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Home My WebLink AboutTR-5605 Glenn Goldsmith,President OF SOT Town Hall Annex A. Nicholas Krupski,Vice President ®� ®� 54375 Route 25 ® P.O. Box 1179 Eric Sepenoski Southold, New York 11971 Liz Gillooly Elizabeth Peeples � ® � Telephone(631) 765-1892 R Y Fax(631) 765-6641 C®UNV BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD April 20, 2023 Andrew &Andrea Weisbach 497 Ripplewater Lane Southold, NY 11971 RE: 497 RIPPLEWATER LANE, SOUTHOLD SCTM#: 1000-76-1-15.3 Dear Mr. and Mrs. Weisbach: On April 10, 2023, a Field Inspection was performed and it was determined that the buffer and path on the above-mentioned property do not match that which was permitted under Wetland Permit#5605. The following action was taken at the Southold Town Board of Trustees regular meeting held on Wednesday, April 19, 2023: RESOLVED, that the Southold Town Board of Trustees DENIES the request for a Transfer of Wetland #5605 from Gail Rerisi to Andrew &Andrea Weisbach, as issued on August 23, 2002. If you have any questions, please contact our office at (631) 765-1892. Sincerely, Glenn Goldsmith President, Board of Trustees GG/dd Glenn Gurusmith,President �o\pS4FFO(,�CGGy Town Hall Annex A.Nicholas Krupski,Vice President C 0 54375 Route 25 Eric Sepenoski w ,? P.O.Box 1179 Liz Gillooly �y • o�� Southold,NY 11971 Elizabeth Peeples �Ol �a Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: o Completed infield by: 9II2A6c}- Pefole c ANDREW & ANDREA WEISBACH request a Transfer of Wetland Permit#5605 from Gail Rerisi to Andrew &Andrea Weisbach, as issued on August 23, 2002. Located: 497 Ripplewater Lane, Southold. SCTM#: 1000-76-1-15.3 Type of area to be impacted: Saltwater Wetland Freshwater Wetland Sound Bay Part of Town Code proposed work falls under: ✓Chapt.275 Chapt. 111 other Typp of Application: Wetland Coastal Erosion Amendment Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Info needed/Modifications/Conditions/Etc.: r Vyn !Vkye, }o hong+r 4'0" wrat mkt% MNA swQ" M,0h-A1&6V10&1nut b-jK-tr nem a► ke'4u cr mt. Prey i dt h,t Dowyo o Qin to 112-116 *9- 1 Present Were: G. Goldsmith N. Krupski E. Sepenoski L. Gillooly ✓ E. Peeples February 9, 2023 D Town Of Southold: MAR 6 2023 Board of Trustees Southold Town Transfer of Permits: Board of Trustees #8501—Pool/Deck #6173- Pier #5605- House We purchased our home at 497 Ripplewater Lane, Southold NY 11971- in March 2021.Just recently we realized that the permits are still under the original builder/owner of the property. The paperwork is still filed under : Gail Rerisi 497 Private Road,#22,Southold SUM #76-1-15.3 We would like to transfer the name over to our name: Andrea and Andrew Weisbach 497 Ripplewater Lane, Southold. NY 1197 Enclosed is a check for$150 to transfer the permits to our name. Thank you. Best, "---/ Andrea and Andrew Weisbach James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen John Holzapfel Town Han 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0134C Date July 24, 2006 THIS CERTIFIES that the single family dwelling and 50' buffer At 497 Private Road 1/22 Suffolk County Tax Map # 76-1-15.3 Conforms to the application for a Trustees Permit heretofore filed in this office . . 5605 1 1 Dated 7/2/02 pursuant to whIch Trustees PermIt # Dated 8 23 02 'Was issued, and conforms to all of the requirements and conditions ofthe applicable provisions of law. The project for whicb tbis certificate is being issued is to construct a single family dwelling wlbasement, with a 50'non disturbange buffer. Tbe certificate is issued to Gail Rerisi owner ofthe aforesaid property. ~~7 Authorized Signature James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen John Holzapfel Town HalI 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 AugLlst23,2006 Gail A. Rerisi Attorney at Law 5 Bethpage Rd. Hicksville, NY 11801 RE: 497 PRIVATE RD.#22, SOUTHOLD SCTM#76-1-15.3 Dear Ms. Rerisi: The following action was taken at the Southold Town Board of Trustees regular meeting held on Wednesday, August 23, 2006: RESOLVED, that the South old Town Board of Trustees APPROVE the request for a Transfer of Permit #5605 from Patrice M. McCaffrey to Gail Rerisi, as issued on August 21,2002. If you have any questions, please contact our office at (631) 765-1892. Sincerely, Jame}:; ~ ~ President, Board of Trustees JFK:lms . . GAIL A. RERISI ATTORNEY AT LAW 5 BETHPAGE ROAD HICKSVILLE, NEW YORK 11801 (516) 939-0669 FAX (516) 939-9006 July 26, 2006 Board of Town Trustees Town of Southold 5:3095 Route 25 PO Box 1170 Southold, NY 11971 r 1.:1)" 1[ n~ lt~ : II,) i-- le,\: l!~~J::~,." >ID6 I: RE: Permit 5605 Permit 5604 Dear Board of Trustees: This is a request to transfer Permit # 5604 issued to the prior owner, Stephen E. Brander, on August 23, 2002 to the current owner, Victor Rerisi, PO Box 112, Bayville, NY 11709. Likewise, this is a request to transfer Permit # 5605 issued to the prior owner, Patrice M. McCaffrey, on August 23, 2002 to the current owner, Gail Rerisi, PO Box 112, Bayville, NY 11709. Enclosed is a check in the amount of $100.00 to cover the fee for both of the above. If you should have any further questions, please contact me at your convenience. yyo~ ail Rerisi 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 YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-GONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. tJnc (e- çrf'-,~ INSPECTION SCHEDULE ~ Pre-construction, hay bale line /,J. t,:.bo...~ 1 sl day of construction , . .....: '~-'_'¡" .! '-" ~ .c...\. c·..t¡ , .~.- '. \: ~~ '.I" ~ .,.;.' , " Yo constructed .,/ Project complete, compliance inspection. . . Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: f(1-tJ¡J'('I, Î'ì'1 (' {lO-/ i A '}- Please be advised that your application, dated 1/~/oJu has beep reviewed by this Board, at the regular meeting of x-Id' JOJ-:> and the following action was taken: . ( ~ 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 re-application fees will be necessary. COMPUTATION OF PERMIT FEES: J... {¡ìS ~ (?(' \'>ðf\5. ® ..if ~ .00 ß'¡C h ~ ..!!; /C\ ,('j') TOTAL FEES DUE: $ IO.ex) tll¿t.~1 ~ ~.. ~?~. 