HomeMy WebLinkAboutTR-5053
.
.
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
March 19, 2008
Mr. Roger Flore
6165 Mariner Sands Drive
Stuart, FL 34997
RE: 1555 FLEETWOOD ROAD, CUTCHOGUE
SCTM# 137-4-34
Dear Mr. Flore:
The following action was taken at the Southold Town Board of Trustees regular meeting
held on Wednesday, March 19,2008:
RESOLVED, that the Southold Town Board of Trustees APPROVE the request for a
Transfer of Permit #5053 from William Walsh to Roger Flore, as issued on August 31,
1999.
If you have any questions, please contact our office at (631) 765-1892.
Sincerely,
1::K;: 4
President, Board of Trustees
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Notes:
'1."""P;;rpose: Pri\lQte boat dockage
2. Datum: ALW
3. Timber to be CCA-treated
4. Site: 1555 Fleetwood Rd.
Cutchogue, Suffolk Co.
SCTM #1000-137-4-34
5, Soundings taken @ low tide 4/28/99
By George Costello Jr. Dock Building
6. Adjacent Owners:
I - Scavone
2 - Malon
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1iMI5e.R /?AMP
Southhold Town
Board of Trustees
{APPROX. 150 FT.
'1Iw e" ~ t:<>LPlI IN
rL.DATSuPfl>R"T P"..ES(-rI'I'~
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If<l>f:' (,,\<20
1"j""se;1t RAMP
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80'
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2'-2"
1'-2"
4'- 8"
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8'-6"
PROPOSED DOCK FOR wn.LIAM
WALSH ON EAST CREEK,
CUTCHOGUE, SUFFOLK CO., NY,
SHEET 1 OF 2 7/7/99
.
.
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
Southold Town Board of Trustees
Field InspectionlW ork session Report
Date/Time:
Applicant:
Agent:
Location and SCTM#: \ ~ 7 - 'i. - J '1
Description of r !
Activity: '1 ~ ~ ~ C_ F '""'~, -h a.--.
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Type of area to be impacted:
,(I Saltwater Wetland
, -
Freshwater Wetland
Sound
Bay
Distance of proposed work to edge of above:
Part of Town Code proposed work falls under:
-I- Chapt.275 Chapt. 111 other
Type of Application: _ Wetland _Coastal Erosion _Amendment hdministrative
_Emergency _Pre-Submission _Violation
Info nec;ded: r" r('
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gelett' >I.. ~r"'l_' ~(<>~
Modifications:
Conditions:
Present Were: _I. King _I. Doherty _P.Dickerson tC..n. Bergen _B. Ghosio, Ir
_H. Cusack _D. Dzenkowski _Mark Terry _other
Form filled out in the field by:
MailedIFaxed to:
Date:
Environmental Technician Review:
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Notes:
~pose: Private boat dockage
2. tlatum: AL W
3. Timber to be CCA-treated
4. Site: 1555 Fleetwood Rd.
Cutchogue. Suffolk Co.
SCTM #1000-137-4-34
5. Soundings taken @ low tide 4/28/99
By George Costello Jr. Dock Building
6. Adjacent Owners:
1 - Scavone
2 - Malon
{B)~(G~~W~~
U1l MAR - 5 2008 /l!J
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Diltancc from
Bulkhcad
10' ALW
20'
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40'
50'
60'
70'
80'
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0'-7"
1'-S"
2'-2"
3'-2.
4'- 8"
6'-6"
8'-6"
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1iMBe.R R!wvtp
South hold Town
Board of Trustees
{APPROX. 150 FT.
~op. e" IS CloLP\lIN.
rU,ATSvPPl>RT PlLES(WP.~
p fc'x2.0 I
11""BJ5R RAMP
PROPOSED DOCK FOR WILLIAM
WALSH ON EAST CREEK,
CUTCHOGUE, SUFFOLK CO., NY,
SHEET 1 OF 2 7/7/99
Board Of Southold Town Trustees
SOUTHOLD, NEW YORK
PERMIT NO.
