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HomeMy WebLinkAboutTR-5278Board Of $outhold Town Trustees SOUTHOLD, NEW YORK PERMIT NO. ~Z'I~'~0~' · DATE: .~'~bruatTy..2~, 20( GARY LAUBE ISSUED TO .................................................................................... ut'lt ri ati u Pursuent to the provisions of Chepter 615 of the L~ws of the Stere of New York, 1893; end Chepter ~ of the L~ws of the Stere of New York 1952; end the Southold Town Ordinence en- titled ."REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS end the REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;~, end in e¢¢orderme with the Resolution of The B0erd edopted et e meeting held on ....~]~.~...~]~ .... . 2g.(~.]~..., end in consideretlon of the sum of $ .20.0~.0.0. . peid by Gary Laube of ............ ~.~).~!~ ..................... N. Y. end subject to the Terms end Conditions lis~ecJ on the reverse side hereof, of Southold Town Trustees euthorizes end permits the following: Wetland Permit to construct a two-story wood frame addition to an existing two-story frame residence. ell in ecoordence with the detei~ed specificetions es presented in the or;ginafing application. IN WITNESS WHEREOF, The seld Boerd of Trustees here- by ceuses its Corporete Seel to be efflxed, end these ~.resent$ to b~ subscrlbed by · majority of the seld Boerd es of th~s detm Alb~u_u~ - Ah~nt ·Artie Fos~:~r - ~.bs~nt - · Trustees TERMS end C. ONDmONS The Pe~mi~ee Gary Laube - 310 Ackerly Pond Lane. Southold part of the co~sideratioa foz the issuance of the p,.~l;~ do~ ~ ~ p~ m ~e ~1- 1. ~ ~ ~ ~ ~ T~ ~ ~e T~ ~ ~ld ~ ~ fi~ ~y ~ 2. ~t~~a~of 24 for ~ ~on may ~ ~ ~ ~ ~ at a ~ d~ m ~ ~ ~ or pmj~ ~vdv~ top~~m~~~' .~ w~ oti~y ~ 4. ~t~ewo~l~~J~t° ~ ~ ~ ~p~ ~ ~ ~ ~ ~ of ~ ~t ~ ~lu~on ~ ~ ~M ~ '6. ~~H~~~the ~t ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~le ~s~ ~ f~e ~ ~ ~d P~ ~ ~ ~ ~ol& 8. ~at ~e ~d ~atd ~ ~ ~ the ~ ot ~ ~~ ~ ~ ~' o~ 9. ~at ~e P~mit~ ~H ~n aH o~t ~i~ ~ ~a~ ~ ~ ~ New York State Office of P~rl~, Recreation ~md HI~ic Pre~ervelimt Historio Preservation Field 8ewioe$ Bureau Peebies Island, PO Box 189, Waler~ord, New York 12188-0189 518-237-8643 February 12, 2004 Gary Laube 310 Ackerly Pond Lane Southold, New York 11971 Re: National Register of Historic Pisce~ 'Town Doctor's House' Dear Ga~y Laube, The British have a quaint term for the state of extreme surprise and astonishment: "Gob smackedP I think that would about de~rlbe my response to the incredible transformation you have achieved in the restoration of the Town Doctor's House. Nsad!e~.___~ to say, I would be pleased to work with in developing the documentation nee~d to place the property on the National Register. I will go back through the information you initially subrnltted and see what additional information might be needed to complete lhe history of the property. I will also schedule a visit in the spring to gel the black & white photographs required by the National Park Service. Unfortunately, due to the state's fiscal difficulties, travel is restricted at this time, But at some point I can make the case that my work on saatem Long Island can't be accomplished without the state paying for a mole/room and a few meals. I look forward to seeing you and your resurrected house in the spring. In the mean time, I11 will move this nomination to the active pile and begin a~emb~ing the nomination do~umant. - -- If you tia~e an/'quaaions, piea~ call me at 518.237.8643, extension 3283 or ernall me at iamee.warr® O oorhp.state.nv, us Sincerely, ~:r ~~nmtion Program Analyst An Equ~ Opp~:~un~/Amn'mmw ,~W, on .,~m'~cy Albert J. I<rupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 TO; FROM; DATED: RE: Building Department Board of Town Trustees December 11, 2002 Gary Laube 310 Ackefly Pond Lane Southold, NY SCTM#70-5-5 The Southold Town Tmstee's have reviewed the survey dated May 6, 2000 and revised March 5, 2002 with regard to the septic system and found it to be