HomeMy WebLinkAboutTR-5072
Board Of Southold Town Trustees
SOUTHOLD, NEW YORK
PERMIT NO. 50? J..
DATE: Oct. 28, 1999
ISSUED TO ... CONRAD & JESSIE VEROSTEK
l\utqurii::ntiun
Pursuant to the provisions of Chapter b 15 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 .Oct. 27 ,
19 99, and in consideration of the sum of $ 150.pO . paid by
Nicholas Vero for Conrad & Jessie Veroste!< ............
of Southold N. Y. and subject to the
Terms and Conditions listed on the reverse side hereof,
of SOjltholc;l Town Trustees authorizes and permits the following:
Wetland PermIt to remove exist. structure from exist. foundation,
and remove exist.locust post/concrete 'foundation,excavate for ne
, poured concrete foundation within exist. building footprint, & reloc
exist. structure on new foundation with the condition that staked
haybal<:s be placed dQWI'Ihdu.rin¡¡ const.. and that drvwe).1~-, hlì
all In accoraance wlTn T e aeTðflea speclf'cafíons as presen1'\ra 1
the originating application.
installed; two - 4'indepth X 8' in diameter pre-cast drainage
IN WITNESS WHEREOF, The said Board of Trustees Mre-
by causes its Corporate Seal to be affixed, and these presents to
be subscribed by a majority of the said Board as of this date.
Trustees
.
.
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TERMS and CONDITIONS
The Permittee
Conrad & Jessie Verostek
residing at
pan of the
lowing:
N. y~ as
consideration fot the issuance of the Permit does understand and prescribe to the fol-
415 Mill Creek Rd., Southold
1. That the said Board of TrosTees and the Town of Southold are released from any and
aU damages, or claims for damages, of suits arising directly or indirectly as . result of any opec·
adon perfonned pursuant to this pennie, and the said Pennitœe will, .t his (If her own expense,
defend any and all such suits' initiated by third parties, and the said Pennittee .'b...... full liabillty
with respect thereto, to the complete exclusion of the Board of Trostees of the Town of Southold
24
2. Tbat this Penult is valid for a period of mas. which is considered to be the
estimated time requited to complete the wotk involved, but should årcumstances warrant, request
for an extension may be made to the Board at a later date.
3. 11,at this Permit sbould be retained indefinitely. or as long as the said Pennittee wishes
to maintain tbe structUre òr project involved, to provide evidence to anyone concerned that .uth·
otization was otiginally obtained.
4. That the work involved will be subject to the inspection and approval of the Board or
ilS agents, and non-compliance witb the ptovisions of the originating appli01tion, may be cause for
revocation of tbis Petmit by resolution of the said Board.
5. That thete will be no unreasonable interference with navigation as a result of the wodt
herein atid10rized.
6. Tbat there sball be no interfetence with tbe right of the public to pus and repass along
the beach between higb and low water marks.
7. That if future operations of the Town of Southald require the removal and/or alteratiODS
In the location of the wotk herein aulhorized, or if, in the opinion of the Board of Trostees, the
wotk sball cause unreasonable obstruCbon to free navigation, the said Petmlttee will be required,
npon due notice. to temove or alter this wotk Ot project betein stated wIlhout expenses to the Town
of Southold.
8, That the said Board will be notified by tbe Permittee Ot the completion of the work aulh-
orized.
9. That ,he Permittee will obutin aU othet permits and consents that may be required sup-
plemental to this permit wlùch may be subject to revoke upon failure to obtain woe.
.
.
Albert J. Krupski, President
James King, Vice-President
Henry Smith
Artie Foster
Ken Poliwoda
Town Hall
53095 Main Road
P.O, Box 1179
Southold, New York 11971
Telephone (516) 765-1892
Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
October 28, 1999
Mr. Nicholas A. Vero, Architect
110 Mill Rd.
Westhampton Beach, NY 11978
Re: Conrad & Jessie Verostek
SCTM#135-3-30 .1
Dear Mr. Vero:
The following action was taken by the Board of Town Trustees
during its regular meeting held on October 27, 1999 regarding
the above matter:
WHEREAS, Nicholas A. Vero on behalf of CONRAD & JESSIE VEROSTEK
applied to the Southo1d Town Trustees for a permit under the
provisions of the Wetland Ordinance of the Town of Southold,
application dated September 20, 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 October 27, 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 of the Southold Town Code,
.