50S3
DATE: Aug. 31. 1999
ISSUED TO. WILLIAM WALSH
1\utqnri1!utintt
Pursuant to the provisions of Chapter b 15 of the Laws of
the State of New York, 1 893; 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 . Aug, .25
19. 99, and in consideration of the sum of $ 1,218,00 .. paid by
En-Consultants, Inc. on behalf of William.Walsh.
ofCut"h"gue. N. Y. and subject to the
Terms and Conditions listed on the reverse side hereof,
of South old Town Trustees authorizes and permits the following:
Wetland Permit to remove a 5'X 8' .sectlon of existlng stairs to
grade, construct a fixed timber dock consisting of a 4'X 50' I
, fixed catwalk; a 3'X 12' ramp; and a 6'X 20' timber float supporteO
by (2) 8" diameter dolphin piles with the condition that th~re be
all in accordance with the âetailed specifications as presented 1M
the originating application.
no pilings more than 24" above the catwalk decki .
IN WITNESS WHEREOF, The said Board otIl.frustees 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.
.
.
"I:æi T\WITI'iI/Uu..rUl'l'\m."...un...........
TERMS and CONDITIONS
The Permittee
William Walsh
residing at
patt of the
lowing:
1555 Fleetwood Rd., Cutchogue N. Y, as
consideration for the issuance of the Permit does understand and prescribe to the fol·
1. That the said Board of Trustees and the Town of Southold are released from any and
aU damages, or claims for damages, of suits arising dittctly or indirecdy as . result of any oper-
ation performed pursuant to this permit, and the said Permittee will, at his or her own expeose.
defend any and all such suits initiated by third paråes, and the said Permittee assumes full liability
with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold
24
2. Tbat this Permit is valid for a period of mos. ..hich is coøsidered to he the
estimated time required to complete the work involved, but should årcumstances ..arrant, request
for an extensinn may be made to the Board at a later date.
I
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.,
3. T1lat this Permit sbould be rerained indefinitely, or as long as the said Permittee wishes
to maintain the structure or project involved, to provide evidence to anyone concemed that auth-
orization was originally obtained.
4. That the work involved will he subject to the inspection and approval of the Board or
its agents, and non-eompliance witb the provisions of the originatiog application, may be cau.<e for
revocation of tbis Permit by resolution of the said Board.
5. That there will he no unreasonable interference with navigation as a result of the work
berein atidlorized.
6. Tbat there shall be no interference with tbe right of the public to pass and repass along
the beach between high and low ..ater marks.
7. That if future operations of the Town of Soutbold require the removal and/or alterations
In the location of the work berein authorized, or If, in the opinion of the Board of Trustee!, the
work shall cause unreasonable obsttuctton to free navigation, the said Permittee will he required,
upon due notice, to remove or alter this work or project berein stated without expenses to the Town
of Southold,
8. That the sa.id Board will be notified by tbe Permittee ot the completion of the work anth·
orized.
9. That tbe Permittee will obrain all other permits and consents dIat may be required ""p-
plemental to this permit which may he subject to revoke upon fallure to obrain same.
.
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.
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
August 31, 1999
Mr. Robert Herrmann
En-Consultants, Inc.
1329 North Sea Rd.
Southampton, NY 11968
Re: WILLIAM WALSH
SCTM#l37-4-34
Dear Mr. Herrmann:
The foIlowing action was taken by the Board of Town Trustees
during its regular meeting heId on August 25, 1999 regarding the
above matter:
WHEREAS, En-ConsuItants, Inc. on behaIf of WILLIAM WALSH applied
to the SouthoId Town Trustees for a permit under the provisions
of the Wetland Ordinance of the Town of Southold, application
dated July 19, 1999, and,
WHEREAS, said application was referred to the Southold Town
Conservation Advisory CounciI for their findings and
recommendations, and,
WHEREAS, a PubIic Hearing was heId by the Town Trustees with
respect to said application on August 25, 1999, at which time
aII 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 appIication, and,
WHEREAS. the structure complies with the standard set forth in
Chapter 97 of the SouthoId Town Code,
.
.
WHEREAS, the Board has determined that
will not affect the heaIth, safety and
peopIe of the town,
the project as proposed
generaI weIfare of the
NOW THEREFORE BE IT,
RESOLVED, that the Board of Trustees approve the application of
WILLIAM WALSH to remove a 5'X 8' section of existing stairs to
grade, construct a fixed timber dock consisting of a 4'X 50'
fixed catwaIk; a 3'X 12' ramp; and a 6'X 20' timber float
supported by (2) 8" diameter doIphin piIes, with the condition
that there be no piIings more than 24" above the catwaIk decking.