acceptable. Albert J. Krupski, President James King, Vice-President At-tie Foster Ken Poliwoda Peggy A. Dickerson BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 November 21, 2002 Mr. Gary Laube 310 Ackerly Pond Lane Southold, NY 11971 RE: SCTM#70-5-5 Dear Mr. Laube; The folloxving action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, November 20th , 2002. RESOLVED, that the Southold Town Board of Trustees Approve an Amendment to Permit #5278 FOR CLEARING THAT HAS OCCURRED WITHIN 100 FEET OF WETLAND RESTORE WITH VARIETY OF PLANTINGS TWENTY FOOT LINE WHERE THOSE PLANTINGS ARE PROPOSED - SECOND ROW OF HAYBALES IN THERE TO PREVENT ANY POSSIBLE SILTATION OR STABLIZE THAT TWENTY FEET WITH WOOD CHIPS RIGHT AWAY If you have any questions, please call our office at 765-1892. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK:cjc Telephone (631) 765-1892 Town H',fll. 53095 Main Road P.O. Box 11"/9 Southold. New Yo~k 11971 SOUTHOLD TOWN CONSEHVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Monday, November 18, 2002, the following recommendation was made: GARY LAUBE to Amend_Permit #5278 for the clearing that has occurred within 100"of the wetlands, and to restore with a variety of plantings. Located: 310 Ackerly Pond Lane. SCTM#70-5-5 The CAC did not make an inspection, therefore no recommendation was made. October 31,2002 Gary. Laube 310 Ackerly Pond Lane Southold N.Y. 11971 To whom it may concern, Enclosed with the amendment to the Permit for the above aforementioned property are pictures, a survey of the property, a diagram of the proposed gardens and a list of some or all of the species of shrubs and trees to be used on this property.. A list of these tress and shrubs are all northeast natives and we are trying to ascertain how to build an 18~h century garden on this location. With the help of Tim Coffey and his plan designer we will work through the winter to determine the exact design using some or all of the plantings described above. There could be other native plants added to this as the design comes to a finish. There also will be an 18th century rock wall built along side the property, and the road that will also help run offonto the property. Shrubs: Ilex Verticilota- "winterberry" Ilex Glabra - "Ink berry" Salix Species "Pussy Willow" Itea Virginica "Sweet Spire" Clethra Alnifoia "Sweet Pepper Bush" Vaccinium Corymbossum -"Blueben3''' Vaccinium Species "Crannberry' OCT 3 I Trees: Swamp Azelea Ilex Azalea Ilex Opaca "American Holy" Deciding on more that are indigenous to the area Constable, hol , NY ©CJS 3205 (2/97) *FALSE STATEMENTS ARE PUN SHABLE AS A CRIME, PURSUANT TO THE NEW YORK STATE PENAL LAW. OCtoI~ 23, 2002 310 Ackeniy Pond Lane Southold, New York 11971 To whom it may concern, On October 23, 2002 Mr. Forresl~r put a stop to any work of cutting or pruning of any trees or bushes on the ptolm'ty aforementioned above. He informed me that I would need in which I will proceed with immediately. I did another permit from the Town trustees mean time the winter is approaching not know that I needed a permit for this. But in the and [ would like to put down the wood chips that we put through the chipper around the house to stop any ero~inn and. some grass seod. There are a few piles of dirt to the North side of the house that w~e put there when they dug the foundation and I would like to clean that up. Would you plgase allow me to do this while I wait for the permit to fimsh the rest of the property. UU! 2 4 ?IL] Southold Town Tree Commit ee P.O. l-lox .l 17!), Southold, NY 11971-0959 (631) 765-1800 To: Southold Town Trustees From: Mike Domino Co-Chairman Date: October 31, 2002 On Monday, October 21, 2002 at the request of the Planning Department, I - as co-chairman of the Tree Committee -- agreed to inspect the large Sycamore and other trees on Ackerly Pond property. I was advised that Town Trustees were on site and inspecting. A woman who identified herself as the owner informed me that