.
WHEREAS, the Board has determined that
will not affect the health, safety and
people of the town,
the project as proposed
general welfare of the
NOW THEREFORE BE IT,
RESOLVED, that the Board of Trustees approve the application of
CONRAD & JESSIE VEROSTEK to remove existing structure from
existing foundation, and remove existing locust post/concrete
foundation, excavate for new poured concrete foundation within
existing building footprint, and relocate existing structure on
new foundation with the condition that staked haybales be placed
down during construction and that drywells be installed; two _
4'in depth X 8'in diameter pre-cast drainage rings.
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,
~ ~ /4.-/.Jo~' n .
" , ~
Albert J. Krupski, Jr.
President, Board of Trustees
AJK/lms
cc: DEC
Building Dept.
.
.
Telephone
(516) 765-18'12.
Town Hall. 53095 Main Road
P,O, Bo, 1179
Southold, New York 11971
SOUTHOLD TOWN
CONSERVATION ADVISORY COUNCIL
At the meeting of the Southold Town Conservation Advisory Council held Monday, October 18,
1999, the following recommendation was made:
Moved by Scott Hilary, seconded by William McDermott, it was
RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH A
CONDITION of the Wetland Permit Application of CONRAD & JESSIE VEROSTEK 135-
3-30.1 to remove existing structure ITom existing foundation, and remove existing locust
post/concrete foundation, excavate for new poured concrete foundation within existing building
footprint, and relocate existing structure on new foundation,
415 Mill Creek Rd" Southold
The CAC recommends Approval with the condition that haybales be placed down before
construction,
Vote of Council: Ayes: All
Motion Carried
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Name of Applicant Conrad and Jessie Verostek
c/o Alyce Verostek
Address 415 Mill Creek Road
Southold, New York 11971 Phone Number: (516165-4712
"
.
Albert J. Krupski, President
James King, Vice-President
Henry Smith
Artie Foster
Ken Poliwoda
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use
,! n ¡
Coastal Erosion Permit APPlica~i~
~Wetland Permit Application .,.".
_Grandfather Permit Application!,"·
Waiver/Amendment/Changes :.. '
Received Application: 9·.J..o- '1
Received Fee:$(~O ___
Completed Appl~cation V·.lD-~
Incomplete
SEQRA Classificat~on:
Type I Type II ~ Unlisted
Coordination: (date sent) ----
CAC Referral Sent: '-Å.Or- r
ate of Inspection: /O-.;¿O--, ,
Receipt of CAC Report:
Lead Agency Determination:
Technical Review:
Public Hearing Held: 10 -"-7-f!
Resolution: .
'.
Town Hall
53095 Main Road
P.O. Box 1179
Southold. New York 11971
Telephone (516) 765-18,'!2
Fax (516) 765-1823
I :.-;..-~.- . . . ______
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SEP 20 /999 " ',j)
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SEP 2 0 1999
v
Suffolk County Tax Map Number: 1000 - 135-3-30.1
Property Location: 415 Mill Creek Drive. 150.21 West of curve
at Mill Creek Drive
(provide LILCO Pole I, distance to cross streets, and location)
AGENT: Nicholas A. Vero, Architect
(If applicable)
Address:
110 Mill Road, Westhampton Beach, New York 11978
1
Phone: 516-288-1404
FAXI: 516-288-0549
4IPoard of Trustees APPlica1lÞn
GENERAL DATA
Land Area (in square feet): 15,560 s.f. (.333 acres)
Area Zoning: f2.-2-
Previous use of property: Existing Residence
Intended use of property: Maintain Existing Residence
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):
1. Remove existing structure from existing foundation, and remove
existing locust post/concrete foundation.
2. Excavate for new poured concrete foundation within existing
building footprint.
3. Relocate existing structure on new foundation.
~d of Trustees APPlicatio~
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: A new foundation is required to
replace the existing locust post foundation that is in need of a
major structural overhaul.
Area of wetlands on lot: I 2,000
square feet
Percent coverage of lot: 12.8
%
Closest distance between nearest existing structure and upland
edge of wetlands: 75.0 feet
Closest distance between nearest proposed structure and upland
edge of wetlands: 75.0 feet
Does the project involve excavation or filling?