9¡ SIGNED: y. PRESIDENT, BOARD OF TRUSTEES . BY: ~~~ ~~~tu 4/98 . . TERMS and CONDITIONS The Permittee Patrice M. McCaffrey residiag at 79 Ketewamoke Ave.. Babvlon N. y~ as part ol the coosidention lor Ibe is$o·.nœ ol die Pemdt does uøderslaDd and prescribe to the loI- lowiøg: 1. TIw the said Board of Trustees and the Town of Soutbo1d a.re released lrOfD any and aU damages, or daims lor damages, of suits arisiøg ditec:üy or iodirecdy as a muk of any oper. aûoa perlocmed putsuaat to this permit, and the said 1\. JI4"" wi1I, at his or her OWl!. a¡-. delead any and aU such lUllS '1":.1.-1 by third putics, and the said 1'.... I. ~ ._ fun 1åIII1Ity with respect thereto, to the ~ exdus100 ol die Boud of T.- of die TOWI!. of ~ 2. That this Permit is YIIlld lor a period ol 24 mos. which is c:oasi~ered to be the estimated time· required 10 complete die -..or!< Ù1'9Ðhed, but shoa1d åraJmstaaces wunJIt, ~ lor an exœmion may be made to the Board at a Iaœr dace. 3. That this Permit sbould be maioed iadef"milely, or as loøg as die said ~ wishes to maiou.io the structure or project Ù1volved, to pro\'ide evidence to anyone c:oocemed that auth- orization wu originally obtained. 4. That the wode imolved will be subject to the ~ and approval of the Boatd or its agents, and noo-œmpliaoœ with the provisions of the origi....,¡'Ig app1ication, may be caose lor evocation ol this Pemdt by resolution of the said Boud. 5. That there will be 00 uoreasooable Ù1terlereoce with oavigatioa as a muk of the wod< berdo authorized. 6. That there man be 00 interference wilh the right of the public to pass and ft>ISS a10ag the beach between high and low water marks. 7. That if future operations of the Town ol Southold require the J't:II1Oft.I and/or alceradoas Ù1 the location of the _de berdo aølbod nl. or if, Ù1 the opiaioo of the Board of TrusteeS, die . work shall cause unreasonable obsttucboo to lree oavigWoo, the said Pemúttee will be roquIrecI, upoo due ootice, to remove or alter this work or project herein stated without expet.ses to the Town of Southold. . 8. That the said Board will be notified by the Pemdttee Ot die comp1edoo of die work aoth- orized. 9. That the Permittee win obtain aU other peroúlS and cooseølS d1at may be required sup- plemental ro this permit which may be subject to evoke upon lailure to obtaJn same. '0' " ,.,,,._,,,.,,, .......,.,.,.... .. It" "0' " '.\' '.' " '." " " " " , , " " " " " " " " " " " " " " " , " " ",". 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 August 23, 2002 Ms. Patrice M. McCaffTey 79 Ketewamoke Ave. Babylon, NY 11702 RE: 497 Private Rd., #22, Southold SCTM#76-1-1S.3 Dear Ms. McCaffrey: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, August 21, 2002 regarding the above matter: WHEREAS, PATRICE M. McCAFFREY applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of South old, application dated July 2, 2002, 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 August 21, 2002, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 97 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, 2 . . NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approve the application ofP A TRICE M. McCAFFREY to construct a single-family dwelling with a basement, with the condition that drywelts and gutters are installed to contain the roof run-off and hay bales are placed down before the project begins, along the 50' non-disturbance buffer line, and as depicted on the survey dated July I, 2002 and last revised July 22, 2002. BE IT FURTHER RESOLVED that this detennination 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. Pennit to construct and complete project will expire two years fÌ'om the date it is signed. Fees must be paid, if applicable, and pennit issued within six months of the date of this notification. Inspections are required at a fee of$5.00 per inspection. (See attached schedule.) Fees: $10.00 Very truly yours, a:.L..J () ~~. Q;. t"", 'v Albert J. Krupski, Jr. President, Board of Trustees AJKJlms ... . . Stephen Brander & Patrice McCaffrey 79 Ketewamoke Ave Babylon, NY 11702 Ph & Fax 631-669-6682 - '- i ; ~ ___·r___.___... 30 July 2002 t'" h AUG - I 7"1 Ms. Charlotte Cunningham Southold Township Board of Trustees PO BOX 1179 Southold, NY 11971-0959 631-765-1892 Re: Submittal of Site Plans showing Wetland Buffer Zone Boundary 2 properties SCTM # 1000-76-1-15.3 & 15.6 Dear Ms. Cunningham: Following upon our conversation of 11 July 2002 I have had my surveyor add the necessary information regarding the above matter, He has also staked the seaward boundaries of the proposed structures on the lots in question. Please review and advise your findings, I would Hke to point out that these lots are much larger than the surrounding lots in the bordering neighborhoods. The coverage of the adjacent land is very low, as the driveway and parkin~_areas will be porous aggregate; and the elevation of the land where we propose placing the structures is 12 to 18 feet above the high water level. Our adhering to the 50 ft. buffer along. with these factors shall make their Impact on the wetlands inconsequential. In fact due to the shape of the Wetlands boundary only the northwesterly corners of the structure approach the buffer. On average the distance of the structure from the boundary is more like 60 feet on lot 15,3 and far greater on 15,6. We hope that you can approve these applications in an expeditious manner. The Suffolk County Water Authority is putting in the water this month and we would like to get moving on the structures as soon as possible. Sincerely, SI~E ~ooM& pam!.~]f~ .. ~ -f 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 ConserVation Advisory Council held Wednesday, July 17, 2002, the following recommendation was made: Moved by Drew Dillingham, seconded by Nicholas Dickerson, it was RESOLVED to recommend to the South old Town Board of Trustees Wi.~~'~" the Wetland Permit Application of PATRIÇE M. McCAFFREY to construct a sing e- family dwelling with basement. 'C', ".''''''>!'''':''''' "'i_:;,.",:">.,.:,·"'~<o,, ' iX Located: 497 Private Rd. #22, Southold. SCTM#76-1-15.3 The CAC recommends Disapproval of the application because the project was not staked and flagged. Vote of Council: Ayes: All Motion Carried "" " ". - .~;~";~-;""''''~- -" - ---.. ... ..-uu__"___·__ FROM STEPHEN BRANDER (f/J FAX NO. 6316696682 ...... Jul. 172002 11:14AM Pi Stephen Brander & Patrice McCaffrey 79 Ketawamoka,Ave Babylon, NY 11702 p:¡.