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Home My WebLink AboutTR-5512Albert 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 CERTIFICATE OF COMPLIANCE # 0029C Date MARCH 25, 2005 At THIS CERTIFIES that the single-family dwelling 1280 Smith Drive South, Southold Suffolk CounW Tax Map # 76-3-11. I Conforms to the application for a Trustees Permit heretofore filed in this office Dated 2/25/02 pursuant to which Trustees Permit # 5512 Dated 3/20/02 Was issued, and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for a single-family dwelling The certificate is issued to aforesaid property. Timothy Holloweil owner of the Authorized Signature June 26, 2003 Board of Town Trustees Town of Southold VIA FAX 765-1366 The following will confirm my telephone conversation today with Charlotte in the Board of Trustees Office. We currently have a Building Permit # B.P. 29429-Z for demolition of aid and construction of new at: 1280 Smith Drive South Southold, NY Timothy P. and Margaret A. Hollowell Could you please arrange a Pm-Construction Hay Bale Line Inspection at the site as soon as possible. Demolition is scheduled for Monday, June 30, 2003. Should you need to contact me I may be reached at: 631-924-4195 business 631-765-3037 home Thank you for your assistance. mah Sincerely, Margaret A. Hollowell 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-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. I.S.ECTIO. Pre-construction, hay bale line 1st day of construction constructed ~//Project complete, compliance inspection. . . 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 May 1,2003 Charles M. Thomas, Architect P.O. Box 877 Jamesport, NY 11947 RE: TIM HOLLOWELL 1280 SMITH DR. SOUTH, SOUTH OLD SCTM#76-3-11.l Dear Mr. Thomas: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, April 30, 2003: RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to Permit #5512 to remove an existing residence and to construct a new residence upland, with the condition that hay bales are placed down landward of the non-turf buffer, and as depicted on the site plan prepared by Charles M. Thomas last revised January 28,2003. This is not a determination fTom any other agency. lfyou have any questions, please call our office at (631) 765-1892. Sincerely, (l~ 1 L· ¡ ~ /~-Avß., C, I , F Albert J. Krupski, Jr. President, Board of Trustees AJK:lms 0 -' ,0 '::C: !- ;:) 0 <J) 0"'" '0 ~ z « ~ 0 0 a:I I- w I- « 0 '. I----r-- ~ ~ III " I I lI:;&hCIIII .. ---- 10 -.,... ,.. ...."'- ~IU"ØI""__"-'Io~ IIÐ"ØOO'1.O_"-I"EI'I'CIu;""", J ......Ø"t~_ CIIII'IØIa.......1'O. __......,... ~ ~~ c:.r:t.tD . ,_ .. 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J · tJOtJ tI~ ~ ~ \ '\ -. -; '= ,~;,:'" _ ..n. --- __ ,\ ~_ ~LI~;>:~ ',ì;< SEP;:; =: L'C:;w~CTION E?¥1')fI~~ feslOev,-< ,~> ~ I ¿JÞ~, ,/ / -þo ~ 'Kttv11)VÐ'? ;. ~ if.¡S< '¡.Ø- -/ /<# 'v\~ ~~'v~/~~"\;,~~y>t- t _C 4- ! 48 ~~ ~r' ~.AP ~t::. SO::JS!:: \E-:.r(. /' F'~EJ' ~.¡O'/::1'vfBEÇ;:: -:;¡4~ 'i_---. có3·:::: ,./ SL~;:::C_< ¡ -<;o#- ,cØ- ø ::: --,":"-=:7 SC...~-C_~ --=-t",~, ~c: ~ -- " ~ ..... " -,~ - - .- -, - - r: -:::T' -é-=-_<.?-__. SCA:...-=. = 4(:-0 -:.-.,(~ .::::.¡:::-- - ~ - -'-_. 'S,""-::: D_A", JF -.....E Chorles M. Thomos arc.hltec.t PO BOX ðT1 ..JAME5PORT, NY 11'141 (631) 121-1'1'13 HOLLOHELL RESIDENCE Sl'-~,-- JQi.,i"E so'.. -.... SOl. ~-C_S: ....=:V't Y.:'R.IC £...." ,L ~. t..CY. 10. 'C2 <;(fV' '<aV. 2ò, '02 <;(fV ...A>',28?" .~!,."F'::',"""'", ;¡~"'~ / " C ' ' ',., _ ~ rn.I /,3," 'é;: IT\-\ DR ~'" t~ .. ': -- ",," ,. 'r 1-..-' P\f'E /r/ ï\ "", .~,,':,' 'It \ . \ .~ _'\ Iì,:~\'<',~' :<, \ ,..' \ < ~ ~" ;:é <, ~> ;.qÿ ~'- '0 "1 ' ~~ xv l-Oi..... \ \ \ \ ~. oIMIlØ'lllDCDTOIU.¥.o.'t2IIDANIt IUVA'IIOfII MI WC/WII TIIJI< ¿.' L fOf'UD_n.1UTotOI,(IIiIIT,,- !_.....-lrI"TICr....W..crnbI'Ølt.ITO.I[DIIOOIII~.'.JOD1M,i.OoII.. ,,- 4.1ØM.111 ~1111b J1)IIA 1 mAlØICOIIoo.- ..soo "'I ftSIIIFII,NJ........ US[:1IJ{.).fT ~t'oIIIIH"CA,IT~~.1IOI .l"ICI'CIIIØoP.......1'OOl .IIIIOIIIIØI~__(.I.·IIIA..~·_ f2ZJ~.,.nc...(,)'_....._~cøc.lUT1Cr_ 6. TIt( I.OCATÞOI WUJI iYCI~ aIO'III'IIiIØIVII__~ ~ '*PYA11OIdI .-/0. (I,,,,. *AMtD .- 0TICItI. . L' -1:-; r::. ;:H..-[ <1\ 'I:~r_n- 5' \1 PAU IIIOWM nlf[ TO IotiD SAND "LJ r M .."""..~."...""".,,..... 11..""....,_.""..., "lj , \ '< \ ~, r ~'., _ \. .,.fD: ENCOUHT'[lt£D '.1' II[lOW sUItr.l,a 't I ,',' . '.: .: '_f~ ¡ :. ~l ~~', - "t', I' ,'J ,;, : 1.1f:!. - _ _·+,.I~ -: ."J.- \, r I_ :'~ r', :' -f : . , ~\ 'tr: \\ :<'.:,~ ~Ol: ", ~ j' .'r.~ ..... - - . :, ,f ~.