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 appIication pending for the same
or simiIar project.
Permit to construct and compIete project wiIl expire two years
from the date it is signed. Fees must be paid, if applicabIe,
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: $1068.00
Very truIy yours,
~9 /~~}h.
Albert J. Krupski, Jr.
President, Board of Trustees
AJK/Ims
cc: DEC
ACE
Dept. of State
.
.
Telephone
(516) 765-1s<l2,
Town Hall. 53095 Main Road
P.O. Box 1179
Southold. New York 11971
SOUTHOLD TOWN
CONSERV ATION ADVISORY COUNCIL
At the meeting of the Southold Town Conservation Advisory Council held Thursday, August 12,
1999, the following recommendation was made:
Moved by Scott Hilary, seconded by Ken Meskill, it was
RESOL VED to recommend to the Southold Town Board of Trustees APPROVAL WITH A
STIPULA nON of the Wetland Permit Application of WILLIAM WALSH 137-4-34 to
remove 5'X 8' section of existing stairs to grade. Construct a fixed timber dock consisting ofa
4'X 50' fixed catwalk; a 3'X 12' ramp; and a 6'X 20' timber float supported by (2) 8" diameter
dolphin piles.
1555 Fleetwood Road, Cutchogue
The CAC recommends Approval with the stipulation that the catwalk be reduced.
Vote of Council: Ayes: All
Motion Carried
.
".,." .
.'
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,
f
. TRUSTEES
JOhD M, Bredemeyer, III. President
Alben J. Krupski, Jr.. Vice President
HeDry P, Smith
John B. Thlhill
William G. Albertson
Thlephone (516) 765.1892
Fax (516) 765-1823
SUPERVISOR
SCOTT L HARRIS
Town Hall
53095 Main Road
RO. Box 1179
Southo1d, New York 11971
BOARD OF TOWN TRUSTEES
TOWN OF SOTITHOLD
Aug. 6, 1.992
'1<.~ ef F lo~ '
(leU: 77 do. - bll 'i-LIllo
Janet Walsh
P.O. Box 569
. Floral Park,
NY 1.1002
Re: SCTMlI 137-4-3.4
Dear Ms. Walsh:
The fOllowing action was taken by the Board of Trustees at their
regular meeting of JUly 3.0, 1992:
.
RESOLVZD that the Southold Town Board of Trustees approve the
request for a waiver to build a deck onto exis~ing house as
applied for. '".
If you have any questions, please give us a call.
~ " ~ '
Ifr;., trulY'yours,
~ -- ~(l~l ~:J!C
John M. Bredemeyer, III
President, Board of Trustees
.'
JMB/jmt
ce. BUilding Dept.
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Albert J. Krupski, President
James King, Vice-President
Henry Smith
Artie Foster
Ken Poliwoda
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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
TO: William Walsh
Please be advised
has been reviewed
August 25, 1999
that your application, dated July 19. 1999
by this Board, at the reguIar meeting of
and the following action was taken:
( XX) Application Approved (see below)
(-) Application Denied (see below)
(-) Application Tabled (see below)
If your application is approved as noted above, a permit fee is
now due. Make check or money order payable to the Southold Town
Trustees. The fee is computed below according to the schedule
of rates as set forth in the instruction sheet.
The following fee must be paid within 90 days,or ]e-apPlication
fees will be necessary. ,
COMPUTATION OF PERMIT FEES:
¡:~ ;¡: : p crq, 11
\ ( .-' l
catwalk
ramp
floa t
200' X $3.00
36' X $3.00
120' X $3.00
$600.00
$108.00
$360.00
TOTAL FEES DUE:
$
1068.00
SIGNED:
tk~,.1 ~ ;{4 .,,,..1..' 9,
PRESIDENT, BOARD OF TRUSTEES
BY:
~.L{/U2 n -J-rn nfiJ ...1___ J
RK, BOARD OF TRUSTEES
4/98
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BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
.