-&-~ ax.63~-669~682 11 July 2002 Ms. Charlotte Cunningham Southold Township Board of Trustees Re: Hearing .on the. Wetlands parmit tQrl.ctsJ aO.Q-76-1-15.3 and.,15.6 Dear Charlotte: We.wo,uId,like.to request.a:r.escb.eduU['Q.of our hearing,on the Wetlands.per:mit in order that we can have our surveyor stake the property and include the 50' ' wetlands do not disturb area on the surveys in q¡J~ion. Could you please table the issue for this coming Wednesday, July 24th. and reschedule for Wednesday, August 14th? We will Ql!t the required issu!¡!s in order. ) Sincerely, ~t~~~, .., -:.....-;:--" - -- 'P"'",;--' " , 'r·...'I ,¡ ',ji.,.. \, -,\" \ \ ." \ \, - ...",,- " \' . -- , \~¡'. '¡ ._-:-:,;:,.;,\ "i\ \1L-~~ · . Stephen Brander & Patrice McCaffrey 79 Ketewamoke Ave Babylon, NY 11702 Ph & Fax 631-669-6682 3 July 2002 ,.. Board of Town Trustees Southold Township Town Hall PO BOX 1179 Southold, New York 11971-0959 Lj! JUL - 52002 I JiO!:' ~._--- -, , t~:. \i C~: :. ':! . ,._. ~---- -1 Re: Wetlands permit application follow-up Lots 1000-76-1-15.3 & 15,6 Dear SirlMadam: Yesterday I mailed two (2) applications for wetlands permits on lots which my wife and I own. I "whited-out" an error on the survey but decided the better choice would be to send you a new corrected copy. I received that from the surveyor this morning an am enclosing 3 copies for you to attach to the original applications. Hope this meets with your approval. Sincerely, ~~, Stephen E. Brander , -- ell ~ q N ~ ~ /~ Q¿ W CD ::E ::» z CD o ., I CD ,t.·, ~ .~.J ¡' I , ~. ~._--'~ I·~" :-'.---' . --- , . --,~ - ê;.":'::':..::::::¡ ¡:::: 15. .... s Ii , ~ ,ð- 7~ , \ , , Ib~ ~gl nn~ ill ~ . ·1 tln¡ iU ~I ~ I!)k ~~ 51 ¡ ~~ ~~ i~~ ~!~ ~ I!) ~1!)!i!1tI§1~~..: _ ~ glru~/~~ð ~ ~ II e II I , ã 'I il III I -e liid..b ~II - [jjjj ~ i! ~ :ij :! ~ ~J CI) 0 t->-w-' o w 0 .... CD I- ::I: CCl)I- => => W D::: 0 N >I-CI) LL. OOLL. ~ 0 o..°z' 0.. D::: ~ ð ~, m ~ be. .... o event M3IMV8 NIVW 2 ~ en t: ~ . 0 ~ cq CI :J '": ~ ~ !ìiUJ § i Ê~ "C ~ g~ m ~ - .... ··I~~~ iz~ ã Œ~i~ii . . Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Albert J. Krupski, President James King, Vice·President Henry Smith Artie Foster Ken Poliwoda Telephone (631) 765-1892 Fax (631) 765-1366 Office Use Only 1}J "I )Od- f IS' . ~ BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Coastal Erosion Permit Application / Wetland Permit Application ~ Major _Waiver/Amendme a geV _Received Applicatio ' tJ Received Fee:$ ,- f _ /' Completed Application 1/ If 0 Y _Incomplete _ SEQRA Classification: Type I_Type II_Unlisted_ _Coordination:(date sent) CAC Referral Sent: ~ / Date ofInspection: 7 I (, /0 f).. _Receipt ofCAC Report: _Lead Agency Determination: _Technical Review: ~ ~ I _Public Hearing Held: f} Ý _Resolution: Minor Name of Applicant 7f!-r1<-( ce µ, U CC~." Address 79 Kefewfh-zall<-e!lve- f3~/(W. N.ý. I r7Dl..-- Phone Number:( ) r; 3/ - (,6 9-h 6 fi2-- t--J-.- Suffolk County Tax Map Number: 1000 - 76 - I - I ç 3 ict 1 f~ , -l-?-~' Property Location: () rJ Cj "r.Ç e C,r~/( OFF'µ ",,',J 8 rry't/í Q.¿. )~+-we~ ./Wi -T 5M r?ff (I~C ¡.J L I L fL(- ¡. N T z+ I. CO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: . . Board of Trustees Application Land Area (in square feet): GENERAL DATA 9? '3fJ7 P , I t-'-fD Area Zoning: Previous use of property: III/--C.Ihv' í Intended use of property: ?rlv~ SIMJ(~ r~HL-'1' i2a-¡fJt:JL-~ Prior permits/approvals for site improvements: Agency c:;....nfot-J') T'M~ f?ow,;:>. Date ~lAhJ7,t/I¿'"",) ;p¡?r/Ji/#? ~("P~ ~K.1f5 ~(I9-f-- ~ No prior permits/approvals for site improvements, Has any permit/approval ever been revoked or suspended by a governmental agency? ~No_ Yes If yes, provide explanation: Project Description (use attachments if necessary): {' ty'/I/7'P LolL ,- / ~ I Ì-7 ~IA-CTUr~ 1;;1771 ~/!!,.4&.// ¡-9~ (Jl?/ sIr/? §t..(ý'/ey §u,P:1~ ptß · . Board of Trustees Application WETLANDffRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: CÞ?JS rr¿ucr < r.-l1. L-r r::/f-/tor/i. y l-¡¡)y'W.e Area of wetlands on lot: ,5857) square feet Percent coverage oflot: !~ Ç"_% Closest distance between nearest existing structure and upland edge of wetlands: A.)( tr feet Closest distance between nearest proposed structure and upland edge of wetlands: (p 2 feet Does the project involve excavation or filling? No /' Yes If yes, how much material will be excavated? I Ò!J- cubic yards How much material will be filled? S cubic yards Depth of which material will be removed or deposited: c¡ feel Proposed slope throughout the area of operations: ~4 'S' ~ Manner in which material will be removed or deposited: +h <, /ì)ffl7<.YrJ ~9 lor !:r"¡¡'(( &o~e.- + hl/r.i?-U,1 ". ¢e¡;fir/ hn{p.. 67 h.4-CJ4fi'-c.. 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): ¡t}"..ve, þ<..<·r f,tJ, ""5 ,'ç c. ¡efJ fh.rJ"7 -h--.M-- wd:/¡1-?/Ù tAl;71-I C¡0¡Jrf) 1'(Bvtlv'/) ('Ã'VW .,....T,(;eç· fì(sò c.~rA-c-rnf'e. WI L-L he nr I { +» I to r /rÓt'J¡)e IAJmeN l-e-v'~ · . Board of Trustees Application County of Suffolk State of New York rß-"rl(~c...e k. ¡L(C~.#-H-~. BEING DULY SWORN DEPOSES AND AFFIRMS THAT SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF IllSlHER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN nus 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 TillS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENT ATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF nus APPLICATION, JdI DAt:ifJ ~-'i ,20 O~ SWORN TO BEFORE ME TillS \'., /D >P brJ.eTc V~~~liC ,I JAYNE E. BARTH Notary Public, State of New York No. 01 BA6016514 Qualified In Suffolk County Commission Expires Nov. ~ 3 , d 00 ~ . . PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: £WíI-r LÇ;+Jrpe{n,;J (e<;'f7NJ"j (f-r 290 5u,.., ~e, ~....'ffk)¿ D nt,4,Uù 70.> Ç3 L.~N< ~e ;ha.Lsr/l/k.11/. yo -(.({ +,~ r~ç I¿/~ c-e Shphe.-J 6-~~ HCrMr£, &;YOS5. ðz.fJ1 (;/.T f-.o J ,00b - 7 @ ?9 ~~oþ' Þ d-- 7C .:;.......-- ¿h.Je , S D IA 77fð ::;; 3' ("- U.S. Postal Service CERTIFIED MAIL RECEIPT (Domestic Mail Only; No Instlrance Coverage ProvIded) c::1 ("- no U1 0.37 2.JO OOT ID: 0'IQ2 c::1 c::1 c::1 c::1 Postmar~ H6re { Cltrk: KIfIDI STATE OF NEW YORK COUNTY OF SUFFOLK ?,.,,-f\(G.e H (.{ f. c::1 ... U1 ~ -;;;~~;':~~Y;f:ø~~~~ ~ -c;i,'-S-tate, ZIP ... Y I ( 702--' 2.67 11Y7/01lfR. I -.1 , residing at N. , being duly sw~n~_~eposes and says tha on the day ~ ~~ deponent mailed a true copy of the Notic 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¡ tha~~'d Notices were mailed at the United States Post Office at '~ {---.J (\J.Y , that said Notices were mailed to each of sa1d persons by (certified) (registered) mail. %<-<-Øt llIo/f0Y Swo- ~e_fore me this ~ :;It I {/l day'OCJf:i.L¿, ¥~ ~~, Notary ubllc, tate of New York No. 01 BA6016514 Qualified in Suffolk County Commission Expires Nov. õ>~ cl 00 d '.. ¡. . .' 