¡ :1" ,'''';£.:' ,_ - < _ - f. _. ¿ ~DQIU.D['.!· ¡--o ~ =,~~_.,," Wil.T[J I:NCOIJIIT'œD 1-" II:I.O'fI' SU!lF'AC( ,-- \\~, -- -- \. \\. , \ \ " ~\,"I"'\"\"\ . \ /~/ ~ ~ ~ II '\"'>.. ' ~~ // .,. If.~y 0/ / V~ " \ ~~ ø< /'- /' ',..# \ \ ~y /' ,-, / Y"' ...'\ 10').~""'-{i;. _ ,/~'iS / // ~/~. / , / SITE PL,ÄN SCALE I' := 40'-0" ê--r-""'/ ./ ~~ n t¡~ - ~ --....... ....... ... .. - -.....- .....,-- ...0 et' # ø , , S[PTIC SYST[M CROSS S[CTION LOT, 41 ~ 48 MAP OF, GOOSE NECK FILED, NOVEMBER 22, Iq48 NO. 1663 CO SUFFOLK SITUATED, SOUTHOLD, TO¡'<jN OF SOUTHOLD DIST. 1000 SEe. 16 BLK3 LOT 11,1 t I SITE PLAN OF THE HOLLOHELL RESIDENCE Charles M. Thomas cu'c.hltec.t PO BOX E'>ì1 .JAME5PORT, NY 11"141 (63/) 121-1<1"13 SMITH DRIVE 5OlJ1"H SOUTHOLD NEH YORK REV, NOV 10 '02 REV. NOV, 28, '02 REV. ..JAN, 28, '03 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 (616) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO:Î L in l1Ci..l ~ U Please be advised that your application, dated ~/~llo3 has be~n ~eviewed by this Board, at the regular meeting of Lf/ JO/O!J and the following action was taken: ( v/) Application Approved (see below) (____) Application Denied (____) Application Tabled (see below) (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: ..$ /0, DO - l rwpectA.iY) ~~ (~ attðc- hod) TOTAL FEES DUE: $ j(J.OO t!Lt,¿, , /l ~~ ,¡~..t' 9' SIGNED: y. PRESIDENT, BOARD OF TRUSTEES BY: "~n .J%:r~ , BOARD OF TRUSTEES 4/98 . . . Charles M. Thomas, Architect P.O. Box 877 Jamesport, New York 11947 (631) 727-7993 email: cdthomas63@aol.com March 28, 2003 Town of Southold Board of Town Trustees Southold, NY. Re: Hollowell Residence (permit no. 5512) (Request for permit modification) Dear Sirs, This letter is submitted to request a permit modification for the above referenced residence. On March 20, 2002, my clients received a permit from the Board of Trustees to construct an addition to and renovate their existing residence. A copy of that permit is enclosed. As you can see, the setback from the approximate water line of the permitted residence is 85'. Due to the complexities involved in expanding the existing residence, which included the necessity of obtaining variances from the Zoning Board of Appeals, my clients elected to pursue an alternate plan involving the construction of a new residence on the upland portion of the property and the removal of the existing residence. The new residence could be constructed pursuant to Town Code, DEC and Health Department codes without the need for any variances, More importantly, the new residence plan shows an abandonment of the old septic system with a new system to be installed over 110 feet landward of the old system. A copy of the survey showing the proposed residence and septic is also enclosed. The new residence has already received a permit from the Suffolk County Department of Health Services and the DEC. Copies of those permits are also enclosed. The construction of the new residence proposed on this parcel would not have required a permit from the Board of Trustees except for the fact that the existing residence, which will be removed, is located within Board of Trustees jurisdiction, Because the proposed new residence will have substantially less impact upon the wetlands than the previous expansion and renovation plan, my clients are respectfully requesting that the Board of Trustees amend the existing permit to allow for the removal of the existing residence in lieu of proceeding with the permit to construct the addition, . . . Board of Trustees April 3, 2003 Page 2 My clients greatly appreciate the Board of Trustees reviewing their request. Kindly contact me if you have any questions or if you require further information. II , . ·1 I ["'o&~ \~ ~-~ 10"' \2' _---~\_~ 'OO~ .- \ --30 ___ \ ~.. .....xl TO ....... '.. ....I\M UW... .. __ .... 1.. L ~_rœrørooøu:DJ.T,,- J _ ~ "- CM>IØnD ,. . , '" I ~ ... . '... ...., II' "-' . ":-:~=-:-T·_TO":':~~~-.:.sK1fW"""..ot. I' .~rgo_1'OIIl ,I \ .s- ~~-7\\ 't~ /:..~ ~c,\' ',\ 4~ '~~\ ""'P,,..-.::="{~~ \ " ~ _ --r \ ~'-"'~_c"J'-_.r_ D__~._ "J ._.... _ ~ <-= ...-.: ,_ !I.....ux..'>œoor~_~__.._...... 0.1:.....,.. ...c;...,. IlOo10 _...... __ C'T\C8 " ~ ~ _TT 1.UID .....- ~o\I.I ....,. ... TO IIII:D SouCI .,'- ...I'[II..,·...c:~r"II('OIlC1.uIC \ , ...!'(It..,..z IIttN'II r'1oI[ s....c .' ,. "'"' I . 'J" 1...-- 1" ". .---'-' LPT~ .''''0 DCOuIittIltÐ 1.1" .tOW SUW4Cr , ·t.' t----<--- NCIPOKO -..or '.5" \) .~. \ ~' ~Oø:- "~J ¢# '..\ ..