No
x
Yes
If yes, how much material will be excavated? 150
cubic yards
How much material will be filled?
o
cubic yards
Depth of which material will be removed or deposited:
feet
6 .
Proposed slope throughout the area of operations:
o
Manner in which material will be removed or deposited:
Excavated with backhoe and dump trucks.
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):
No effect.
. . t...-
T 4·16_01 /21871- ï'!x! 12
- I I 617,21
" PROJECT 1.0. NUMBE¡:¡
Appendix C
Slate Environmental Quality Review
SHORT EN~RONMENTALASSESSMENTFORM
For UNLISTED ACTIONS Only
PART I-PROJECT INFORMATION (To be completed by Aoplicant or Project soonsor,
1. APPLICANT /SPONSOR I 2, PROJEC7 NAME
Nicholas A. Vero, Architect Verostek Residence
3, PROJECT LOCATION:
Munic:loallty Southold Cùunty Suffolk
" PREC:SE LOCA TlON (Street aadress ana road inlerSec'Jons. prominent landmarKs. etc.. .Jr ;)rOVlce :nap)
415 Mill Creek Drive, Northside,
150.21 Feet West of curve of Mill Creek Drive
-
5. IS PROPOSED ACTION:
.' o New o Expansion ~ Mooificatlon/alleraUon
6. DESCRIBE PROJECT 8RIEFL Y:
1. Remove existing 1 story structure from its existing foundation and
remove existing locust post/concrete foundation.
2., Excavate for new poured concrete foundation.
3. Relocate existing structure on new foundation.
7, AMOUNT OF LAND AFFECTED:
rn1!ially .335 acres Ultimatelv .333 acres
I 3. '/JILL ?!=!O?0SEù ACTION COIvIPLY WITH Ë,'(ISTING ZONING OR OTHER EXISTING LAND US¡: ::1ESï~IC7rGNS?
gYes ONO If No. descnbe bnetly
g, 'I/HAT IS ?AESENT LANù u::i:: IN VICINITY OF PROJECT?
XXReS¡dentlal n.!noustnal C C.JmmerClal o Agnculture - -
I ~ Pao</ForesUODen ,>cace !........; Olher
Jesc:lbe:
10, DOES ACTION INVOLVE A PI.:RMIT APPROVAL OR FUNDING. :-.lOW OR UlTlMATELf ~ÑOM ANY OTHER GovERNME~TAL AGENCY (FEr:
STATE OM lOCAU?
DYes UNo If yes. list agency(s) and øermitfaoprovals
'r
11, DOES ANY ASPECT OF THE ACTlor~ HAVE A CURRENTLY VAUQ PE!=IMIT OR APPROVAL?
DYes ~o It yes. list agency name and permtf/approval
'2, ,1S A AESUl':" OF PROPOSED ACTION WILL ::;<ISTING PERMIT/APPROVAL rtEQUIAE .\.10DIFIC..\¡ ION?
DYes IKJ No n.
- - - - . -
I CE/1TIFY THAT ¡HE INFORMATION PROVIDED "'eaVE IS T;:¡UE -0 THE 3ESr OF.yy KNCWl;:;DGr::
,10plicanllsponsor name: Nicholas A. Vero,
s,qna'u,.~ _ ~V ->~
Architect
D.He:
9-10-99
If the action is in the CO"$tal Area, and you are a state agency, com pie Ie Ihe
Coastal Assessment Form before proceeding with this a~~essment
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?ARi III-OEiERMINAiICN OF SiGNIFICANCE lTe je eomoleted jy Agency)
INSïñUC-:-10NS~ For '33C:1 adverse ~tfec: identitie-:::l acove.,::1etermine wnerner It is SUCSTantial. large. imcortã.nt or otherwise
:'3c:-i !ifec': snouid :Je ;ssessed in c::Jnnec:ion 'Nun Its (31 setting (Le. urban or íural); (I:;) ;JrobaC1lity ot oc::~q; lC} L
irre'¡erslbility: :e) geogracnlc ,3coce: ana (f) maqnltuce. If ~ecessary. add attachments or reference SUPPorting materials,
2XClanaticns ccn[alO suttic:ent delali ~o snow tnat all ~e!evant adverse impacTs nave been identified and adeQuatelY ace
C~eCK ~hi5 :;ox :f you ilave identHi~å one or more ;;otemialIy larçe or significant aC'Iersa imoac::s Wi'll
aC~:Jr. Then :)(oceeo (ji(ec~ly to :he ;:UL!... =-:l.F 3.na/or preoare 3 p05itiv~ cec!araticn. .