14·~8·4 ¡2IS1}- Tnt 12 I PROJECT 1.0, NUMBER 617.21 Appendix C State Erwironmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISiED ACilONS Only SEO PJA-f-. J, .. 5~ /hT"ft.(feÐ S IA ( ..1'7 f.-./ ff'ert-ri>Nt- dr, OAJ :;(.((.)~ IT'-S Lof If 4'osr- A.}O(ffft..y 5. IS PROPOSED .iCíION; New 0 Expansion 6. OESC1=IIBe PAOJECT BRIEFLY: o Moaificatlonf.lter&tJott Co-tVs~r S/;';"jre +/h"'/'G-y ~ vcJr77f B~~t!Vt" . ¡#S IV ~ "'~v~. 7. AMOUNT OF LANO AFr:ECïEO: Initially I B-~ acres Ultimatelv A B :5 ,acres a. WILL ?RO?0SëO ,Q,C¡lON COMPLY WITH ëXISTING ZONING OR OTHeR exISTING LAND USE !=IESTrfrCi10NS1 ~.. 0 No If No, :..e".. b".fly ¿';:'..v;~ r.s ~ ~ ~ ?/1f'VA, wRS p"""-' I rwrwJ) S...!,-.(,.rt5'-'. ¿1-1¡"c.lf'lreL ~~ ?/r;ot- ) ~¡J"¡)'¡tuf (<171..- I I o'F ~. WHAT IS PRESENT LAt:¡) IJSi: IN VICINITY OF ?ROJECT'? &;¡~.sldenIi8 O.!nClustrla, C CommercIal ~crlb.: G Agrlcullure ~ Pa~k/Fc:rIlSUODen so see LJOtl'1er 10. aOES ACTION INVOLVE A P5RMIT .4.PPROVAL. OR FUNDING. NOW OR UnIMþ.íEL'f FROM ANY OTHER GOVe¡:¡NMENïAL AGENCY !F::DERAL. STATE OR LOCALJ? fiš Yes 0 No If y.,. fist agencytsl and ø.rmIUaOP(~as , 5"...+h.........c"...."""7 h;e,M-H.. <;Re(J~---, ~ tle#ÞO'.t; /)¡E.G - ',./ eV I (U..J . ". DOES ANY ASPECT O~ THE ACTIO"" HAVE A CURRENTLY VAUD PERMIT OR APPROVAL'? o Yes· ~ No It y'!s. list agency name and permit/approval ':r '12. AS A RESULT OF PROPOSED ACTION WILl.. EXISTING PERMIT/APPROVAL. REQUIRE MoorF!CAiION1 OYos ONO CERTIFY THAT THE INFORMATION PROVIDED ABOVe IS TRUE. -:-0 THE BEST OF MY KNOWLEDGE Ocl.:e: SIQnature: If the action is in the Co¡¡~tal Area, and ,.ou ore a state açency, complete the Coastal Assessmen! Form before prtJceeding with this a~~essmen: OV!:R . . .~.J.;r;- /I_£NV!RO~L\1ENï.J. 'SScSSMENï 1-:"0 be c:Jr:':~:e!e:J -;y .~;e~c· :ce.s ;"C7;CN =:.;c.:::;.~ ':'.'n I ¡ ~c:: i 71-t¡::¡f.5HCL.J:N 5 ,'J"':::;~, =':..tõ.í i:i,:,'" ,-"'1'(")' r,'IO I >, I ;t :te~. .:oc:rClna:s :J'1e "~",I"W :ro<:es! an., '.,ISIt 'ne =;jL_ ::~r 3. 'NlLi.. 4.C7:CN ..:;e·:.!¡vl.:: ·:::CPOiN..:ë.o ::tEvlel'l,<,S ?P.C'JICE:J ,='::A !Jl'ILS7EO ..:...C7íCN$ ,¡..I '5 .\",Ç:=:R, ~.~~7 '):~ 57 ;-,av oe suce~sll!:Cec ~y iI"lQ(;:er ,nvol"eeJ ac;ency. - 1--: '..-JYe!il ;""";:-10 "t .'Jo. .! ,1eç';¡'I:'¡S ~ec:,¡"~ G. C:ULD ;,C':'íCN ~ESUL';" 'N ~NY ~ovE¡:;SE =~:::·:7S A$SCC:;.'jEO ',VIÏI-!. -:~E. ~·Jl...~\"JI."G. ',s,ns"NerS -:"I.y:e ,.¡n(jWflltan. " :eçrOlel Cl. :'''ISlln9 ~( r:U.a.llt"l, ]urtac! or .~rOfJncwaler ~uaiIV ·~r ::uannty, :'ICISa ,evels. ~x:;:nç :raltic =at:er~s. 30lid .vaSi.e ,Jroc~C:::;" Jr .Jls;.: pOUIIn!!al :cr !fOSIOrt. ::ra,lna7!-:>r !IQoC:inQ .)roolems1 =""Claln .)nørlv: C~. ).~stnedc. açrlc:.sllurat. Jrcnaeologic31, ~510nç. Jr :)ther ,atural ,r CUltural ;esourc~s: or ~ommunlly or i1eu¡:-:CCtnOOd .::':arac:er? :"::)Ialn ~, '''eç~[atlon ;Jr ~aun~. ~lsn. ~r::81If¡sn or 'Hlldrile s~eces. ilgndicant "aCltaIS. :Jr :nre3lened or ~nc:anc;ereo 3Cec:es? Ex:ta,n 'Jr!8Iiy: C-I, Ac:lmmunlt·(!; existing ¡)Iansor qoalS as.otHci..II'f aaoQleO. at a cnange In use or !ntenslty or use of ~and or other natural re~ourclIS7 ~praJn .:. -, ~-, ûrowth. sLlcsecuent ::Ieyeloemenl. .:)r related aC:VI!les likelY (0 oe ,nducea :¡y tne ~rcoosea aC:1001 :x;)Vill1 .)r:etly. .....,,). I.on~ :erm, :mort :err:1. "::,:rnUlalive. or oU,er ~ffec:s not ·cemifleCl in C~·.:S? =.:rOlaln ::'tIf~tly. '..... ':U':ef ·moac:,s ,inc:..Jc:nç :::1anr;es ,n 'Jsa of !!Inef ~uar1tlty ~r :y~e or !ne~c;y]? :.x:II.tln ~(9I!Y. " 'J. S i"i-fe::;:E.':A is T¡.,ERS \..:Kai.::':-O Se. C::Nr;:¡OvE.=:(S'f =!E~ïa:? ':"0 =OfaNïl..:.t... ACVE.?:S¡;: :'NvrRCNME?,/ï':'(. .MPI\G7'S? - - -......: 'fa::; i-."Io :t ~e$. !:rClaIM ,natl'f P,~RT III-DETERMINATION OF S¡GNIFICANC~ ,To ~e comcleled ~y Agency) INSïr:lUCTIONS: Fot e3C:'1 adverse ~ttect identilleo: atove. determine whettler it is 3ubsrantia. large. :mtOl'!õm or otnef'wvISe signiHc Ë3cn tHec': SMOUld :Je assessed in connection 'N'ltn Its (a) setting (I.e. urban or rural); (b). "rocaoility of OCCQ:.!I1ng; (C1 duration irre'/erSlb,lHy: fel oJeo~r.aDnic scoce: anCS (f) maQnauce. It ,ecessary. aCId auacnment$ or reference supporting materialS. =!1SUf~ e:xOlanations contain sutffc:ent celal! 10 snow that a.1I relevant adverse impactS have been jeJentif!ea ana adeQuatelY a~creSS8C. C:-tecJ< :his box :f 'IOU ;,ave identified one or more :::otentia1/y larçe ot significanr acverse imoac:s Wr:IC:1 ,'.',). ';' occur. Then ~rocgea .jirectly ro :he ¡:UL:'" =---.1.;:: ~ncUor prepare a positive- declaraticn. . _ Chec!( thiS ~ox :f 'IOU :lave determined. ~ased on the information and analysIs above and any suocorti::;; dOC:.Jr.':enfatlcn. ~h2.t :t:e ;:)rooosec ac:ion \'VtLL ~~or result in~y significant .adverse :3nvlrcnrr:en:al imcac~:: AND ;)rovlce ,In auac:'Iments as necessary. the reasons sup coning (!"liS determination: ....."",o!' :)1 _O:J<I .",..",TlC,! ....·'nl .J' ,~",=, ",...nO!' -'I <~·'Gon\.IJlo: ...;n.c:rr .n ......"11 "'''':l'Ic·, ,(Iii! O' <...~oonHO'O: 0111(;o!'r ;'III'I":""!" )1 "·~'.J.¡t<t, :11 ,..:.,:......"( .I')m r~SOO(;\JO·~ .,)I'.<:~r' .i'Io:/'I.J!U(~ H <o!"C<:In,.a,o!' ":I:'C~' ,41 ...(',*0 ......lI'ncv ~ J"tC " ~ ¡ . . . '..·H5·¿ 1-2IS7)-Texl '2 I PROJECT 1.0, NUMBEA SEQ 617.21 AppendIx C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I-PROJECT INFORMATION ero be completed by Applicant or Project sponsor) PPUCANT ¡SPONSOR r-- r _ I Ii.- . f1 CCfi-Hï/t 1. PROJECT LOCATION:,... Munlcløallly:J£) l- .I, PRECIse L.OCA TION (Street adðress and read IntersectIons, orominenr lanamarks. 9[C_. or ørovloe map! PJ.4 f--. Countv S..... t-F.:,) K. s~ hr¡Pt.-{fe{) 5 CA. (' v'~ /,.oJ ttr~t-r~ v-r, OA.l $ur.;e.., iT,s L.of if 4'0t;..- 'voY-TTft--y '- '0 IS PROPOSED ACTICN: New 0 Exøansion s. OeSCfUee PROJECT BRIEFLY; o MoøJficatloniarter.tlon Cr¡-,VS~ S";'¡"i'-e -F..".,/c-'f ~ wr7Jf 3/13"~ewr- ,/fr7 pet" ~ «/'vtey. 7, AMOUNT OF LAND AFFECTED: Initially , B-~ acres Ultimately _ B '3 Icres a. WI!..I. ?RO?~SEC ACTION COMPLY WITH ë::XfsrlNG ZONING OR OTHER EXISTING I,..A:\IO USE RESTRIC";'lCH$? ~e$ 0 No If No. .oe..".. ."efly ~AI;~ 1"5 Æ!. _ ~ /~#Yh, 1....J,4-:$ p___'- "tlfrv-lJ) 5..)" ..t,oI'iS'.-J . ¿rl/Ctffl-~ ai../CJ/:S ?/9-t ) ~(I{()'¡ùf Ie¡ 72-- 01" 9. WHAT IS PRESENT l.AND uS'ë: IN VICINITY OF ilROJECT? Q.