Albert 1. Krupski. President
John Holzapfel. Vice President
Jim King
Martin H. Garrell
Peter Wenczel
Town Hall
53095 Main Road
P.O. Box 1179
Southold. New York 11971
Telephone (516) 765-1892
Fax (516) 765-1823
ùffice Use Only ADurJulr;,l-.Œ.~'._-91.~I999J ]Im~
COdstal Erosion Permit Applicatio
~Wetland Permit Application
___Grandfather Permit Application I
Waiver/Amendment/Changes TO
Received Application: 7-{t¡-''I' WN OF SOUTHGLD
Received Fee:$/.rO ___
Completed Application 7-1 "-''
Incomplete
SEQRA Classification:
Type I_Type II_Unlistedí
Coordination:(date sent)
CAC Referral Sent: 7-,.).0- 'f" /QI 0,
Date of Inspection: ~_ I~_~, ~
Receipt of CAC Report:
Lead Agency Determination: JUL I 919M
Technical Review: v~
Public Hearing Heïd:!t'-..2.~-? 'I
Resolution:
Name of Applicant
W.lll.lam Walsh
Address
1555 Fleetwood Road, Cutchogue, NY 11935
Phone Number: (516) 734-5605
Suffolk County Tax Map Number: 1000 - 137-4-34
Property Location: 1555 FIeetwood Road, Cutchogue
300±' north of East Road
(provide LILCO Pale # , distance to crass streets, and location)
AGENT:
(If applicable)
En-Consultants, Inc.
Address:
1329 North Sea Road
Southampton, NY 11968
Phone: 516-283-6360
FAX#: 516-283-6136
1
.
Board of Trustees
.
Application
GENERAL DATA
Land Area (in square feet) : 12,721.81
Area Zoning: R-40
Previous use of property: Residential
Intended use of property: No Change
Prior permits/approvals for site improvements:
Agency
Date
x
No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspended by a
governmental agency?
x
No
Yes
If yes, provide explanation:
Project Description (use attachments if necessary):
Remove 5' x 8' section of existing stairs to grade. Construct
a fixed timber dock consisting of a 4' x 50' fixed catwalk;
a 3' x 12' ramp; and a 6' x 20' timber float supported by
(2) 8" diameter doIphin piles.
?
B!Prd of Trustees APPlicatio~
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: to provide safe, private
boat dockage.
Area of wetlands on lot:
o
square feet
Percent coverage of lot:
o
%
Closest distance between nearest existing structure and upland
edge of wetlands: n/a feet
Closest distance between nearest proposed structure and upland
edge of wetlands: n/ a feet
Does the project involve excavation or filling?
x
No
Yes
If yes, how much material will be excavated?
How much material will be filled?
n/a
n/a cubic yards
cubic yards
Depth of which material will be removed or deposited: n/a
feet
Proposed slope throughout the area of operations: n/a
Manner in which material will be removed or deposited: n/a
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):
n/a
3
, .
FLEETWOOD ROA.
Suft'olk Hea-tl'Om a 25
1" = 3000' "S .
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Notes:
1. Purpose: Private boat dockage
2. Datum: ALW
3. Timber to be CCA-treated
4. Site: 1555 Fleetwood Rd.
Cutchogue, Suffolk Co.
SCTM #1000-137-4-34
5. Soundings taken @ low tide 4/28/99
By George Costello Jr. Dock Building
6. Adjacent Owners:
I - Scavone
2 - Malon
Distance from
Bulkhcad
10' AL W
20'
3D'
40'
50'
60'
70'
80'
Water
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PROPOSED DOCK FOR WILLIAM
WALSH ON EAST CREEK,
CUTCHOGUE, SUFFOLK CO., NY,
SHEET 1 OF 2 7/7/99
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.
.
14-16-4 (2I87)-Text 12
I PROJECT ,.0. NUMBER
617.21
Appendix
State Environmental Quality Review
SHORTEN~RONMENTALASSESSMENTFORM
For UNLISTED ACTIONS Only
PART I-PROJECT INFORMATION (To be completed by Applicant or Project sponsor)
SEQR
1. APPLICANT /SPONSORWILLIAM F. WALSH BY I 2. PROJECT NAME
EN-CONSULTANTS, 1Ne.