~ C:'eç:< :his ~ox :r you have ae!ermmed, ::Jased an the infcrmation and analysis above and any SiJI
r COC:.Hì":emaucn. :hat ;t':e :)rOOQsea ac:ion '."IIL!... ~~OT result inJoy signiíicant acverse envlrcnmenta¡
~ND :)rQv'ce 'In ~;,tac:lí.lents 3.5 neç2ssarv, the ~easons 5upconing thIS determination:
j. ;;;Z;;Y ;¡;'ÚÀ- 1.l~J i: ~;dfU
AL.IJ~,e7 .T- 1\£(1/5/.(( ;;'_" .,"" "e"'I/lþ·;¿~¿g,.~t/
cLlJ.~;¥·'()' ""'"L"'/" .n:" "1t ""7) ;,,,<,, <,~""< 0''''''
/" I"~i~ ;,LJ
;...n.llufC' 11 o(,,\CQn"OIII~ '::I:,,,:o!" n _~.I( .~>:~ncv >,>:n..:Ul~ )f .""...J.I,.., 'If ":":I!"~nt :r.-:¡m {I!'~oon"ol" Jr'·.
/0 ' JZ cJ - 7' Ý
.:;...11:'
-
. . {.-
1.4-:6·... 12J871- iext 12
.. I I 617.21
" PROJECT 1.0. NUM8EFI
Appendix C
Slate Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART I-PROJECT INFORMATION (To be completed by Aoplicant or Project soonsor)
1 _ A.PPlICANT ¡SPONSOR I 2. ?ROJEC-:- ~AME
Nicholas A. Vero, Architect Verostek Residence
J. PROJECT LOCATION:
Municipality Southold C,Juntv Suffolk
4, PRECISE LOCATION (Street aDdress and road inrersecrions. crominent lanomarks. ~[c..,J( "ovlae :nap)
415 Mill Creek Drive, Northside,
150.21 Feet West of curve of Mill Creek Drive
.
-
-
5. IS PROPOSED ACiION:
.' DNew o Expansion I!J Moaifìcalion/alleration
Õ, DESCRIBE PROJECT BRIEFLY:
1. Remove existing 1 story structure from its existing foundation and
remove existing locust post/concrete foundation.
2., Excavate for new poured concrete foundation.
3. Relocate existing structure on new foundation.
7, AMOUNT OF LAND AF¡::¡;CTED:
Initially .335 acres Ullímatelv .333 acres
3. '/JIU.... FRO?OSED ACTION COMPLY 'NITH EXISTING ZONING OR OTHER E..'<ISTING LAND USE ::IE5ï¡:¡IC7ICNS?
gYes DNo It No. describe brrefly
g, 't/HAT IS ?AE5ENT LAND U::ë IN VICINITY OF ?AOJECT?
X'XneSldenual rï.!nClUSfrtal C Cùmmerciâl U AgtlcUlture ' I PanúForesuOoen scace -
I L..:Olher
Desc~lbe:
:0. DOES ACTION INVOLVE A ?!:RMIT APPROVAL OR FUNDING. NOW OR ULïIMAïEL"f FMOM ANY OTHER GOVERNMENTAL AGENCY W::i:
STATE Oñ LOCAL)?
DYes UNo If yes. list agency(s) and permit/acørovals
.'"
11. DOES ANY ASPECT OF THE ACTlOr..¡ HAVE A CURRENTLY VAUQ PERMIT OR APPROVAL?
DYes ~o /I ylits. list agency name and permlUaoproval
12" AS A AESUL-:- OF PROPOSED ';C,lQN WILL s<rSTlNG ?ERMIT/APPROVAL FleQUIRE :v1QQIFICAïION?