---/ t:f'~'{\ ~)C15Î11\J4 ~'Oavc.! iD f¿ tf¡:MO~t."17 ~~·\3'\"H , , , s .,......,¿,--:::> SC'-,'-'--:'_=:- -:-,',~. ::.-= / ti ,r', . ~ \ '--' ~... -\ " '-"~~ t ~ \01b4' ,.,.E 1. ~ ., ,,'\: ~C>~, 'Ji>, / \\~ ~~" ,¢>:3:¡ ~'" ,/ ¡, ~ ~c:fø<'i:Ø' /?//#'.-\~ ~~~~ ~y>t- , '0 ~~, ~ ~"" t ~-~ .~ j -......- ..-.-... . ·.·JTC"&"....... . NÐf'lJ.Nnt IHC> _-. ~~J-.O'"cu.ut,..,..uu . ~ðOI"".· ---- .....u DC:CUitTtIED L' 1It1.OW"'-4CI: SEP"C SYSTE~ CRCSS SO::TION · tJou k 6u~~ '~4~ /' cG3~-:: ~ ~~ _0- 4- ! 48 "1,AP ~t::. SC0S~ \::::.< ç:::'L:::J ~~O'/=tv19E;;::~: '::::4:; ~'.~ Sc. "':=C· '- <: ~ ~- J, ¡..,. ~""" -~-~- - - - <-")'c.."'- :-.~':: S~c -f:- :?_< ? :='L ~ ~ :: : = 4~ -.J HOLLOHELL RESIDENCE Charles M. Thomas orchltect PO BOX ðTI ..JAME5PORT, NY 11C:¡41 (631) 121-1C:¡C:¡3 -:-,~E :=:..-A' :.:-,::: -.....:: Srv,-- ~"/E S()~ .... SO,.......-tC_~ ....=-..... 'r' .:qt: ~ ~, NOV. 10. C2 ~v· NOv. 28. '02 ~v .JA" 28 03 . . ~'<f'J ~..f't( ,'..:.r:..f \'111 DRIve 5OJíI"' \0'1.12' -- T. ;I,.þ:a~_.. :.::~~ 1Ion.w a. .... .. ... "" ,. ... .-u MY" L ...... IPnt ,.. ___ ,. " I .,. . _ _ . 1.6a ..... ,,- 4. .....~MTDI,.., "'.~__._...--...... ....e.)." ~r"'NÐ:IoII'~~_ .__D:I"..-.... .___.--.(I'r.....r_ l1li..--.. ~ - (I) '..... __ _ __ __ '- L'" ..oc..ftCIoorwauNMÞ________ _,...... _,,__~~tIo___.,..., ." -," ~ r~ . "1 ..; aow." IoUCI ....~ ....., ..,.. q,( 10 CD IoIIICI ,,- ....mIfNoU....FMralllUl.... r . ....YO.. MI.I MØIIII ... ... PL.EASE N~-:__, itary System not to béJw~ed er driveway. 'I ,r ~ \ ",fþ~"'I·IKI.ø-"1II:I. , " T .'" ~ '. _,: i: -·-,.-E' .1.._: 'I .~.' .~ . -'.~';", '.~. ... OLK~~iMENToFHEALmsERVJ ,.~~~ ¡p~~VALOFCONSTRUCTIONFOR~ \ _, 4}NGLE}::¥Iffi.X .RESID!:NCE ONLY tr> j.:.2f,.:6'5'·'H - - . I . ~ ,\ , \\ '\ \ --- ---\- ---...... --- , --- t~ 0 q~ ~ . -- I ......... - --- ·.-.cNØ~ ..-'~ '.\ , \ 101b4' t ~ t:~is\i(\9 bCl aodo~men ~ by Health 0 be v.lit08SS ~ /.' ~~// ~cf~ fI-Y /'" / ø-v.¡i:- ~ 'v:iØ! /> / ~ ~~. ,O?- ~'^'"'~ t I - - ~ 1 ------------- j I S ~- --. I r I I t:: ;----' i-M,\( SCALE " = 40-0' ~IItAØ(L' ~ ~rY~"6lW.' I '-- ¡J ~¡·~C.U,II""'WAru ....TU~..,·II:I.o......1iIŒ ------ SEPTIC SYSTEM CROSS SECTION CeL ~-t i r-Qý\ ~ v-e..h' d ."^ 5 e..p-1 ,"C / wrJ< ~d. ;;¡, d;si-r'6J1~ ~ls "-OT, 41 ! 48 MAP 0<= GOOSE ·''::CK: <=ILED, ',Ov"EMBE" 22 '''48 NO. 1663 GO. SUFFO...K: S~c:"'TED, SO~THOLD. T:),'1r-. 0" SOUT'"1()"-D \.C5'>_ '" /' ....- / /' / DIST. iOOO SEC. 16 5:...K:.3 ,-OT ~:.I HOLLOWELL RESIDENCE Charles M:~Thomas ( - .. CI r c.. h 1 te -6 t· . PO BOX ðTI ..JAMË;p0RÍ', N"( '·''141 (631) i2ï~i~3-c', S'T= PLAN OF "-HE 5MjTo-t :?RIVE SOUTH, SC)I,J;MOi...D NEn YC>R.K 'Œ'V. NO\! 10."02 'ŒV· NOV. 28, '02 'ŒV' .JAN. 28, '03 r.. - - .¡ 1,1 :::-... ~',;::. ~.' , - - 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 March 22, 2002 Charles M. Thomas,Architect 206 Lincoln Street Riverhead, NY RE: SCTM#76-3-11.1 Tim Hollowell Smith Drive South Southold, NY Gentlemen: The following action as taken by the Board of Town Trustees during a Regular Meeting, held on March 20, 2002, regarding the above matter. WHEREAS, Charles M. Thomas, Architect on behalf of Tim Hollowell applied to the Southold Town Trustees for a permit under the provisions ofthe Wetland Ordinance ofthe Town of Southold, application dated February 25, 2002 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 March 20, 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 prernises 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 97-18 ofthe Southold Town Code. ~ . 2 . WHEREAS, the Board has detennined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT. RESOLVED, that the Board of Trustees approved the application of Tim Hollowell. for a Wetland Pennit for one story addition, approximately 68 sq, ft. BE IT FURTHER RESOLVED that this determination should not be considered a detennination made for any other Department or Agency, which may also have an application pending for the same or similar project. Fee must be paid, if applicable and pennit issued within six months of the date of this notification. Two inspections are required and the Trustees are to be notified when project is started and on completion of said project. FEES: NONE Very truly yours, /Nt., .-1 fl. '-"'-'~ L 1""- /4.--¡~~ ~ Albert J. Krupski, Jr. President, Board of Trustees AJKIcjc cc DEC Building Department ~ Board Of Southold Town Trustees SOUTHOLD, NEW YORK ss-,...".. PERMIT NO. . DATE: .March 2.0., 2002 ISSUED TO ..<::I1~r.le!S M·Iha'1.1a.'