DEC had issued a permit. Tim Coffey arrived and pointed out work scheduled/completed. I explained I was there in an advisory capacity and lacked jurisdiction. I looked, listened and left. At no time did I give an okay for work done or scheduled. I made three statements: I was concerned for the welfare of the large Sycamore. I hoped to be notified of future work, which should always be done by a certified arborist. I was neither pleased nor displeased with the pruning done by Mr. Coffey. Since Tree Committee members were not involved in the planning process and did not inspect the trees prior to cutting, it is not possible to make a determination concerning the need for pruning/clearing. Mr. Coffey did follow current accepted practices. I said I have no problem with that. I have many concerns with Town procedures and the current planning process. Members of the Tree Committee and 1 welcome the opportunity to meet with the Trustees to share these concerns. Please contact us towards that end. THIS IS NOT A PERMIT New York State Department of Environmenta~.g~bn~er~a~ion Notice of Complete Applicati . i' 2 5 'i; Date' Apri 23,200l i. .~. '. ~ Applicant: GARY LAUBE PO BOX 1770 SOUTHOLD, NY 11971 Facility: LAUBE PROPERTY ACKERLY POND LANE SCTM 1000-70-5-5 SOUTHOLD, NUt' 1197l Application ID: 1-4738-02816/00001 Permits(s) Applied for: I - Article 24 Freshwater Wetlands Project is located: in SOUTHOLD in SUFFOLK COUNTY Project Description: Applicant proposes to construct a two-story addition to the existing single family dwelling, a sanitary system, and well within the 100 ft. adjacent area of freshwater wetland SO-36. Erosion control structures xvill be placed along the limit of clearing, grading, and ground disturbance during construction to minimize possible sedimentation to the wetland. The property is located at 310 Ackerly Pond Lane, Town of Southold, County of Suffolk, SCTM 1000-70-5-5. State Environmental Quali~. Review (SEQR) Determination Project is not subject to SEQR because it is a Type II action. SEQR Lead Agency None DesiDaated State Historic Preservation Act (SHPA) Detertnination The proposed activity is not subject to review in accordance ~vith SHPA. The permit type is exempt or the activity is being reviewed in accordance with federal historic preservation regulations. A vailabiliiy For Public Comment Comments on this project must be submitted in writing to the Contact Person no later than 05/18/2001 DARLEEN M. GERBINO NYSDEC SUNY @ STONY BROOK BUILDING 40 STONY BROOK, NY 11790-2356 (631) 444-0365 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 February 23, 2001 Mr. Christopher Stress, AIA P.O. Box 821 Jamesport, NY 11947 RE: GARY LAUBE 310 Ackerly Pond Lane, Southold SCTM#70-5-5 Dear Mr. Stress: The following action was taken by the Board of Town Trustees during its regular meeting held on Wednesday, February 21, 2001 regarding the above matter: WHEREAS, Christopher Stress, AIA on behalf of GARY LAUBE applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated January 10, 2001, and WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and, WHEREAS, a Public Heating was held by the Town Trustees with respect to said application on February 21, 2001 at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viexved 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 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 approve the application of GARY LAUBE to construct a two-story wood frame addition to an existing two-story frame residence. BE IT FURTHER RESOLVED that this determination should not be considered a determination made for any other Department or Agency xvhich 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, Albert J. Krupski, Jr. President, Board of Trustees cc: Building Dept. DEC (631) 765-1892 Town Hall. 53095 ~ ~ P.O. Box 11~9 Soufltold, New York 11971. $0UTROLD TOWN CONSERVATI0~{ ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Thursday, February 15, 2001, the following recommendation was made: Moved by Bill McDermott, seconded by Scott Hilary, it was .. ' RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH A STIPULATION of the Wetland Permit Application of GARY LAUBE 70-5-5 to construct a two-story wood frame addition to existing two-story frame residence. 