DYes IKJ No
r CERTIFY THAT THE INFORMATION PROVIDED AeOVE IS TRUE -:-0 THE 3EST OF MY KNCWLEiJGE
Apclicanllsponsor name; Nicholas A. Vero, Arehi teet
~-y: ~
Sfgnalure: -----==. _~__~
Odle' 9-10-99
If the action is in the CODsta! Area. and 'Iou are a state agenc'l. complete the
Coastal Assessment Form before proceeding with this a:¡.~essment
OV!:R
?~;;.~ ¡1=-,=~,'~IM~.~J~:~~.~ï ~S~S=~~~Ë~ : :-:~ ,:~..~~~~~'~~~~~ ~~~ ~;2~C.
I .... ...GE:. ....C.,I..,' _...C__..... _NY. I. _. ''''''..t:...,...,GL... r 'J .~.,-.-.r-. ~r-.I ).',.. f I~::'. :::crClna!'3 'ne '!!V'~"" :roce5~ ,!nc 'J:'Se ·I".e =:~L_
! ---,:'fo!s 1_;..10
=. ·.....ILL AC7:CN .;:U~·:~:":: :::CROIN..., t:~ =tEVIÐN ....s ~P.C·"CE~ =.:;:;. Ul'IL.S7:;} .:.;:7iCNS ,N ) .'J'('::=:R. ;: ~;¡7 .; i ~.~í'
~ay :Ie sucersedec ::y :!.ncmer .nvOlvea açenC'l.
,/ .·~o. i!. .ieçJ.t:·,e
'- Yes
~~ o
c, O;:::ULO ..:..C7:CN ~E5iJL:-·N ),NY ACve::.SE =:=::=:::-:75 ASSCC:;":::'J .'J17!-! -~E :=·JL:"'':'.'JI~G, .;"nS"Ners :'7':ay:e -:anc....rn:~n. .f :e';I:::le\
':1. =.,.lslIng J.lr !:uallt'f, sur:,¡¡c:! ::Ir JrOL:nawale! ::ualifv Jr -:canufy. .'Olse ·ev~ts. ~x:s:¡nç :::s::ic ::a[:êr~s. ~clic .vas:e :JrCCt:c::::n
;Jo!enILal 'or :!rosõcn. ::raanaçe or :loocanQ Jroclems? =..:-::claan :merly:
C~. Á~s!"e!tc. 3çr1c:JUurat, JCc~aeologJC3.1. :-'15;onc. ::Ir Jlner .,al:.H31 ::Ir cmr:.;t:)1 .·~sourc~s: ::Ir ::.:;Jmmunlt'l ::Ir .-:elC;;'ICcrncoc .:::.¡;;rac:er"J _'
........ '/eçe!allon .:Ir ~auna. :Iso. ~r:ellfisn or '1f.lelHa soec:es. ,¡U;OIiic.Jnt :'Iacltats. :;r :hre3t<!:!'H!<I )r ~ncançerea .:öcec:es? ~ct.ã.ln :](toul'{:
C' A c~mmumt·"s ¿Xls::ng ;)Ians or ·;oaI5 as otflcl;;'U,:, iCOC(eCl. ~r a cnange In use or Intenstly IJT use 01 ~ana or .:I[her natural resourcss? :::
::5. Growtn. suoseouent -:eVelocmenl, .:Ir felarea ac::vllles likelY !O ::1e mduceo :lY !ne ::rocos¿CI ac:tcn? Ëx::llaln .Jrreilv.
-:3. '-cng :erm. :o:nort :err:"l. ':':.JmulallVe.::Ir o(ner etfec:s I10( IcenutieCl In C:·(;5? =;(.:lIaln :merl'f.
':[1':2:" .moac:.:> dnc:;Jclnc; ':~anges m :..tse 01 :wner .:Iuantlty .?r :y¡:e or ~ne~c;y,? ::.x:;llô n :;(lell·f.
J. S ::-I!::::::'E.:;R;5 -:-¡..,E:::t;E "..:K::!..::" -:-0 :3E. :;:}ro j::'ovE?S'f ~ë'-A7=:> 70 ?QT=;"lï!;.i.. ~::::V~?Së ~:, vIRCNME~"i~L ..·.~P~C7S?
_ ':'e5
___ ~~o
., "es, ':!:o:.clam :Jnellv
?ART III-OETE:1MINATlON OF SiGNIFIC.o.NC:= (To oe com Dieted oy Agency)
INSïñUC-:-IONS~ rot e3c:t adverse '!!fec't identified aCcve, determine wnetner it is sucstantiaJ. targe, ¡mcOl1ant or otl1erwls.
