROM TIDAL WETLANDS BOUNDARY IS BEYOND lRUSTEES JURISDICflON PURSUANT TO SOUTHOLD TOWN CODE CHAPTER 97. 2. That the property which is the subject of Environmental Review-is located adjacent to your property and is described as follows: 302 TOWN CREEK LANE, SOUTHOLD 3. That the project which is subject to Environmental Review under Chapters 32, 37, or 97 of the Town Code is open to public comment: on : SEPT. 24, 2003@7:00pm You may cont:act: t:he 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 does not reference any other agency that might have to review same proposal. OWNERS NAME: JENNlFER&PHlLIPSTANTON MAILING ADDRESS: 18 ORCHARD STREET, NO.5 NEW YORK, NY 10002 PHONE .: 212-941-6101 Ene.: Copy of sketch or plan showing proposal for your convenience. 5 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 BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application (ì of J_ ~~!;i~--~ ST ATE OF NEW YORK) I, ~ ~a"l\ AFFIDA VITIiIJr.ftQ§(f[!tjtlTS INC. dbiJ. ~:1?C) ~!í)qTH SEA RD. ,ræid;u5"'t <:A'ITfH,~.'PTf)N NY. 11968 r." 1-2£3-6360 being duly sworn, depose and say: That on the /7J-.day of ~1., 200~ I personally posted the property known as 77.-0 -ro ~/ ,; by placing the Board of Trustees officia poster where it can easily be seen, and that I have checked to be sure the poster has remained in Pla~t days prior to the date of the public hearing. Date of hearing noted_thereon to be held . ~ ~ 'M-,)" ðv..- !tv ~j....~O ~fl! J Dated: (signature) Sworn to before me this ..;;tp'-day of¥.L 2003 ~i?~k -. ------ . . PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: PHILIP STANTON Address: 18 ORCHARD STREET, NO.5 NEW YORK, NY 10002 JENNIFER & PHILIP STANTON 18 ORCHARD STREET, NO.5 NEW YORK, NY 10002 STATE OF NEW YORK COUNTY OF SUFFOLK ROBERTE.HERRMANN doing business atEN-CONSULTANTS,INC. 1329 NORlli SEA ROAD SOUlHAMPTON, NY 11968 , being duly sworn, deposes and says that on the 28TH day of AUGUST .20 ~, deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at S~~~ , that I ~; ::~;. ma"ed '0 each 0' "a'd ~ln" b, (cee""ed) d8'7<-- ~ Sworn to~efore me this day of L£u¡¡J-J ,20°3 ~ Q( ~ d c:/.k A k> ~r- Notary PuMi~ - B~d of Trustees APplicatio~ ,.. AUTHORIZATION (where the applicant is not I, P/¡(/¡p 8 .Ç"hNhYJ residing (print owner of property) the owner) at/? lJ~d ~!r- {mailing address) #5 /1/dW y~, /V, V >000.2- do hereby authorize Eh~ CmJe-//z:,lt'fs. /UC, (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (-". '. W ~tr~-\ ~ ~~ \Mld 10'''" SOU \ 1n¡,d.ee-s ßtI'3tO 0 ., 8 - ~ard of Trustees APPlicati~ County of Suffolk State of New York p~ BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREJlÆISES IN CONJUNCTION WITH REVIEW OF TillS APPLICATION /~7Q C Signature SWORN TO BEFORE ME TillS vS DAY OF ~,20~ ~.cM2 N ary Public L YOIA CHEUK NoIary PubIi::, S1ate of New York No. 02CH6063678 Qualified in New York CGur.~y Ca11rnEsicn 8<pies Septernœ. 4, 2005 .- . . III'PLICIINT TRANS^CTIONhL DISCLOSURE FOnH The Town of Southold' s Code of nhics prohibits conflicts of interest on the ar~ of town officers and em 10 ees. The .I:l.!!!. 088 of this form 1s to rovlde info mation wh ch can alert tIle town of possible conlI eta of ntørest and allow It to take whatever accion is necessary 1;.0 avoid same. YOUR NIIHB. C;¡/!-Æ/JtJÂ/, p"~rL-f.P R. (L8gl:; name. first name. m ddle "11:.1a1, unless you are applying 1n the name of someone else or otl\er entity, suel1 as a company. If so, indicate tile other person's or company's name.) NATURB 01' APPLICATION. (Checlc all that apply.) Tax qrigvance Variance Change of zone IIpp,Dval of plat ~ Exemption from pla~ or orrlcial map Other ~ A (If "othe<." n.me the activity.) (Ai2..J.