~1S1C18'nlla O.!ndustfl81 0 Commercial ~Cflb&: o ..1gtlculture LJ Par""FQresUOoen scace i~Otne( 10, DOeS ACTION INVOLve Ã P'5AMIT APPROVAL. OR FUNCING. NOW OR ULTIMATELY FROM ANY OTHE.R GOVERNMENTAL AGENCY (F=OERAL. STATE 0" LOCALI? fiJ Yes 0 No If yes. li$~ agency(s) and oermtUaDprOVl.lS Þ . 5'...-FH....K.,Cð..-...-.",. hY-f+f.. ~¥~SA./. --per.; '~ "DE- - ,./ eV¡et..J . DOSS ANY ASPECí OF THE ACTIO,", HAVe A CURRENTLY VAUO PERMIT OR APF'ROVAL? o Yes' ~ No If y~5. IIsl &Q8C1CY name and permlt/aøproval .".. 11, 12. 4.5 A RESULT OF PROPOSeO ACTION WilL !:XISTlNG ~ERMITlAPPCl;CVAL. REOUIF:e MOQIFICATlON"? 0_ O~ _ I CEATIFY THAT THE INFORMATION PFlOVIDED ABOve 1$ TRUE 70 THE aeSi OF MY KNCWl':'DûE Oolle: S¡çn8Iute: If the action is in the CO¡¡5tal Area. and 'IOU are a state agency, complete the Coastal Assessment Form before proceeding with this a,~~essment OVER 1 , k ..--"~'- - ~.:w c;. I I.:J OJ2 r'::)i,;:;s!e~ 'Jy ..\ç9:!1C· . .:3AKï ¡'-=N'J!RO~lMENI ~. .... .:ces ;.c,:"c~ ::.':CZ~:.J :.,"n ~__'fU C,\o :!. "N!L~ .:.C7iC.\ ,qe·::::::\¡;:: :=CI=:C::N~ ,c:..::ì ~E'IIE'N ':'S FC1C'lrCE:J .:::,:~ :,mL~S';"SJ ':'C7:C,o,S ;:.... :) .'n':~R. =';..;=1.';'" '5' I :I, .":"!~ lJe sucerse~ ::)y }.no(:".cr ,nvo¡"eCl ,¡.çenC"f ~'r9'S '.-;:\10 . .::; l ':"r12E,shGLJ N ., 'I~Ç;=r:. "':..':;,i" -):; '.;:~ :1 f'!$. :ocr.1ll"lal" "ne r~'Ylew :;roc~~, ane. Jsa 'Mil =:':L_ ;,...,.. , .'10. i ..eQa!:...e ::e.ç,:,¡,_ C. :':':UI-O ,;C":".!CN .:l:E.SUL7 /'If ~NY AOI/Eë:Së =:=-~:·:~·S .-\SSCC;":' 'T:::a ',vI'iH ---E ~·J~:''':'W¡NG. :,),nsw@rs .~..v :.e 'anClwrut~.,. I :eçICI~1 :1. =;wwnq .Uf ctualil"(, ]urfac.t ~r ~rQuncwa~er .:ual!~'1 .j( ::l.:anlHy, ,'Clse .e'll!is. -!:Z:!SiU1Ç :raWc ::al:erns. ~oric: Yasa~ ;¡f,JOL:c:,.-;n Jr J'S~c ,o:e:nflal lor <!fOSlon, ::ratnaçe Qr ¡Io~dnq JroQlems? ;'~OLatn :;¡netly: cz. Ae~the¡J<:, açrlc;,¡ltural, 3o!c:~aeGr.:JlJlc.aI, ,1rston.:- :If ..:'ther :'I3t'Jtšl ~r c:...ltur;lI ·...souro:s.s: ':)r :.:)mmunlty :)r :'Ieu;i:tCOtr1oad '::':arac:ar? :.-c:c!a.ln . c.:.. I/eqerallon ~r taUn:¡, :15n. 5~f!I¡fl.sn or 'N'Ilaflfe SDe::les. :¡¡gl"di.:anr :'\aOltaIS. or :nr~::uane<:J Qr ~nc:an;erec !;:ec:es? S:claln :If!atl'(: c.=.. ,). c.;:mmunt(·('S eXls.:r-g ;)!an, Ot ~oalS as.ottlc:a.IIY :1dOcreO. )r a cnange in U38 ot t~tenslty of use ot !ano cr ot!'!er natural resoUfcu? E:rclatr :. .:~. Growfn. sucseauent :eVe!ooment. ~r rSlatr.:! ac:lvlt:es IlkeõY :0 Or! :nduceo 'JV !ne :Jrccasea aC:lon7 ~O:Ilaln :mei¡v. ':3. :..onç :ærm. 3nor: :i!!rm. '::.smUllilt/e. or ·::It"9r gfec:s nct ,oenl:f[*!(J In C~·C5? S1cOlaJn 'r:~fl'l. ;1~'!r :mo03.C:S .rnc:uc:nr; ::-:anr;es In ;Jse of iIi!lner ouanmy .,r ::..ç. ::If -!~ergy7 ~l,:miLn ~"lItly, " 'j. ,5 :"HE.~e. ~R'S ":",..,E?E _:KE:.::':-O SE. :'::NT~CV=.;¡.S'( :::IEt..A7E0 -:-0 ':QT~;-'!T¡'-t. .J..:J\,~.:-:rSê :'.~VIRCNME:-ï":'l.. .,',1PltC:-S7 '~'f83 '- :-~o :f ':'es, :lxcta,n ~rieity ?ART III-OETE¡¡MINATICN OF SiGNIFICANCE ITa ~e completad ::'y ;>.gency) INSiRUCiIONS: rQr eaC:1 adverse effect u:JentJUed acove. C1etermine wnerner It Is subst..ntial. large. ;mccnant or orr:erwlSe signific :.aC!'1 !ifl:c~ Si10uld tie a.ssessed in connectiQn '....'1" its (8) setting (I.e. utÞan or rural): (1:) ,Jrccat'lility ot OCC::L;iJ'1g; (CI d:.¡ratjon· 'r:e'/erSIÞlli!y: ie geogracnic .\c~pe: ana (f) magnlh,,¡oe. If necessary. add attachrï.ents .or reference supporting .-nacenals. !:.:1surF.! !XC1sna[lcns contain sufticient delall to snow t/'lat a1 ;s!evant adverse Impacts na.ve ceen ideruitie( .anc: ade(U~a.:eIY aCCressec. C:'ec~ :his ~c'X if you :'3ve identified one or ,î':ore .:::otenriaJly larçe or significant aC"erse imoac~s ·.vhic:1. .".1;..'~ OC:::.¡f. ¡hen ~rcc.eea Jirecny to :he FULL ::'AF ana/or preoare a posirive- cecJaraticn. . C~ecx ~his '::,ox .f you have determined. ~aseQ on ¡he information and af'lafysìs abc·./e ana any suooort;r:c cc'c;.Ui1enrarlcn, ::12,¡ :he :Jrocoseo ac:ion ','''ILL ,'~OT result jn~r:y slC;¡niiican1 adverse e:wlrcnrr.enral ¡mOdc:,; AND ,:,rcv,ae Qn ;,HaC:1ments 35 necessa.ry. the reasons supconing rnis determination: ......,"~ '1f ...:..0 ....-:~r1('1 .....('1( .)/ . vCI: .....m' JI (..,;on\.OI~ ",;ul,o:r II ;"..:..0 "0;1:"", ,. .u~ 1;0: ..(o.:~CO(tS.ClIO: vtroC~f ",",,,..¡;,,rf!' .J, <I/',cor.~,o"r ';f:'C~( .n _I!'.H'I .'o;enc.,. ¡..,....,¡I...'o! )f ,.....·.J.Ul!'f :!, .1.1:"....."' Irom :~1CO...":J'... ;J:'.(';>r' ~ J..rt' 2 . . Dear Neighbor: BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of aDDlicant: SCTM #1000-76-01-15,3 YOU ARE HEREBY GIVEN NOTICE: I. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: Construct a single family dwelling on the above reference lot. 2. That the property which is the subject of Environmental Review-is located adjacent to your property and is described as follows: All that certain plot, piece or parcel of land, situate, lying and being Bayview in the Town of Southold, County of Suffolk and State of New York, being bounded and described as follows: BEGINNING at a point on the division line between land now or formerly of Michael F. Zukas and May Zukas, his wife and land now or formerly of West Creek Development, said being North 39 degrees 55 minutes East, 563.95 feet northeasterly along said division line from the easterly side of Main Bayview Road; RUNNING THENCE along said last mentioned division line, north 39 degrees 55 minutes East, 330.00 feet, more or less, to the center of West Creek; THENCE easterly along said center line, 122.49 feet more or less, to other land now of formerly of Michael F. Zukas and May Zukas, his wife; THENCE along said land now or formerly of Zukas and alon9- a 30 foot Right of Way, South 39 degrees 55 minutes West, 415.00 feet, more or less, to other land now of Zukas and May Zukas, his wife; THENCE Along said last mentioned land of Zukas, North 48 degrees 50 minutes 30 seconds West, 90.00 feet to the point or place of BEGINNING. 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: July 24th, 2002. 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 does not reference any other agency that might have to review same proposal. OWNERS NAME: Patrice M. McCaffrey MAILING ADDRESS: 79 Ketewamoke Ave., Babylon, NY 11702 PHONE #: 631-669-6682 Ene,: Copy of sketch or plan showin9-proposal for your convenience. . . . .ø' ~;v~," ,,1- ø-.f ",--:~ /. ß Þ / ~ .