3. PROJECT LOCATION'
Municipality CUTCHOGUE County SUFFOLK
4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map)
155 FLEETWOOD ROAD, CUTCHOGUE, TOWN OF SOUTHOLD, SCTM #1000-137-4-34; MAP PROVIDED
5 IS PROPOSED ACTION:
~New o Expansion o Modification/alteration
6. DESCRIBE PROJECT BRIEFlY:
REMOVE 5' X 8' SECTION OF EXISTING STAIRS TO GRADE. CONSTRUCT A FIXED TIMBER DOCK CONSISTING OF A
4' X 50' FIXED CATWALK; A 3' X 12' RAMP; AND A 6' X 20' TIMBER FLOAT SUPPORTED BY (2) 8" DIAMETER DOLPHIN
PILES.
7 _ AMOUNT OF LAND AFFECTED:
Initially 0.292 acres Ultimately 0.292 acres
8. WILL PROPOSED ACTION CQMPl Y WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
~Ves D No If No, describe briefly
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
~ Residential o Industrial o Commercial D Agriculture o Park/Forest/Open space DOlher
Describe.
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOWOR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL,
STATE OR LOCAL)?
~ves DNo If yes, list agency(s) and permit/approvals
DEC, COE, DOS
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
DVes ~ No If yes, list agency name and permit/approval
12. AS A RESULT OF PROPOSED ACTION WlLL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION?
Dves ~No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
ApplicanUsponsor name: TODD W ASKUCH, ENVIRONMENTAL ANALYST Date: JULY 15, 1999
s;gn~ {( )¿~~
If the action is in the Coastal Area, and you are a state agency, complete the
Coastal Assessment Fonn before proceeding with this assessment
OVE
I
B4IÞrd of ~~us~ees ÀPPliCati~
AUTHORIZATION
I,
j¡J / ¿ £ 14 11 f:::::¡,{/,4?? ¡:¡
(pr~nt ~wner of property)
residing at / ,ç,ç-7' F¿ e-f[Ju/~P
(mailing address)
¡?ÓAT7
Cv (C./1 ClGu£ MYi/'1)~
do hereby author~ze
fÇ tv-Co 1II'St..J¿-TANí'i' / /'Ie::
(Agent)
to apply for permit(s) from the
Southcld 3ca=~ of Town Trustees on my behal=.
~~?;~~
........
.
.
"
NOTICE TO Þ~JACENT PROPERTY OWNER
BOARD OF TRUSTEES, TOWN OF SOUTHOLD
In the matter of William F. Walsh
SCTM#lOOO_137-4-34
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 5' x 8' section of existing stairs to grade. Construct
a fixed timber dock consistin of a 4' x 50' fixed catwaIk; a
3' x 12' ramp; and a 6' x 20' timber float supported by 2 8"
dlameter dolphln plIes.
2. That the property which is the subject Environmental Review
is located adjacent to your property and is described as
:ollows: 1555 Fleetwood Road, Cutchogue, NY
3. That the property which is subject to Environmental Review
under Chapters 32,37,or 97 of the Town Code is open to public
comment. You may contact the Trustees Office at 765-1892 or in
writing.
The above referenced proposal is under review of the Board of
Trustees of the Town of Southold and dose not reference any
other adjacent that might have to review same proposal.
OWNERS NAME: Willlam F. Walsh
MAILING ADDRESS: 1555 Fleetwood Road
Cutchogue, NY 11935
PHONE #: 516 734 5605
Ene.: Copy of sketch or plan showing proposal for your
convenience.
.
.
PROOF OF MAILING OF NOTICE
ATTACH CERTIFIED MAIL RECEIPTS
Name:
Address:
Frank Seavone
11 EIIen Court
Glenheaa, NY 11545
Stanley Malone
264 Linton Avenue
Lindenhurst, NY 11757
STATE OF NEW YORK
COUNTY OF SUFFOLK
dba En-Consultants, Inc.
Todd Waskuch , ~ at 1329 North Sea Road
C:""rhrimpr"n , being duly sworng deposes and says
that on the 15th day of July ,19 9, deponent mailed
a true copy of the Notice set forth in the-šõãrd of Trustees
App1ica~ion, 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 Soutllampton , that said Notices
were mailed to each of said persons by (certified) (~eç&5~)
mail.
c:=;;~ !J )~J
~
Sworn t~re
day of
.~~
me this
,19l'7
! 0 -f-...--
Todd WaskucIl
~~
'D11nli~~
KIM H. STEPHENS
«t lio:q Public-Slate of N." York
~ (", ..,%:?IT:is~lon No. 501S9~1
~~. _"_,n..d '0 vuffolk
. .' Coun:i.. 'Zì~
CC,7"ÎI.~a iJn Exoires A;JQust 2, ~
6
.