è.,.Axchite.cton.behalf .af TIM HOLLOWELL Î\utqnriZ!utinu Pursuant t.o the pr.ovisi.ons .of Chapter 615 .of the Laws .of the State .of New York, 1893; and Chapter 404 .of the Laws .of the State .of New Y.ork 1952; and the South.old T.own 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 acc.ordance with the Res.oluti.on .of The Board ad.opted at a meeting held .on.~.,,!c:l1..2Q.. .2002., and in c.onsiderati.on .of the sum .of $...2Q9..,.00 . paid by Charles...M..Thomas, Architect/behalf ··of·Tim"·Hollawell .of .....IUy.,rll,.,a.clL .. N. Y. and subject t.o the Terms and C.onditi.ons listed .on the reverse side here.of, .of S.outh.old T.own Trustees auth.orizes and permits the f.oll.owing: Wetland Permit far a .one stary additian, appraximately 68 sq. ft. all in acc.ordance with the detailed specifications as presented in the .originating applicati.on. IN WITNESS WHEREOF, The said B.oard .of Trustees here- by causes. its C.orp.orat~ S~al t.o be af~xed, and these p~esents t.o be subscribed by a maJority .of the said Board as .0 thiS date. A../., /(7'¿';7 - .4"p A, lile F'u~l'tl ¡¡}bsent) . rules ... . . Telephone (631) 765-1892 Town Hall. 53095 Main Road P.O. Boz 11'79 Southold, New York 11971 . SOUTIIOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Monday, March 18,2002, the following recommendation was made: Moved by Drew Dillingham, seconded by Scott Hilary, it was RESOLVED to TABLE the Wetland Permit Application ofTlM HOLLOWELL for a one- story addition approx. 68 sq. ft. Located: 1280 Smith Drive South, Southold. SCTM#76-3-11.1 The CAC Tabled the application because the project was not staked. Vote of Council: Ayes: All Motion Carried ~ . . TERMS and CONDmONS · ...( f¿'¡t.. The Pennittee 'T''¡rn Molls.:!ell residing at ðæith Sh eet Gvull, 8uu¡h 1~ N. y~ as part ol the coosideratioa lor che JsSuånCe 0 ~e t docs uødentaocl and prcscribc to the lol- lowing: 1. T1w the said Board of Trustees and che Town ol SouchoJd are released lrom my and aU damages, or claims lor damages, of suks arisüJg dh-ccdy or inditec:dy as . rauh ol my oper- atioa pcdo.cmed punuaøt to this permit, and the aid Peauitœe wilJ, at his or _ own C2l'61SC. delend my and aU such IlÙts·/..HlofWI by third pardcs, &ad the said ~~ ___ lul1liabU1ty with respect thereto, to the axuplete adusIon ol the Board of Trusrtes ol the Town ol ~ 2. That this Petmit is vaüd for . period of 24 mos. which is coasIdered to be the estimated time· required to complete the work inwl-', but should citcmiIstaDces warnat, rec¡uest for an exœasion may be made to the Board at a l-.: dale. 3. That tIûs Permit should be reWncd indefinitely. or as loog as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone a>nœmed that auth- .orization was ori¡:inally obWocd. 4. That the work inwlved ..m be subject to the inspectioo and approval of the Board or its agents, and non-compliance wich. the provisions of the originating appIication, may be cause for revocation of this Permit by resolution of the said Board. 5. Thar thctc ..m be no unreasonable inle<ference with na'figation as . result of the woå: beIein authorized. . 6. That there shaU be no interference wich the right of the public to pus &ad RpISI aloag the beach between high and low wale< marks. . 7. That it future operations of the Town of SoutboId reqnìre the remova1 and/Of: alœradoas in the location of the _rk herein antbodzed, or it, in the opinion of the Board of Trusteef, the. ",orlo: sha1l cause unreasonable obsltuCDOo to free navigation, the said Pennittee will be required, apoo due notice, to remove or alter this _rk or project herein stated without e..~ to the Town of Soutbold. 8. That che said Board will be notilied by the Permittee ot the axupledoø of the woå: auth- orized. 9. That che Permitlcc will obtain aU other permits and consents that _y be tequired sup- plemental ro chis pcrmit which may be subject to revoke upon failure to obtain same. , \'.' ',-",..~'..'}." ~., . ..",..\'.1 ." .c, .' . " '.' . , \. \. '.' ,. . . . . " . , , ,..... \' . . . . . . . . . , . ,. . . ._."1: -I. , c.'?'lcotions indicated ".,.on elt_nlfy t "i. plot of the hereon described property j true and corr-eet representation of 0 recent 5l,r.,.y mOde and plotted unde,. my dlr'sctlon In accordance with the existing Code of Prgc!ice for Lend Surveyors by th. New 'York Stole ASSociation of Prof...ionOI I.and Surve)IQr.. Said cGrtiflcotions sholl run only to th. person for w"orn the Survey;, prepored cnd on the., oMlOI( to Ihe title company. qovernmentol 0gency and lending institution listed ".reon. This certification is only fOf the londs de!:crlbed ...,reo". it', not 0 certification of title. zoning or freedom from encumberonces. Certification, or. not tranSferable 10 odditionel institutions ,f 'v9s.Q...." t owners. -- r"~....... ~ \\9'2-·4- ~ ~\ ~\ ~~ \\ ~\ ~\ a. « ~ · <0 ~ IÖ (\ (\ lOT 49 ~ · · o o · o ~ o I") z ~ - ... "- LM: SuRVEY VIEW: PLOT tv 8/vfr'''/t 80:3:, 0J::i" ~ o 00" ý~ ~ ...... &0,. 