~ z · · ., · · I~ ~ 1 : 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 1JI~ )O'ð- T I~. ~ BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application / Wetland Permit Application 1 Major _ Waiver/ Amendme a geV _Received Applicatio ' 0 _Received Fee:$ ('t ,- / _ /' _Completed Application 7/'10 Y _Incomplete ' _ SEQRA Classification: Type I_Type II_Unlisted_ _Coordination:(date sent) CAC Referral Sent: ~ / Date ofInspection: 7 I {" /0 !)... _Receipt ofCAC Report: _Lead Agency Determination: Technical Review: ~ ~ / Public Hearing Held: rf} Ý Resolution: Minor Name of Applicant 7,.-rir ceo µ,. J.1 cC¡¡J:.J::(- 'Y Address 79 KefBuJ;:ntaJKe Ax. f3~1 ð<V. N. i. I r7 D 1..-- Phone Number:( ) h ~ / - "G 9 - b 6 [;2-- 1-J-- Suffolk County Tax Map Number: 1000- 76 - I - Ie;, s 1;.,.1 ~ Property Location: I'JnJ Cj "rlie c.-~/( 0 FF µ ¡¡.í tV 8"'.YVíf¡¿,) ~/+-i.AJe~ ø~~-Ø-r"f" .¡¿; -I- 5r'V11?1-f 1) ";:"~ NÐYt1f L1 L II.{- ¡. NiT Lj.. I. (pro ide LIÍ.CO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: \~~ \~ . . Board of Trustees Application Land Area (in square feet): GENERAL DATA ~? '3f77 P / I tt. - '-f D Area Zoning: Previous use of property: if I/-u¡--,Vï ?íIV.+--fe.. SI^"7(~ r~(L.'1' ~¡fJr:;JL-e.... Intended use of property: Prior permits/approvals for site improvements: Agency c;~H.-nl-Ot.l) T"-"It1 &;~..::>. Date '5",hJJ,i/I~"# tp¡?rdl/-H /t('P~ ~K.~ (J(¡r-f-. ~ No prior permits/approvals for site improvements, Has any permit/approval ever been revoked or suspended by a governmental agency? ~No_ Yes If yes, provide explanation: Project Description (use attachments if necessary): {'?r.A/7P uL ,- / ~ /Ì-7 "fí1Z.u.C-TUr~ ("JIm i9r5eM ~7 ¡.-?'5 per- <SIr&' ~uy',,/~ 5up¡1~ prß . · . Board of Trustees Application WETLANDffRUSTEE LANDS APPLICA nON DATA Purpose of the proposed operations: CnV':5 T-eucr ~ r"'!? l-t' í-lTMfl.. y VzcJv11.e Area of wetlands on lot: 585D square feet . 17. '} % Percent coverage of/ot: Closest distance between nearest existing structure and upland edge of wetlands: J( fr feet Closest distance between nearest proposed structure and upland edge of wetlands: &.2 feet Does the project involve excavation or filling? No / Yes If yes, how much material will be excavated? I Ò!>- cubic yards How much material will be filled? ç cubic yards Depth of which material will be removed or deposited: 'J feet Proposed slope throughout the area of operations: ~ /L 5" 0 Manner in which material will be removed or deposited:--=t<h4' /ï)~~ ~9 lor g,...,/H( cDo.<e,- -r hllr~fM e. ~<?f'f-jf/ hn(1!. by hA-U:..Hi' ~ Statement of the effect, ifany. on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): ¡t/o,;v'e, í3r.,;¡ lit",; ,"( ,.Jeel !h.J"7 -h--~ iA/d-//17VtJ tAl íTll C¡f}øtÞ 1(fhA.N't> ('.-ðVW r-rr~ec (ì(5ò c.ïe.uc..-rl-1fre W¡·/..-L h~ ~ {' -+--" (í-, ( /1"Ó¡'}¡)e CAJ/tle¥' I e-uvf · . Board of Trustees Application County of Suffolk State of New York 7ß'"r1(~c...e 1-1. µ'CCM-.J-r~. BEING DULY SWORN DEPOSES AND AFFIRMS THAT SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF IDS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN TIllS 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 TIllS 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 TIllS APPLICATION, ~ DA~Uj ,20 () ~ SWORN TO BEFORE ME TIDS (' ~>p ¡3&er~ V otary' blic ,I JAYNE E. BARTH Notary Public, State of New York No. 01BA6016514 Qualified in Suffolk County Commission Expires Nov. )3 / ~ 00 ~ . . PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: {¿Wí/-r'S+.tIpefb¡J (eç.(Ï)/M] f,-r 2.90 5ú"-' ~i', .\:J"''ff-knD /74"'íuv 7.:> Ç3 2-~A/K ~e ¡¡;'c,<LSc///le /lJ. Y -f;..,[[ +,~ r¿:r,I.::Ie...> c:..e , .' Shphe..J 6-~ t:'uY107 £.oj ,rOOiJ-7' @ 79 ~.-.rCJI:" ~ He""",,- &r1JS5 ,}-7~~"- tñJe, SDlÅ77It1 :;:; ~ I'- I .".-1 U.S. Postal Service CERTIFIED MAIL RECEIPT (Domøstic Mall Oll/Y: No 1f}!j1l(at1Ce Coverage Provided) o o o 0:1 I J STATE OF NEW YORK COUNTY OF SUFFOLK '?~"c..e H, /-{ ( I- o ~ i 6 [""7'.n.ns&.!'f'd~_8'~~nnn.n. n.! ru \S"''''""' No, I/.h.., ,v,,_~ \ ~ ~~,;'G,~:':·;'p;¡J:;~;:Y7;7ii::.:.'=.'M~~ ~_""'"_,,,.'. i 0.3'/ lOOT ID: 0'102 I 2.30 I postrn"rf. ~ H""e ---j Clm: KII'IOI j 2.67 I ffII01/flZ l o I'- ru U1 , residing at N. , being duly sw~;n~_qeposes and says tha on the day /.ß...Lz. ~:;;.:., deponent mailed a true copy of the Notic 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¡ tha~~'d Notices were mailed at the United States Post Office at :.n 1""'-' fV.'T , that said Notices were mailed to each of sa1d persons by (certified) (registered) mail. %ulÛ/~ Swo- ~eJore me this r:>+ t' (l' day ~tLu-/ )Il~ ~/M ~~c ~ø~. J.c Notary Pu1>ìiê. ~tate of New York No. 01BA6016514 Qualified in Suffolk County Commission Expires Nov. 5> ~ ~ 00 d ·' H·~e..4 I£lS7)- roJxt 12 I PROJECT 1.0, NUMBER I- ~ . ... 617.21 Appendix C Srate Environmental Qualify Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I-PROJECT INFORMATION (To be completed by Apoiicant or Project sponsorl SEa (J)A- 1-, 3. .. .s~ /J'1T~ SIA fv',? W tff"erf=r."vt- I cJ-r. OM :;c-<rJe..., 17-'-5 /...of if ~o~-:- ,(jcr(.71ft...y 5. IS PROPOSED ACTION: New 0 Exø8nslon 6. DESCRISE PROJECT BRIEFLY, o Moaificatlon/altlllratJon Co-""'5~r S/iJe¡'.e F~/r.-'f h-....e. ~ï771 í3¡fj'~~ .,.-Pri 'v 5 t,(l'vey. 7. AMOUNT OF LAND AF?'ECïeC; Initially , B-~ acres Ultlmatelv _ B 3' "cres ô. "JILL ~FlO?t'JSEO ACTION COM PI..':' WITH ëXJSTING ZONING OR OTHeR eXISTING LANO USe FlESi¡::¡:C7'IONS~ ~e. ONO II No,.'e,c".e."eflY ;;¡"'..v;~ r5 Æ~;;Z?/qpvfy wl'l:f pil'-/' ~fr.Ne£J 5...",·.(,,1'5'-' . ¿t-1tCff"IJ-et... ~<:;JI':S ?(p.f ) ~¡I(¡)V~ ('172-- OF 9. V'¡HAT IS PReSENT LAt':o USe:!N VICINITY OF PROJECT'? QResldenllal O.!naus:nal C CðmmerClal """O;;cr.be: U Aqflcuuure i-J Pa:k/ForestlOoen saace ,...J Ottler 10. DOES ACTION INVOLve A peRMIT APP:fOVA.L OR FUNO!NG. NOW OA ULTIMATELY ~ROM ~NY OTHEA GOVEMNMENTAl. AGENCY ~F=DeRAL. STATE OR LOCAU? f5 Yes 0 No If y.s. riS( agency(s) And CJermiUaDprov81S I '5....m--", c.-."",,,>,. h:eJP.-(-H.. <:! ef ~~;- - 7e-.;Þ It\~ Ì)E..c- - .¡' e (/ I er"J . 11. DOeS ANY ASPECT OF THe "\crror~ HAVE A CUR~eNTl.Y VALID PeRMIT OR APPROVAL? DYes· 2! No If y"s. list agency l"Iam. ana perm;t/approval -:.- 12. AS A RESULT OF PROPOSED ACTION WILL. EXISTINQ PERMIT/APPAOVAL ñEOUIRE .\o100rFCATION7 OVu ONO CERTIFY THAT THE INFOFlMATlON PROVloeo A.BOVe IS TRUE "0 THE aeST OF MY KNCWLE¡;;GE srQnalure: m CCallrev I Ool:e: If the action is in the Coastal Arsa. and 'fou are a state agency, complete the Coastal Assessment Form before proceeding with this a,ª-~essmem OVSR 1 . . P...