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) 765-11*12
Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
BOARD OF TRUSTEES: TOWN OF SOUTHOLD
-----------------------------------
In the Matter of the Application
of
JJLùtt~_UJcLl~t\_______________
COUNTY OF SUFFOLK)
STATE OF NEW YORK)
I , Y.D~.A2...r
AFFIDt'£;Æ- OF P01~~Cb~SI LTANTS INC.
~ÅNÙ , I~.!o';'..:t';'uy dt 1329 NORTH SEA RD.
SOUTHAMPTON, N.Y. 11968
S16-283-636Ð
being duly sworn, depose and say:
That on the \8 -P-\ day of ^?;. , 199't I personally posted the
property known as r5sÇ (..Û~D Ç>~-, (' LJtU.\M~
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 place for seven days prior to the date of the
public hearing. (date of hearing noted thereon to b held n,~ '~ I~
Mör"u,t:\ t)~ ~ ~
Dated:
Swo~n to bef9íe_~e this
6)<;'K...day of ~/. 1999
~~0( ~~~
ry Public .
Kill H. STEPHENS
<i H01III)' Pubßa.8l11te of Hew Yolk
Commfulon Ho.1015831
Qua fIed In . , Sullolfl
COun!l..
Co",misslon Exei,.s Au"usr 2,QL
.
.
AI'PLICANT
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold's Code of Ethics prohibits conflicts of
interest on the part of town officers and employees. The
£J:!.!.pose of this form is to provide information which can
~lert the town of possible conflicts or interest and allow
it to take whatever action is necessary to avuid same.
YOURNAHBI W..4¿5-.4/ 1,1//¿¿;i~H F
(Last name, first name, middle initial, 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.)
NATURB OF' APPLICATION, (Check aU that apply.)
Tax grievance
Variance
Change of zone
App~oval of þlat
Exemption from plat or official map
Other
(If "Other," name the activity.) NEtv' /7CN::K
no you personally (or through your COMpany, npoune, sibling,
parent, or chIld) hav.. a relatlonnhlp vlth any offic..r or
employee of the Tovn of Southold1 "Relationship" Includes
by blood, marriage, or business int..rest. "nusin..ss
interest" meann a bunin..nn, including a partnernhip, in
vhich the tovn officer or employee han even a partial
ovnernhip of (or employment by) a corporation in vhich
the tovn officer or employee ovnn more than 5% of the
shares.
YBS
NO
)!
If you annvered "YES," complete the balance of this form and
~ate and nign vhere indicated.
"ame of person employed by the Town of Southold
Title or position of that person
Describe the relationship betwe..n yourself (the applicant)
and the town officer or employee. Either check' the I
appropriate line A) through D) and/or describe in the space
provided.
The town officer or employee or his or h..r spouse, sibling,
parent, or child is (check all that apply),
A) the owner of gr~~~ør ~h~" 5% 0f th~ ~!lar~~ c! t~o
corporate stocle of the applicant (when the applicant:
is a corporation)/
B) the legal or beneficial owner of any interest in a
noncorporate'entity (when the applicant is not a
corporation)/
c) an offf~~rr ~l~~ctori partns~, C~ ~mp13ye6 of ~h~
applicant/ or
DJ the actual applicant.
~rd of Trustees APPlicati~
Coun~y of Suffolk
Sta~e of New York
::'Ã-I\! é. r A W¡Cf ls H 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 APPLI CANT 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 r S) OR REP?ESENTATIVES ¡ S), TO EN J.'l:oR ",.'1'£0 MY PROPERTY
TO INSPEC~ TEE P~!ISES IN CONJUNCTION WITH REVIEW OF THIS
APPLICATION.
S;'¡ORlI TO 3=:?':::RE ME TP.:S
/~
O:-ar-rc,.-t {( ~~
(J S gnature
DAY OF -m7 ,2.9~
(1
~. CA,:
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c[I )"ij~·,,·:·· 1:>:>Iæs March 20. LeO )
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