70> V"-L · 7<, '7 .r2 \ ~ \ .... ~ Eá \ \ l.f; ~a. P" « ~~ . ~(\ .0) 1 . <0 (\ (\ " IJ.J lOT 46 .J.O· ~ · .. ~ ~ Aþ;>¡rlo"¡ · , ~ a " NE\» Þec.K © CONCRE:Te:: COlIER ...... ...J.,TYP,) ~ ~ ~ ..}: 70 !~'rv >-6." -:: I)- 'Ù, ,~ ~ ~f Goo· ~ ¡¡<1 , 0""" ~ l. .1.J~tt \S'þ""">t-" . .- ~ .1/4'/0, - ... ------ --- ~ ,/ cp.~~ n,. offsets or dimensions shown from tl'1. structure. to th_ property line. or. for 0 SPecIfic purpose end use ond therefore or. not intended 10 guide in the .rectlon of fence.. retolning wall., pool., potlos. planting oreos. additions to buildings 01"10 any other co"s!ructiol"l Sub!JuI"'oce Condllion. not shown. [0........1.. ......1.-.'-_, ", "-" It _y. not ....._. ~Iy "Of".. ........."'...1. ..... "01 ploeoll e. .. "corio' I",. _yo C> 2001 B.B.V.. P.c. ~ Barrett, Bonacci & Van Wee Ie, P.c. CIVIL ENGINEERS/SURVEYORS/PLANNERS 175A Commerce Drive, Hauppauge, NY 11788 TEL 631/435-1111 FAX 631/435-1022 www.bbvpc.com LOT: 47 & 48 BLOCK: -_ MAP OF: GOOSE NECK FILED: NOVEMBER 22. 1948 NO.166.3 CO. SUFFOLK SITUATED: SOUTHOLD TOWN OF SOUTHOLD CERTIFIED TO: TITLE NO.: TIMOTHY P. HOLLOWELL & MARGARET A. HOLLOWELL SUFFOLK COUNTY NATIONAL BANK :,=·',.:~.iC·r'~''',E.~:.. p--/ L.;r..¡o TITLE It"¡SURANCE COf.fP;"NY .'.C..~',=:·-;-~~ ..4~·'=:TF-;·~CT, INC. ...J 6 <.::.:::...'....E- 1" UNAUTHORIZED AL TERA nON OR ADDITION TO THIS SURVEY IS A VIOLA TlON OF" SECTION 7209 OF NEW YORK STATE EDUCAnON LAW REVISIONS: COPIES OF THIS SUR\·:::Y MAP NOT SEARING THE LAND SURVEYOR'S EMBOSSED SEAL AND SIGNATURE SHALL NOT Sf: CONSIDERED TO BE A TRUE AND VALID COPY. JOB ~iO: A01C1'JC' ---- - - ~-- ---~-- D·\TC: ~= 5,~·: JI .--.-., - 40' [-,ST. 10ÙO SEe -'6 =Lr, :: l...':): 11.! ertifications indicated hereon slonlfy that thl. plot of the hereon described property Is 0 true ond correct representation of 0 recent JUrvey mode cnd plotted under my direction In accordance with the existing Code of Proctlce for land Surveyors by the New York Stote Association of Professlonol Land Surveyors. Sold certifications sholl run only to the person for whom the survey is prepared and on their bshQIf to the title compony. governmental ogency ond lending Institution listed her.on. This certification Is only for the lands described ¡hereon. It's not 0 certification of title, zoning or fr.edom from encumberonc... Certifications are not tronsferable to additional institutions or subsequent owner.. " ............... ... 't ... \\9'Z-'A' II¡ 8"",,.,.,.., 0 6'0~ . ,'/:ill I o 00" ~ VI!: ... ... ... 10>. 1 :'OÚ.,..,.., ~ ~ ,%-, ~, ~ \\ ~\ ~\ LOT 49 .............. ... ... " a.. <:( ::E \ 'i \ .~ OIRT OR'\o£'IVAY ~ONCRETE COVER ... ~TYP.) ~ ~ Ija.. Æ~ . ...~ 10'1 to ~ ~ " I ~ I lLJ LOT 46 APPtïIO,,( ~ . ~ a FEB 2 5 I I . ~ IÖ ~ ~ I I \ \ L¡>¡ ~ ~ i '0> '6~ ~ - cf(i.ø.. .... ................... ~ I o o . o t"> o It') z ~ .. ~' . . p..,., ~"<'.,'.<4~ ~ ~;11 >1>, LM: SURvEY VIEW: PLOT The off..ta or dimensions shown from the structures to the property IIn.. 0". for 0 specific purpose and use end therefor. ore not Intended to guld. In the .rectlon of fenc.., retaining woll.. pool., patlol, planting areal. additions to buildings and ony other construction. Subsurface Conditions nol sho",", r___... ,,""......,-w., of I~ I'..,. nil ........ ~')'._ _.... _I no' '1....... ,.or. Ir 1"'18 .......)'. 02001 B.B.V.. P.C. UNAUTHORIZED AL TERA TlON OR ADDrnON TO THIS SURVEY IS A VIOLA TlON OF SECTION 7209 OF NEW YORK STATE [DUCAßON LAW ~ Barrett, Bonacci & Van Wee Ie, P.c. CIVIL ENGINEERS/SURVEYORS/PLANNERS 17SA Commerce Drive, Hauppauge. NY 11788 TEL 6311435-1111 FAX 6311435-1022 www.bbvpc.com LOT: 47 &< 48 BLOCK: -- MAP OF: GOOSE NECK FILED: NOVEMBER 22, 1948 NO. 1663 CO. SUFFOLK SITUATED: SOUTHOLD TOWN OF SOUTHOLD CERTIFIED TO: TITLE NO.: TIMOTHY P. HOLLOWELL &< MARGARET A. HOLLOWELL SUFFOLK COUNTY NATIONAL BANK COMMONWEAL TH LAND TITLE INSURANCE COMPANY ADVOCA rES ABSTRACT, INC. DR. GC CH. W.J.B SCALE: ," - 40' REVISIONS: COPIES OF" THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL AND 5'GNA TURE SHALL NOT BE CONSIDERED TO BE A TRUE AND VALID COPY. JOB NO.: A010100 DATE: FEBRUARY 8,2001 DIST. 1000 SEC. 76 BLK. 3 LOT 11.1 . . 