Ë.ac:t :!tfec-:: siJould ::Je assessed in connec:ion 'Nitn Its (a) setting (i.e. uroan or :-ural): (t) ;)rocacllity ot OC::~Q: (C)
irreversibility: ie! geogracnic 3coce: ana (f) magOlluae. If :1ecessary, add attachments or reference supoonlng marerialS.
~xClanarions c:mtam suftic:ent delati to snow that all re!evant adverse impacts have been identified and adecuatelY aCI
C~ecx. ~his box if 'fOU have idemifiea one or more :Joremialfv !arçe (lr significant aC'Ierse imoac:s wn
oC:::.Jr. Then :Jrcce20 airec~ly ~o :he '=ULL =AF" 3.naior preoare a positive- declararicn,
_ C:'ec:< :his ~ox :t you ;'ave determined, :Jased on the infcrmation and analysis .=.bove ar:d any su
~OC~fi":en(a[lcn. :h2ï: ~r.e :JrDcosea ac:ion WIL!... ~JOT result InJr.:, significant acverse envlrcnmenraJ
AND ;)rovlce ~n :;¡nac:¡ments 3S necessary. the :'easons 5upcorring tnlS determInation:
..n.".... 11 _.......<J ~ "","C"
"'Inl .II . ~co::' "~,np )1 -<,·~.::on\.Olo::' ....1I.o:-:r n ~"";:] "',,""C"I
:'110::' .)1 -<~'~oon\,o.~ '.JII,C~'
,";n.lH;fC' )I -<~'con"Ol~ ·:I!L':~r n _.....10 ~-:~nCy
;.'(n..a"",. )1 :"·..".).,¡(~r 'Ir ;":~.,,,nl (')m ·"1con\lO..~ Jrr,
~
,).HC
,
.
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~~v
.
Albert J. Krupski, President
James King, Vice-President
Henry Smith
Artie Foster
Ken Poliwoda
Town Hall
53095 Main Road
P,O, Box 1179
Southold, New York 11971
Telephone (516) 765-18f 2
Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTH OLD
BOARD OF TRUSTEES: TOWN OF SOUTHOLD
-----------------------------------
In the Matter of the Application
of
fO!loo.£L;'_~ <"~l.c._V_~~_
COUNTY OF SUFFOLK)
STATE OF NEW YORK)
I, ~\,¥,p \JPI"1'"f:.\""'(
AFFIDAVIT OF POSTING
, residing at 4\5 \'\\\\\ (\eP'(, \)~\\Ie.
being duly sworn, depose and say:
That on the day ofCctlî, 199 , I personally posted the
property known as LH':) î(\', \ \ C 1:"'1' f"- Ù" 1Je.
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 seven days prior to the date of the
public hearing. (date of hearing noted thereon to be held ~~llqqq
~ 1:00 PW\.
Dated:
~ D&i\~-,
(si tureJ
Sworn to before me this
).7"1 day of m~ 1991
fd..¡ .1-t.- iI· YJ1.u.L.l.-/
Notary Public
EDYTHE V MULLEN
NOTARY PUBLIC, State of New Yo"k
. No, 4B951 93
C a~a"~led in ~uffoJk COUnty_
omml&S (>n Exp"es Mey 26. po I
~d of Trustees APPlicatio4IÞ
County of Suffolk
State of New York
Nicholas A. Vero
BEING DULY SWORN
DEPOSES AND AFFIRMS THAT HE/KKK 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.
~ ..Þ'~Ú- ----
--- .~
SJ.gnature
SWORN TO BEFORE ME THIS
;;;2-0
DAY OF
~
, 19.z:.z-
"
UNDA I. STANTON
Notary Public, State of New YorII
No. 62-4602164
, Qualified in Suffolk co~ h.
,.."~~,..,~~ ~'ci'es --"). ~ ~<'7V
7
tlrard of Trustees APPlicattlr
~
County of Suffolk
State of New York
Nicholas A. Vero
BEING DULY SWORN
DEPOSES AND AFFIRMS THAT HE/KKK 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.
~/~
Signature
SWORN TO BEFORE ME THIS
,0
DAY OF
~
,19~
(
.---
lic
-.......