310 Ackerly Pond Lane, Southold The CAC recommends Approval with the Stipulation of a maximum available non- disturbance buffer. Vote of Council: Ayes: All Motion Carried Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (5 t6) 765-18q2 F~x (516) 765-1823 BOARD OF TOWN TRUSTEES ' TOWN OF SOUTHOLD LE'FrER OF REQUEST FOR AN AMENDMENT 'OW~R AGENT PHONE ADDRESS TAX~A~O. /000 echo -~_$ __ request an Amendment to Permit Signed By: ~dbert 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 BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application ................ STATE OF NEW YORK) AFFIDAVIT OF POSTING I, ~O~ ~[~-~ , residing at %!~ ~K~\~ ?~ I_~ being H~ly'-'sv;orkn/ depose and say: That on the ~ day of~[~, , 2007, I personally po,sted ~t~h~ property known as ~[~ Fq¢:k~o.~%w ~l ~0..~ ~c~u~.~. ~5-~ by placing the Board of Trustqe~s o~ii~-i~l ~oster w~re ~t 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~e p~ublic hearing_. ~)ate .of hearin~ no~ed thereon to be held ~_~h/..mi6 Dated: II U{ lO'z_ Sworn to befor~ me this ~ day of ~t~o~ . 200~ .Lp~ln~e~ La~'~sa f New Vol1[ NOTARY PUBLIC State o No. 01LA605925'~ Qualified In Sultolk County ~, -~ Commission Expires May29, 20~ "~ (digna~ PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Address: 64- ssa STATE OF NEW YORK COUNTY OF SUFFOLK , residing at g.O .~1c/:)30 . b} c~ [rSc~x~4 }~, ~ Cat3el ~-~c~[~O~/~ , being duly sworn, deposes a~d says that o~ the ~ I t day of (3c--'{ht~( ,20OZ, d~pon~nt mailed a ~¢ copy of ~¢ Notice set foah. in thc Bo~d o f Trustees Application, directed to ~ach of thc above n~ pa~ons at thc addresses set opposit~ ~¢re r~spective n~es; ~at opposit~ the n~s of s~d persons ~¢ ~¢ ad&ess of said persons ~scssm~nt roll ofth~ ~o~ of Southold; that said Notices were mailed at the UMt~ States,Post Office at ~ ~ , that s~d Notices were ma~d to each ofs~d persons ~y (ceaified) (re~stered) m~l. Sworn to before me ~s ~ ~ Dayof O C~ , 2~ N~ Public NOTARY PUBLIC.~~ No. 01 LA6059257 Qualified In Su~lk ~ Commission Expir~-~'~. ~ Albert J. Krupski, President James King, Vice-President Henry Smith Attic 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 ~/CwOaStal Erosion Permit Applicat~l~., etland Permit Application Major ~_ Waiver/Amendment/,Ch. anges /Re~'ved Application: I/D/O[ /eceived Fee:$ ~'Completed Application //! Incomplete SEQRA Classification: Type I Type II Unlisted Minor I 0 Coordination:(date sent)~ Refe a, Sent: 1/ O/O/ ~'~'~te of Inspection: Receipt of CAC Report: _~Lead Agency Determination: Technical Review: ~/Public Hearing Held: Resolution: Name of Applicant Address /~L~, ~ ~.~/ Phone Number:( (provide LILCO Pole #, distance to cross streets, and location) (If applicable) Address: Phone: Board of Trustees Application Land Area (in square feet): Area Zoning: Previous use of property: Intended use of property: GENERAL DATA Prior permits/approvals for site improvements: Agency Date 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): Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area of wetlands on lot: square feet Percent coverage of lot: [ ~2) % Closest distance between nearest existing structure and upland edge of wetlands: .~.~,~.;~ t feet Closest distance between nearest proposed structure and upland edge of wetlands: ,,d~--k feet Does the project involve excavation or filling? No ~ Yes If yes, how much material will be excavated?Z~t~ cubic yards How much material will be filled? . '2-ff~ ~ 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): 617.21 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I--PROJECT INFORMATION (To be completed by Aolalicant or Project sl3onsor) SEC 5. IS PROPOSED ACTION: [] New ~,ExDan$ion 6. DESCRIBE PROJECT SRIEFLY: '7. ~.iliatly ~%~: ~cres ultirnat .