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 APPLICATION FOR AN AMENDMENT TO A PERMIT DATElkul ~ I '1.t'D""I OWNER-jÎ~ tbllowELL PHONE ADDRESS \ ?.ÐO SÞ'--\\-n-l QZ.¡Vt:' ~ AGENT C~ ~I\") ADDRESS ?O. '?'~ 817 I SOLl~L.o PROPERTY LOCATION I:z..~ ~ ('('rl_PIZ·IV!é: TAX MAP NO. /000 - 7b - ';; - Ii r PHONE '71- ì - 7Q,' ~~~ tV'1 Il~~ SWpj.. ~~ @re c.~ 11low>A ') request an Amendment to Permit # tÇjÇ"l2. -~ ~II'IOII~ Á1V ~('>¡7A1~ ~fD-...c..c:- . .t -b CoV'}~.J-. À-fVÐoJ ~~I(7~ .. S~BYcß~. {'orA qC\.J1Ÿ- f¡i:J~ '{', r & I jtro:;. . Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda . Town Hall . 53096 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 766,1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD ----------------------------------- In the Matter of the Application of _ _11m. HD\1~ n _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I, ¿~!Z.Lc.s ---nlcWl,ø,s , residing at ...G2.3> M¡;rk~s A. I__~ , \~~~oœ.~ be1ng duly sworn, depose and say: That on the'2. day of ~L , 2005, I personally posted the property known aS~c...l.ow¡;;L..l- ~CiiS'O~...c.(õiï by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the. public; h~aring. Date of hearing noted thereon to be held ~3bJ~1 o r\ ~ Ch;)\::\, t( Î ~()D ~M.. Dated: ~n to before me \Jay of ~YI\ iìillö.\ Notary P lie this 2003 J Lenox Natal)' Public, Slats Of NøwYork Suffok Coonty . No. 4952323 Commiøeion Expqs June 19, 20 to. Albert J. Krupski. presidenl Jam~s King, Vice-President Henry Smith Artie Foster Ken Poliwoda , Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Applicati9'l _Wetland Permit Application L Major _ Waiver! Amendment1f.:~ges _Received Application: ;)-( ~ I (j :)... _ReceivedFee:$ ~ _Completed Application _Incomplete SEQRA Classification: Type I_Type II_Unlisted Coordination:(date sent) CAC Referral ~ent: -.2j 'i1J~ ~ _Date ofInspectlon:---:2:!. ___ _Receipt ofCAC Report: _Lead Agency Detennination: _Technical Review: . _Public Hearing Held:.3( :J-v 10 -V _Resolution: L Minor Ft./j 2 !J Name of Applicant \i~I.ÙII5'u.. Address ~~ I~E' Phone Number:( ) ~DcJ''1..L ~O~ 4:.'$ - 3>D~ 7 Suffolk County Tax Map Number: 1000 - ì b - ~ - I I . Property Location: ~M,nf 'PilI VE <oùnt r ~o u~. , z." }. I (provide LILCO Pole #, distance to cross streets, and I cation) AGENT: .ÞJ12.1..Ø (If applicable) 1!føP-f ~ I}' ~~~ ~ Address: -z,o 6 c....I '" G-Þ t.. N Phone: t2-IV "2.. ì - ~ ~ . ~Oard of Trustees Applic1ln GENERAL DATA Land Area (in square feet): z.z. '5 t::ÞO ~Q. Fr. I ~O rz. Ii! oS \ t> IifN Tl,A- t.- Area Zoning: Previous use of property: Intended use ofproperty:_~, 0 EN n þw ~ Prior pennitslapprovals for site improvements: Agency Date ~ No prior pennitslapprovals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? ~No_ Yes If yes, provide explanation:j.1Þ. Project Description (use attachments if necessary): I 'S1b~ ~o,..1. ~?~. he ~f\. . . Board of Trustees Appli~n WETLANDffRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations:--! ~OP( ..r>"O' '" D J ~P- '8" ~.. €'f. Area of wetlands on lot: o square feet Percent coverage of lot: o % Closest distance between nearest existing structure and upland edge of wetlands: ~ç' feet Closest distance between nearest proposed structure and upland edge of wetlands: ~ 'fj feet Does the project involve excavation or filling? No ... Yes If yes, how much material will be excavated? I.c? cubic yards ,¡:'µ 2 J How much material will be filled? 2.0 cubic yards L__ Depth of which material will be removed or deposited: 3 feet Proposed slope throughout the area of operations: \,., 'S' -;. Manner in which material will be removed or deposited:~","'1 ~.......,~ 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 ifappropriate): ,..se.~tõ I t ___ . Board of Trustees Appli~n COASTAL EROSION APPLICATION DATA Purposes of proposed activity:_l S11)12-'( /,t>1),il oJ ~&s' ~p.'. Are wetlands present within 100 feet of the proposed activity? No .... Yes Does the project involve excavation or filling? No .... Yes If Yes, how much material will be excavated? z. 0 (cubic yards) How much material will be filled? z" (cubic yards) Manner in which material will be removed or deposited:.}I----, ba.J\\, """..." Describe the nature and extent of the environmental impacts reasonably anticipated resulting 1Ì'om implementation of the project as proposed. (Use attachments ifnecessary) ~o 10.1 t!$ r~?' ~.-- . . Town Hall . 