\
¡
..-/
UNDA I. STANTON
Notary Public, State of New York
No. 62-4602184 .
r, ' qualified in Suffolk Cou~þ
'.."m,sslon Expires '/' ~.t:7'7't:>
7
.rd of Trustees APPlicatie
"I
AUTHORIZATION
(where the applicant is not the owner)
..
.....
I~e'S\e_~O\/\mr\ \lffDMresiding at5J Gm\.)e £cx.~d
(print owner of property) (mailing address) ,
Ç-)l ~\îo\c9 ~~
I
do hereby authorize_t.h\~ 'Jerù
(Agent)
to apply for permit(s) from the
Southold Board of Town Trustees on my behalf.
ð 'A<Jr~ A~.~. ~~. I j M¡;;zz:Ju
ner's s~gnature)
finl rn ® rn ~ \\7 f! f;.
I'¡L~~;~~' .:
'" ',~,! nF (:' '
_ ' ,\j u,-,
8
eard of Trustees APplicat.
."
AUTHORIZATION
(where the applicant is not the owner)
I,
(print owner of property)
residing at
(mailing address)
ò-o he:t:.~n'l a.\l.'c.hQ'!:'1.:z.~
(Agent)
to apply for permit(s) from the
Southold Board of Town Trustees on my behalf.
(Owner's signature)
.
.
ArPLt~ANT
TR^NS^CTION^L DISCLOSURE FORM
The Town of Sou~hold's Code of E~hics Þrohibi~s contlic~s of
in~ereB~ on ~he par~ of town officers and employees. The
ur ose of this form is to rovide information which can
alert the town of oss ble conflicts of nterest and allow
it to take whatever action is necessary to avo d same.
YOUR NAHRI
Nicholas A. Vero ",
(Last name. first name, mldd,le lnitial;""unless
you are applying in the name of someone else or
other en~ity, such as a company. If so, indicate
the other person's or company's name.)
\ .;., ',:t~I;:~1 :::~:+~~~,~~"
.
NATURE Or ArPLI~ATIONt (Check all tha~ apply.)
.' ;..' ;·:.~h-:r~t: : ::".' ."¡~. -~;j!" .:' J:r~~
Tax grievance
Variance
Change of zone
Ap'p~p.val of phI;"
Exemp~ion from plat or
other
(If ·Ol;her,· name ~he acl;ivi~y.)
official map
Wetland
Permit Application
"
Do you personally (or through your cOMpany, spouse, sibling,
parent, or child) have a relationship with any officer or
employee of the Town of Southold1 wRelationshipw includes
by blood, marriage, or business interest. wDusiness
interest" Means a businens, including a partnership, in
which the town oEficer or employee has even a partial
, ownership of (or employment by) a corp,oration in which
the town officer or employee owns more than 5% of the
shares.
YES
NO X
If you ansvered ·YES,· complete ~he balance of ~his form and
date and sign where indicated.
Name' of person employed by the Town of Southold
Til;la or posil;ion..of I;hal; person
'Describe the relal;ionship bel;ween yourself (~he applicant)
and I;he I;own officer or employee. Ei~her check the
approprial;e line A) I;hrough 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 I;hal; apply).
A) I;he owner of greater I;han 5% of I;he shares of I;he
corporate stock of the applicånl; (when the applicanl;'
isa corp'ora Hon) I
B) I;he legal or béneficial owner of any interest in a
noncorporal;e'enl;il;y (when the applicant is nol; a
, corpora I; ion) I
C) an officer, director, partner, or employee of ~he
app1ican~1 or
D) the actual applicant.
DESCRIPTION OF nELATIONSIIIP
, "
" .
.,., ,. ..~ ~ .¥ .-. ...
¡ ,
,\ ,
. ,.. .. :. ,.. L ,.~.i..I... .._ .. . ," ._....,.. \,.l7·
.' .'. -. .,'-' ,,' '" '/II:··/.;·,:.n .!~.:j.:;~,'I..;~ '..);¡-;,i,~.:',;~{,.j.
,SUbmiH~d :i~~.'~'~~~:3C~'!~,\'
SignaI;UrQ,~. '. , , '
'" I ~1(j4a~ "¡;,::i;4!, ,', #fþëij(
. pr i nb hame.,: . ;{.L.l.ça~'. "._'~I......:',:':;~..u:1·....~:.t~~~~~ .'i;:,
:..... "'. -. ..,....., ." ,