\i17 I!-S:\PlJRO~J;\1ENï)" 'SSi:33MENï .-:-~J ':}e G:Jr.-::::le!ec:y j,ç;e~c ..\. ::ces ÁC7;CN ::;~C':;E~ ':'Uy 1..2::, 7¡..,ñE5¡..¡CLJ IN '5 ,\"C~? ~:..F.ï ~·_7.:'-" --:y"), C.'IO S. 'HILL ..a.C7:CN ·::;E·::!:'S ::::CPOIN.õt.';"'E..J .=\evIEW...S ~~C'J!De::;t .~.:~ tJI'ILS7'EO .~C7iCNS .N :5.\1 (Ç~R. ~.~i=\ï ii -;.57 !""\~ ':Ie suoersea..:: ::¡';' ¡¡nQ(;";er .nVOtVeo açency. r-! y~s L-.: ~o ;( 'f'!'S. .:ocro,na:e :ne r~...t.,,,,,, :rocess ana 'JSI! :"9 ;;õJL_ ::"Aõ=" ·f .'~o. .! ,'eç:i¡:ve :::ec:.z:~ c. C::ULD ;..C7;CN =:eSUL;- 'N "-NY .1,DVE:=:Së :::~=,':7S ASSCC:":'iED '.vii,.. :":-.: :::':>L...CWI:'<lG. :~nS"Ners ·i).v:e ,andwruten..f :e~!oe) C1. E;u~rlnc¡ JIf QualIty, .3urtac:! or ·~(ounowa!er :UI!iIY -:If ~Lan[ty. ,1CISð .e'lels. =XIS:1n1i :raffic:; ::a!:er~.s. io¡id .vas'e ~rOc~c:::;n ,Jt JIs,::: potential ~cr !rOSrOn, ::ta.lna~'" :If ~IQQQ'inq JfQcrems1 =..talaLn ~tletly: c~. Aot'Sli"e!fc. ac;rlc:JUural. .!rc:'Iaeo1oglc31. :"!Is¡onc. .Jr ;Jlher ..,aturõl )r cullur31 .-es(;urc~.s: or .:ommunlty ~r õ1ett;:'1~ornOod c~arac:er? =..:co,aln ~, ~. 'Jeç!!CaIlOn vr !auna. ~lsn. :3mUlfisn or NlldlUe s~eces. .¡u¡nliicaof ,'\aOitalS:, ;:,r :nreJ.tene<J or .,naanç¡erea 3ceC:es? E;cClalr'l :Jr!e~:y: C.J. A communlty'~ existing ;Ians or qo.ls as otflcl:l.lly ac2oQted. or a cMange in use or int."S¡ty or use of land or other nalural resources? :.'l:prSln ::, C~. GrOWlh. suÞsacuertt 'J'ævelocmenf. or related aC:Ylties likely co ::Ie Induc~a 'Y trze :::rcooseo ac::ion? ::X::l13U'I Jr:.f!y. '~.;I. '-r:nç :.!!rm. :znort :erm. .::.zmulaILye. or ou,er 9lfee:s not 'centifleCl in C~'C5? =)(;::II':,1In jrl.lly. .....,. çlr:~r fmcac:s .inc:;Jc:n,. ::-:ançes In 'J!ia 01 !!tn4t quantity "r :v¡:e or !ner~YJ? :!x,ralo ::met1y, " .J. ·S ;"He::!E.':R:$ ThERE :";K.Ei::':-O 350 C::N7;:;cvEPSY =!E.ATëD ':"0 ':¡QT::NTIAt., .:o.OV::.=!Së :.\IVIRCNME!'I"i':'l..'.1P,),C-:"S'? :- 'fes ~,,o ;t '="'$, ~:rclaln "riet"! ?M~T 1!I-OëiE"MINAïION OF SiGNIFICANCE: ITo ~e comOleled ~y ",,,ene,) INSíRUCTIONS: Fot e3C:1 adverse i!ffect identilft!':] acove. determine whett'ler it is .substantial, large, ;mpol"':ant or otnerwlse Slgnlffc :J.crt eifec": Si"lOtJld ~e .1Ssessed in connection '....I[n its (a) setting (i.e. urban or rural); (b~ ;)roCaoility af occ~g; {C1 duration' irreverSibility; iel ~eogra.cnjc Jcoce: and (f) ma'inltuae. It :u~cessaryr aCId attachments or reference supporting marerials. :;1surF:l !XClanations ccnraln suffiCient delali to snow tt'lar aJ/ ,~eleVant adverse impacts have been identitfed ana adeQuately aC:C:ressac. CheCk ~"is box if 'IOU i1ave identified one or L"'nore ~oten([al1v Jarçe or significant acverse ìmoac:s wr:lC:1 '.1A'~ occur. Then ~roc:eea airec:fy to :he ~ULL =Aï= ~no:ior prepare a pcsítive- declaracTcn. . ~ C~ec!{ thiS ~ox ;f you nave derermined, ~ased on the informa.tion and analysIs above anCl any succorti:::; doc~r.":er1ta(tcn. 'hat ;r.e :noooseo ac;ion \\lILL ~.OT result in..;;V:,! significant adverse ;nvlrcnrr:en:a Imcac~:: AND ;¡rol,rlce an attaCrlments as necessary, the reasons supcorring tnis determinarior.: ......,,~ ;11 _....... .~-:I:'.,(" .J_,n, oJl '~IJ'=' "ulT1P. .)1 <~',~on\.[Jlo: .";111('" n _",,,0 ....".;nc·' .(I~ 01 <..'~COn\.OIO! ul,c~r J,,,n,JIUft' ), ~~'CO""OIIt ;r~'(~r ,n ~","G ~>:o!'"CV "\(".:U'~ )' "''':J~(~' :11..:,1:"-"'" '10,," _!!')gon..o ~ ,)",o:::..r' ~ J..I~ 2 . . .' 1A-~6·4. (2187)- fe,1 12 ¡ PROJECT 1.0. NUMBEi'I 517.21 AppendIx C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I-PROJECT INFORMATION (fa be completed by Applicant or Proiect sponsor) PPUCANT ¡SPONSOR PROJECï NAME I - .Hrc~ DF 3. PROJECT LOCATION:,.. Munlc::l¡)alltv:::':>F) L,.. 4. PAEC:SE LOCArJON {Street 80dreu .and roacllMtersectJons, orominen( lanomarlts. gtc., or ørovrce mac, SEQ -µ~ County:;"", ff¡, !::.. PJA-f-. s~ 1hr#C-tf-eD 51A(V~ VJ trr~~.",fi 1 .,-r. oAJ >t.<r.Je.., ï, (5 tof i.f 4'oS~ ¡(JoY-ïTft-y '- ,. IS PROPOSED ACTION: New 0 ê:cøansíon 6. DESCRIBe PROJECT SFlIEFLY; o Moølficatlont,fteraUon Crrws;-æ....ur s,.i.le¡(e F~ic.-'(' ~ C,AJr771 BM~e../Î ,IPS fer ~ I.o(/.;ey. 7, AMOUNT OF UNO AFFeCTED: InW.a./Iv ' &'~ acres Ultimately B '5 acres a. WIt,.L. ?ROP')SEO AC':"tON COMPL"!" 'NITH. ë-XISíING ZONING OA OTHeR EXISTINQ !..AND uSë ~ESï;:t[C';"'IONS7 l5Z'-e. 0 No If No. ,oese';.o .".fly ;;;ibN;~ 1"$ Æ _ ~ /'If'ern, l...Jk$ p""'" f1JfriNJJ 5u.h-.e''''St-'. ¿J.4/C¡ffleL.. ~~ ?/r;4- )~(I~)';ùR IQ71.-- o'F '3. './/HAT IS ?FlE.SEt-IT UNO LrSt: IN VICINITY OF PROJECT? Q}'iUldenlla O.!naustnat 0 Commercia.l ~C:be; U Agrjculture CJ Park/ForesUOoen SDace i.......J OtMer to. DOeS ACT!ON INVOLVE A. peRMIT APPROVAL QA FUNDING, NOW OR ULTIMA TEL Y 1=RQM ANY OTHER GOVeRNMENTAL AGENCY (FEDERAL. STATE OR LOCAL/? ;g Yes 0 No If yes. list agency(s) and c.rrnIUaøprQval. ¡) . 5...f-F-p~""c.-tV~ h.Y{+-\. t.!e(I#ýí"'_BiV' _"¥eN '~ '"7:JE--c. - . -íei/IBW. 11. DOES A.NY ASPECT OF THE ACTIO'" HAVE A CURAENrLY VAUO PERMIT OR. APPROVAl.? o Ye~: 2! No ¡f V~S. list J.g.enev name and cermluaølJrOval ':7 12. A.S A RESULT OF p:oPOseo ACTION WILL ExrSTING PERMITIAPPRCVAL AEOUIAE MODIFICATION? Dvo. ONo I CERTIFY THAT THE INFORMATION PROVIDED A60Ve IS TRUe ";"0 THE BeSi OF MY' KNOWLEDGE SIQ"alure: rn CCtt ffre'¡ f Oale: If the action'is in the Coastal Area, and 'IOU are a state agency, complete the Coastal Assessment Form before proceed;ng with thìs a-,~~essment OVER ~ . 0' ,~~-, 11- "_,,\I'JIRO," ,'1 E,:o.r-, ~. -..1'\ ~.I< _ ~ ~. SSME:-n 1'7·) 0'2 r;:)i,";::;~~e~ JY i1Ç!?!1C ... :CES ,.\C7,C.... :'.\Cz.-:.:: ;','."( ,,':>':., ':'r"!~E5;'¡OlJ ,N t5 \f':''::=R. '¡~'::,7 ';:i :;:: C:':'.t:S C:\IO :!. N!~ AC7:C.\I ..,e:.::::.:'y;;: :':CFCINA7ê:1 =<!e:1/f2N ...5 ¡:QC'lfCE:J .=,:~ UNL,S":"EiJ ,)"C7;C:<.tS :,'IJ j "·rç:::? ='.4":- '5., ~, ."':"-:!., :Je sucerse::: :>y J.!'1Q¡:",er ,n"'(~~~ ac;:enc"{ ~'f9$ :--=NO . ~f 1-95. ;ocrOlnë¡tOJ :lle r~"rew :roC~!>3 ano J5a :l'1e ::::JL_ :....,.. ./ ,"0. .:I .1I!Q::.t:V4 :::ac:;Jr..- c. ::':ULD ":'C":':!CN .:::I.eS\JL: N .1,'4Y AQVE:=.së =.:=,=;:.::-;'::; ,:::SCC;.:.ì~a ,VIi'\-! --!::. ~':Jl:,"::\N¡N(;; .';'nswets ::"tõY ':.E! '&r1CIwrut!." I :eçICf~) :-1. ':.'CI.stJI'H1 Jr Quality, 3urt.ac", or ';rOlJnow#ter ':ual¡!Y -:;r ~l:a.I"tIl(Y. ,'CISe ;e·/~iS. :!~!S~lnç :ra¡fic ;:alterns. ~oliC .vas.:e ;UCCI:c:;::n Jf J's':: ;JO!t:rWal ler '!roS¡on, ::ra1n89'& cr ~ooalnQ .J(CClems? ;''tDlaLn ::>1I,,ly; C~_ ),o!