53096 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 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD ----------------------------------- In the Matter of the Application Á . 1/ of _ _7 kdx. _11f2lL...{; ~ - - - - - - - - - - -- COUNTY OF SUFFOLK) STATE OF NEW YORK) I,C~ ~~ d~~rn, d~Jse and say: That on the ~ day of ~ ' 200"Z,., I personally posted the property known as~111V...J/,u ~IO~ by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date ot,~he ~ ~ublic hearip9' ~ate of hearing noted thereon to be held rJl~1~~ ð:ù:lJ. .1. D-i th--- ~ ') 0 ~(J.m . AFFIDAVIT OF POSTING , residing at ~95k k Dated: Sworn, to b:fC¡Pl, me this 2- o-ru~y 0!/V\iN~O ~~ DAWN C THQIIMS Notary Public. State of l\èW York No 02Trl49763'3 Qual!fled In Sl'Holk ....:oun~~ CommIssion Expires M:JY 26. ) ___J . . PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS \,Z,8ð 5Mmf" ÞIZ,VEi $rJcJT1f '"1 (, - '2.. - ~. L -\()~"""'" ~ft, ¡'l;.az.:r '+ HA~lo,J - 7'- - :l - 3 '5, t\b lLowr;U.... 11 MOTH '( ~ ~ Þ-t '1 Þo12- 6T "'. STATE OF NEW YORK COUNTY OF SUFFOLK ~ ~ ..,,;...."~,.... l.,-- J being duly swom, deposes and says that on the _1~ day of uk..: 20.D6 deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named ) persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessmen roll of the Town of Southold; that said Notices were mailed at the United States Post Office at that said Notices mailed t h of said persons by (certified) (registered) mail. 1000 - 1 " - ~ - ".1 Name: " -?> - \1..' Go IT llN WAL:re n tJ ì" - ~ - 10. I t:> 'tJ~Il.L. (\40H~S efore me this 2ø~ 2~ - Notary Public DAWN C THOIlI'AS Notary Public. State of I\dW York No.02Tc149763'3 Ouslif,ed in Sl,fjolk ';o~~-:; Commission Expires May 26, Address: 10 I bþ.I"U&L. Lolo) 5',4.¡6W 1~(þÑP. I~~e 'SHltH- 'So "'T1t-ou> , ïli1'l.RA c 'E" ..rrIP~o\ ÞIl.. S. tJ'{"11t:flt ,~z..s "SMItH" 1:>t N ~OIlTHu 1..1>. tJ'\ 1Il\ 1 \ ß ~ Olewq M "'\{c 1\.(6Pfðlf-Þ , N'T Ill" ~ ~ eBoard of Trustees ApPlicaAn County of Suffolk State of New York "'5¡~ll LìlA / B-Of.-l iH-e; ofFiCE op. ~\.& ~.~P-S. ~ BEINGDULYSWORN DEPOSES AND AFFIRMS THAT HElSHE IS TIlE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF ffiSIHER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN TIlE MANNER SET FORnI IN TInS APPLICATION AND AS MAY BE APPROVED BY TIlE SOUTHOLD TOWN BOARD OF TRUSTEES. TIlE APPLICANT AGREES TO HOLD TIlE TOWN OF SOUTHOLD AND TIlE 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 REPRESENTATlVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT TIlE PREMISES IN CONJUNCTION WInI REVIEW OF TInS APPLICATION. ~~ SWORN TO BEFORE ME TInS ~-J. 1')4 DAY OF ¡::;bru/í)'L' I ,20~ 04J..L ~~1 ___ Notary Public DEBRA FREDERICK Notary Public. State of New York Suffolk County - No. 01FR6047399" ~ Commisslo'1 Expires August 28, 20 J!..L..J Ff e'ard of Trustees APPlicate AUTHORIZATION' (where the applicant is not the owner) .., :11loHM . Af....dh~ residing at ~IT~ 11FT StJl1JIf (mailing address) do hereby authorize~~ (Agent) to apply for permit(s) from the I,.:IiM {10Lù) uJESl,..L., (print owner of property) "SDOfHot,;þ. ~I Southold Board Town Trustees on my behalf. signature) 8 .' '''-16-412187)- Text 12 I PROJECT I.D, NUMBE" . . 617.21 Appendix C Slate Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I-PROJECT INFORMATION (To be completed by Applicant or Project sponsor) i~ ,'CII. PROJEC7 NAME l' SEa ",OIJT Municløallty County 4. PAEC:SE LOCATION (Street ..adress and road ~1tersectjons. øromineollandmarks. IIC.. or provrae maø. -;.I~ '1:)rlIV~ 'Sc)Ufr¡ 5Oû"flfoL.O. t-! í II .4-.~ 5. IS PROPOSED ACTION: o New æ Exøansion 6. OESCRIBE PROJEC7 BRIEFLV: />100 IT10J Te> .')(1 ~íl~ A?~Iè.. .. !> OS F~ .' ÅH~ ~A: .- (3"'Moaiflcatlon/alleratlon l ~'TD(2.\ ~Af"i ... . P.o<.lILØI N~ 7. AMOUNT OF LANO AFi'eCTeO; ,e 9" ~ Inillally acres Ultlmatelv icres 3. WIll. i=AO?OSED ACTION COMPLY WITH ëXlSitNG ZONING OR OTHER EXISTING LANO USE RESTRIC7IONS? ~es 0 No If No. describe t)lletly , 9. WHAT IS ?RESENT !.AND lJSê IN VIC:NITY OF PROJECT'? ~~S'denua O.!nau.strl81 C C<JmmerçJal Describe: o A,q,lcuUure o ParklForesUOoen soaee o Other 10. OOES ACTION INVOLVE A PERMIT ,.a,PPROVAL. OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FSÙERAL. STATe 0" lOCAU? ~s 0 No If yes, ~ist agency(s) and øermit/aøprovals 1301lJ:>'~ ~Irt2--M rí "Ft2.0t1 <SOIJ-rr-to (,¡þ TOo.J~. '.". 11 . DOES ANY ASPECT OF THE ACTlOU HAVE A CURRENTLY VAUD PERMIT OR APPROVAL? DYes' ß"NO It Y"5. usa zge"cv name and permiUaøproval 12. AS A. RESULT OF PROPOSED ACTION WILL ËXISTING PERMIT/APPROVAL ñEQUIRE .