~v EYes ~--~ NO If NO, descnOe brmdy ~ aes,denua~ I~.!nausJnal [] Commercial 10, 0DES ACTION INVOLVE A P:-RMIT APPROVAL. OR FUNDING. NOW OR ULTIMATEL'," FROM ANY OTHER GOVERNMENTAL AGENCY ~FEDERAL, STATE CR LOCALLY [~Yes [] NO If yes, Iist agency(s) aha oermitlaoorovals .... ,, ~~ ~. 12, AS A RESULT O~ ~ROPOSED ACTION WiLL S~ISTING ~ERMIT,IAPPROVAL ~EOUIRE ~ODIPICAT,DN? If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding '.vith this a~s, essment OVER I )ART III--0~TEP. MINATICN OF SIGNIFICANCE (To ~e comt)ie~ed by Agency) 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 BOARD OF TRUSTEES: TOWN OF $OUTHOLD In the Matter of the Application of COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I, ~:?~ /_~l~-~ , residing at bei duly sworn, depose and say: That on the day of , 200 , I personally posted the property known as ~;C !~C/~e ~1~ J)~ ~ · ~k~o ~ 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 t~ ~ublic hearing. Date_of hearing noted thereon to be held~ Dated: before me this Sworn/~ dayt° of /~ 200/ ,o~aTy Public,, Sta~e ef I~'rorl AUTHORIZATION (where the applicant is not the owner) (print owner of property) residing at ~i~,~ (mailing address) do hereby authorize (Agent) --"-~Z ~ -~-~)/~k~/-%~'~ to apply for permit (s) Southold Board of Town Trustees on my behalf. from the Board of Trustees Application County of Suffolk State of New York ~o.~ I__a~_..EINGD~YSWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESEXED PER~T(S) ,~D MT AL'~ ST^TE~NTS CONT,~,~D HEREIN '~ 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. SWORN IO BEFORE ME THIS DAYOF ~ /J./,2~ ,20~/ ~ / ,) ' Notary PulPit / -djj Notary Publk,, SLate of N~ ~ No. 4896735 TRANSACTIONAL DISCLOSURE FORM The Town of Southoldts Code of Ethics prohibits conflicts of interest on the part of town officers 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 necessary to avoid same. YOUR NAHRt (Last name, firat name, m~d~.le .... ' .... n tial, unless you are applying in the name of someone else or other entity, such as a company. If ac, indicate the other person's or company*e name.) NATURE OF APPLICATIONI (check all that apply.) Tax grievance Variance Change of zone Appel>vel Exemption from plat or official map (If "other," name the activity.) Do you personally (or through your compeny~ sperms, sibling, parent, or child) have a relationship with any officer or employee of the Town og Southold? "Relationship" includes by blood, earrings, or business interest. interest" means a business, includin~ a par~nerehip~ in which the town o~Eicer or employee has even a pattie! ownership of (or employment by) a corporation in which the town officer or employee owns more than 5~ of the chares. YES NO If you anevered "YEg,N. complete the balance date and sign where indicated. ~orm and Name of person employed by the Town of gout Title or position of that person Describe the relationship between and the town officer er employee. appropriate line A) through D) an{ provided. (the applicant) check the deacribe in the space The town officer or employee parent, or child is (check A) the owner of corporate is a corpora the legal noncorp, corpo )~ an lcer, director, I or the actual applicant. e) __.C ) his or her spouse, sibling, that apply), gte than 5% of the shares of the the applicint (when the applicant b~neficlal owner of any interest in a 'entity (when the applicant is not a part,er, or employee of the DESCRIPTION OF RELATIONSIIIP SURVEY OF PROPERTY SITUA TED A T SOUTHOLD TOWN OF SOUTHOLD ~ ~_~_ · z:,~.~, ~'os~v~,~.. "7:'., ~SUFFOLK COUNTY, NEW YORK 80"48'50,, ~ ., ~~. ' ~*-?~a*~4a.z~ ~:~:~ ~ ' S.C.TAX No. 1000-70-05-05 MAY 6, 2OO0 ,~1. , NN- ,~1~, m AREA : 30,885 B3 sq ff ~ ~ ~ ,,~,, ~ ~ - ~ 0 709 ~. N ~ ~ ~ Z57,32' ~ ' 86'20'30" W , ~o~ "W~ 89.26 /~ ~~ '~ ACK LY OND LANE / 4, FLOOD ZONE NFORMATION TAKEN FROM: '~ / '. _" , ,,.,,,~,,,~o~o..~Land ~urv~vor GAEY