(afl.o'lØ<S Do you personaJ.ly (or Uu:ough YOUI:' co..pany, spauR., siblinq, pnrent, or chIld) hove 8 relntione),lp viti. any officer or employee of t.he Tovn of Sonthold7 -nalationship" includes by blood, marriage. or business interest. "Duslness interest." meana a bUBineoB, including a partnerrrhip, in vhich the tovn officer DC employee has even a partial ovnership of (or employment by) a corporation in vhich the tovn officer or employee ovns lIore than 5% of the shares. YES NO If you ansvered "YES," complet.e the balance of this form and date and sign vhere indicated. Name of person employed by the Town of Soutl101d Tille or position of that per Bon Desc<ibe the <elationship between you<self (the applicant) and the town officer or employee. Either check the appropriate line A) tl1rough D) and/or describe in the space provided. Tile town officer or employee or 11is or her spouse, sibling, parent, or child is (check all that apply)¡ _h) the owner of greater than 5% of the shares of the corporate staclc or the t\pplicant (when the applicant. is a corporation); B) the legal or beneficial owner or any interest in a noncarparate entity (witen the applicant is not a corporation) , _____C) an officer, director, partner, or employee of the applicant I or D) tile actual applicant. DESCRIPTIOrl or RELATIONSIIIP Submitted thi~/flf ~ J.g~ Signature ~~ P<lnt name PtfIU~ ST'IIN~ ~/ , . APPLICANT/AGENTIREPRESENT ATlVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold . s Code of Ethics DTOhibits conflicts of interest on the Dart of town officers and emnlovees. The nuroose of this form is to nfovide infonnation which can alert the town of DOssible conflicts of interest and allow it to take whatever action is necessarY to avoid same. YOUR NAME: _e~rA \-\e.,rrMtll....... I ~ - r ß\l\5" Ih:..... ~ .k( . (Last name, first name, middle imtial, 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.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Variance Change of Zone Approval of plat Exemption from plat or officiaJ map Other (I f "Olher", name Ihe aClivity.) \NL*l Þrt-I 1) S 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, induding 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 ··VI!)'. complete the balance of this form and date and sign where indicated. Name of person employed by the Town of South old Title or position of that person Describe the relationship between yourself (the applicant/agent/representative) 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): _A) the owner of greater than 5% of the shares of the corporate stock of the applicant (when the applicant is a corporation); _B) the legal or beneficial owner of any interest in a non-corporate entity (when the applicant is not a corporation); _C) an officer, director, partner, or employee of the applicant; or _D) Ihe actual applicant DESCRIPTION OF RELATIONSHIP r-. Submitted thi'Æ-daY of ~J . SIgnature . Print Name ~ OWl/- LLIV...-..-u..,..,. 200 3 . ~ EN-CONSULTANTS, INC. ENVIRONMENTAL SERVICES August 28, 2003 Town of South old Board of Trustees Post Office Box 1179 Southold, New York 11971 Attn.: Charlotte Cunningham Re: Jennifer & Philip Stanton 302 Town Creek Lane, Southold SCTM #1000-64-1-12 Dear Ms. Cunningham: . 1329 North Sea Road Southampton. New York 11968 631-283-6360 Fax: 631-283-6136 E-mail: encon@peconic.net www.enconsultants.com ~~ s~p œ I :",œ ~ Southold Town Board of Trustees In regard to the above referenced property, enclosed are the following for the Board of Trustees review: L 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 ofauthorization & disclosure forms. 4. Three (3) work plans. 5. Three (3) copies of survey. 6. One (I) set of site photographs. 7. Application fee 0[$200.00. I trust this information shall allow you to process our permit request. Should any additional information be required, please do not hesitate to contact our office. S inc.eJj~ I Y , In 1/', .1 I' .. n(. Robert'E. Herrmann Coastal Management Specialist /Idt~ Ene.