~tho!c:. ,¡çr!C~!tur31. .ile~altOr"C¡IC3.L. ,'Is:on::. :)r ,j¡:"Iei' .,at'Jr;.1 :1r C:"UUf;J1 '!!SOUrC2S: ':If ::JrnrnI,Jn"'/ :)1' :1e1ç':"ItCrMOCd ':::ãrac:~ar" :.c.t=r'¡ln ~ -::::. l/egefOitlOI'l.:;)r :õun... ;15n. 5r.F!llfJsn or 'Nlicrlre SDeçJI:'~, ¡!gf"'llic!nr .'SClltars. Or :nrU:taneo:! I)r ~'1¡:ançerec !Osc:es1 :'..:cl.,l:In )rT8!J',: \:.1., .A- c:;::mlT'\unlly'5 eXls,:"; ;)lan3 or ~Oa15 as .otflc:a.11y lIC'JcCled. :)f a. cnange in u~a or f~tensty at use ot land cr Other natural resolJrc!J!1 ~.....caJr. :. .:::~. Growln. SuOseouent :eveloo~ent. or relatØ<j: ac:"¡t¡es Ilki:!.y :0 01 ·oduceo ,:,v !he orccolié!C aC:lo"7 !:;:;.¡Ialn :Jrlellv, '~o. ~ong :erm. 1nort :erï.'l. '::Jml.llaWle. or OUtsr slfec::s ('Jot ,oenllfleO in C~·C51 :XCIL31r1 ~r:¡;'I!'I, ;¡:':'!r :moae:!;; .inc;uc¡n¡:; :::-:.ançes:n 'Jse 01 :ilther ':¡U¡¡(I[lIy..,r :yçe ::H ~!\erçy}? :'1::1\..1/'1 :.muJy. " ':P. .5 ':"'HE::!E. ~A.S :-~F.?E _:!<2:..:;":-0 ~e. ~NTRQVE.;:'S'( ~E!...-\íË~ 7"0 ?Qr~NT~A;" ..1.01J'£~Së ::.'IV¡RCNME:-J¡;'l .,',1F'''-C7S? '-':'f8::1 _ :-~o :t ·:'e'S, ðx¡:laln :;,rieitv ?ART IIf-OETERMINATION OF SiGNIF!CANC:: ITa ~e comptetad ~y "gency) INSi;:;UCiI0NS; For eac:J adv~rse ~tfect :dentJtfed 3cove. aerermine 'Nhetner it Is sucstantial. large. ¡;nccrum or o:r:erwise siqnitit; :.a<:h !ft8C~ $i'!ould be assessed in connection .....'In its (a) 3et~lng (I.e. urban or rural); (I::) ;)rotlaCility ot occ:J.;ï1nç; (CJ darafior:· Ir~e'le(sltllHy: ,el geogracnic: -sc:Jce; and (f) magnlt1.u::e.. It necessary, adCl attacnrT:entS or reference supponlng :-mUena!s. E:15ur.<:! !xQ1anaticnS c.onta.ln suttic:ent delaJl to snow that all ¡,!e'lant aGlverse Impacts nave been identified .toC: aaeqlJa:elY acc:ressec. C:'ecx: this bcx if 'fOiJ ;'ave identified one or .-r:Ore :)otenrjally larç;e or significant ac·,erse. Imo2.C~S 'Nhic:1. M~ '( OC:::.Jr. ïhen :)roce:!d .::Jirec:ly to :J1e FULL ~A;= anoior prepare a positive declaraticn. C:'ecx tl"IIS '::ox ·f you I"lave de!ermineCl, ~asea on :he informa.tion anc analysis abc'le and any suooortif":c cC'c;,;mentaflcn. :.'.2,[ ~h:è ~ro"ose~ ac:ioi1 \VIL.L ,'JOT resulr /n4r:y su;¡niiicant adverse -!:1vlrc,,¡r.enral imC'dc::-: AN 0 ;;¡.rcvrqe :In 5IitaC:lr:1ents as necessary, (he reasons supconjng ~nls determma.uon: ...........' ~f ...:..u "..:~I"CY .....,{1[ J' .ue "..mfl' )f .; '.OOI"l\,cle";U',U rI......a ........r.c·' '-'lle :.: <..aOOtl~,OI'" ..)r:lc~r "..nJ;,",r~ .') o(~~cO"'''O'~ .::!:,,::~ ,t' ~".1a .\I;"'''C;Y ,L'<Ii".¡tuto,! "r'.",,~.&fer .Ir ",,,:e·..tlt rrom :!:',oon~':JI~ :'¡;',C"'" ~ J..¡C 2 . . Dear Neighbor: BOARD OF TRUSTEES. TOWN OF SOUTH OLD In the matter of applicant: SCTM #1000-76-01-15.3 YOU ARE HEREBY GIVEN NOTICE: I. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: Construct a single family dwelling on the above reference lot. 2. That the property which is the subject of Environmental Review-is located adjacent to your property and is described as follows: All that certain plot, piece or parcel of land, situate, lying and being Bayview in the Town of Southold, County of Suffolk and State of New York, being bounded and described as follows: BEGINNING at a point on the division line between land now or formerly of Michael F. Zukas and May Zukas, his wife and land now or formerly of West Creek Development, said being North 39 degrees 55 minutes East, 563.95 feet northeasterly along said division line from the easterly side of Main Bayview Road; RUNNING THENCE along said last mentioned division line, north 39 degrees 55 minutes East, 330,00 feet, more or less, to the center of West Creek; THENCE easterly along said center line, 122.49 feet more or less, to other land now of formerly of Michael F. Zukas and May Zukas, his wife; THENCE along said land now or formerly of Zukas and along a 30 foot Right of Way, South 39 degrees 55 minutes West, 415.00 feet, more or less, to other land now of Zukas and May Zukas, his wife; THENCE Along said last mentioned land of Zukas, North 48 degrees 50 minutes 30 seconds West, 90.00 feet to the point or place of BEGINNING. 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: July 24th, 2002. 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 does not reference any other agency that might have to review same proposal. OWNERS NAME: Patrice M. McCaffrey MAILING ADDRESS: 79 Ketewamoke Ave., Babylon, NY 11702 PHONE #: 631-669-6682 Enc,: Copy of sketch or plan showingJ>roposal for }lour convenience. . ~ . . ,ø'\ ~~'" ,4 , i~ +'ò A ,/ i ~ . , , ~ /' i o ~¡..ø/" . :;/" >I /' / r" .......- -.. , . l\t'rLtCl\N'l' TRANSACTIONAL DISCLOSURE FORH . The ToWn of Soubhold's Code of Sthics prohibits conflicts of interes~ on the parb of bown 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 N/\HR. . HCCN:Fv. ?8'ntìce. /0{. "";("'''+;;f'~,' Last name, first name, n t aI, unless you are applying in the someone else or other entity, such as a company. If so, indicate the other person's or company's name.) . "ATORE Or APPLICATION! (Check all that apply.) . : . ~h)!¡ . .:. r~.· :;,}!: -. .~"':~. Tax grievance Variance change of zone ^p'p~pval of plat Exe~ption from plat or official map other X , , (If "other," name'the activity.) Men..fr>\A),j t'e./~lT . DO you perBonally (or through your ~o.pBny, spoune, nibling, purent, or ~hild) hDve B relDtionship with Dny officer or 8111ployee of the 'l'own of Southold? "Relationship" includes by blood, marriage. or business interest. ""uoineoo intereot" lIIeano a buoineRo, including a parbnerøhip, in which the town officer or employee han even a parbial ownerohip of (or empluyment by) a corpuration in which the town officer or employee owno more than 5% of the shares. "(J~ '. YES If you answered -tES,M, cUlllplebe bhe balance öf ~htø törm and date and oign where indicated. Name of person employed by the Town of Soubhold Title or position of that person Describs the relationship between youreelf (the applicant) and the town officer ør employse. Either cheek the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or his or her gpOUSø, g!bling, parent, or child is (check all that apply). ~) ~he owner of grea~er than 5% of ~he shares of the corporate stock of the applicån~ (when thø applican~ ie a corporation), B) the legal or beneficial owner of any !n~erøgb in a noncorporate'entity (when the applicant is not a corporaHon) , C) an officer, director, p"rtner, or emplöyee of ~he ,'!pplicant I or D) the actual applicant.