\otOOIF'~ïION? o Ve. C11ró .n 1 CeRTIFY THAT THE INfORMATION PROVIOED AeOVE 1$ T~UE 70 Tl-iE 3EST OF MY KNOWLEDGE .-sr~~ /.-i"" ~I·<..GI- 0, . . Applicant/sponsor name: O.ue: '2... z,.z..DZ- Slgnalure: If the action is in the CODstal Area, and you are a state agency, compet~ the Coastal Assessment Form be/ore proceeding with this a.~es-some"t ., OV!:R 1 PART [1_=NV[RONME~lï." SS¡;:SSMENï ,'70 ~e c:¡rn:letec :y .~çe. .:... JOES .:oC7":C:-4 ~\Cë=:~":'N . I?: : ';ï,.,RE2i-:CLJ IN :) :>¡':'G2R. .~ .:..ñï ii 7. ~:<:7 i' ye .. .:ocrQlnat8 :ne review ::roc:es::s ana '.JS8 :ne ?"IJL:.. £-A'= i~ '!~S 1- ,~o :. 'NIL!.. ;.,C7:CN .:¡E':~:V:: ::::CROIN"", c:J .::¡E"/IE'N .:.S ?F!C'IICE:J '=·:R Uf'lt.;SïEO ":'C7tCNS iN d ~Y':~A. .2Añï i i i,51 may l:Ie sucerSedec ~y inCIr.er õ1Wclvea açenc"f. ~'f~s L...;:o.IO ir ~o. i ,1eçat:ve ,:!C:a.t;;. C. C::ULO "="C7¡CN .~e5UL7;N ).NY ~CVe;:;SE :::=;::;'(;75 ':'SSCC:.:.ïED '.vI'iH ~",,:E ~·jLL':WING; :.a.nswers ;nay :8 :'1anawruten. ., :eçlCle, C1. =':Clsung ~Ir ~uallt'/. 3urtac8 ;,( .;rounawaler ::uality ~r :t:anut'(, "01S8 ;evels. :!xlsnnq :raltlc: .:anerns. sOlid NaSie ;JrcCt:c::,::n Jr Jls.:;: pOtenllal ~or ~roson. ::ralnac;e or !Iooainq ~rOOlems? Ë:cDlaln ::!neily: cz. ..\e:5tnetlc, ac¡ric:.:ltural. lrc:saeologlcal. :"1is.onc, Jr orner :1atulãl :Jr cuUural te50urc!:s: or =mmunlty or :1eu;nCcrnOOd c:tarac:er1 :.x.ol&IM :r C:. I/eçefauon or ~auna. ~I$n. 3rHlllflsn or ',v1IaIU8 scec:es. slI;mi¡cant :1acitat,S. or :nre~tened ar !ndançerea !C8Cles? :.xclam Jrlefly: Ct. Å ccmmumc'('s exisnng ;llans or goals as olflc:ally adooted. ar a cnange in use or intensity ot use ot land or other natUral resources? :xølaln : C:5. Growrh. suoseauent :eveloomenl. Jr relatea ac:vllles likelY to be induced :)yo tne :;ttooosea ac:ton? :xCilaln .Jrletiv. cs. I,.ong :elm. snort :erm. .::.:mulaUve. or "tner '!ffec:s nor icentitleQ in C-:-CS1 :XDlaln ~neny. ...... r:U:~! :moac:s "inc:~c¡nç ::-:ançes In 'Jsa of !Itner quantity Qr :y¡:;e or !nerqyJ? ~olaln :rierly. " .j. ,S ifolERE. :A ¡S :-¡"ERE '-.:!(ël::' :"0 3E. C::NT~OVe.=S·( =1ELHëO 7'0 ?OTENTlAI... ACV~~S¡; :''''IVIRONMENï'':'l... ;MP'C7S7 '- ~e5 --..: No :t '1'15. ~xclaln :In.rly ?ART III-DETERMINATION OF SiGNIFICANC:;: (To ~e completed ~y Agency) INSïRUC":10NS: ~or e3C:1 adverse etfec't identified acevs. determine whether it is substantia.. large. ¡meertant or otherwise signjf¡ :3C:1 !tfec't snould :Je 3.ssessed in connection 'Nlth its (a) setting (I.e. urban or rural); (bl ~rcbatlility of oc::~g; (C) duratio. irreverslbllily: reI geoqracnic ,¡ccce: and (I) magnltuae. If necessary, add anaehments or reterenee supponfng matenals. :''1sure !:xClanaliens ccntain suttlc:en! aerad to snow that aU :"elevant adVerse impacts have been identified and adeQUatelY aCC:ressec C:'ec~ rhis box ;f 'IOU ¡1ave identiiiea one or .-nore ;Jotentially larc;e or significant aC'Ierse imoac:s whic:'I .'.1:" occ:Jr. Then :)roc~ea direc:ly ro :ne ~LL :.~~ :inO/or pre~are a positive- declaraticn. . , C~ecX :nis ~ox 'f you nave determined, :Jased on tne iniormatlon and analysis above and any suooortir doc~mentallcn. :n,,, :~e ~rooosea ac:ion WILL ~QT result in.cany significant adverse environmental imcac: ~N 0 .:Jrovlce en 3.t!aC:lmentS 3S necessary, the reasons sup::orting tnis determination: """"':'" .c",u "IþCnC'l "'"nl .J' . '1,:11:' 'oI..mP.' .)1 ofL,,¡¡on\'OIC "';",c~r .n :...."'0 ......I;'nc·' :,". o. ,,(o:,oont.Q'c 0.rrc~' ;.¡,:n.ulm~ ) of~\conLla'r _I~'c~r ,n _"'.10 ....".:nI;;Y ).'Cn.u,UC' .)f r'r~oIr/t' IU ,:u:/trO!'nc :rom rl!'tOon\'OI~ :1r1'C~fI - .)",tr 2 · Board of Trustees Application County of Suffolk State of New York ~ì~l-I. U~ I -rt-I-€:- 0 F- Fi CE" ~Ui; ~.~~. ~ BEING DULY SWORN DEPOSES AND AFFIRMS THAT HFJSHE IS THE APPUCANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HISIHER KNOWLEDGE AND BF.T .J'J<:P, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOID TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOID THE TOWN OF SOUTHOID 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 'IRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. ~OM oF- ~~ SWORN TO BEFORE ME THIS ~J.114 DAY OF hbru/iJL' .20-Ll I ~J...L~~;( /" Notary Public DEBRA FREDERICK Notary Public. Slale of New York Suffolk County - No, 01FR6047399.. "-- Commisslo'1 Expires August 28. 20 ..Æ..LJ Ard of Trustees Applicati4 AUTBORIZATrON" (where the applicant is not the owner) .o. I, ~ H-Ou..o uJEšu'" (print owner of property) residing at ~~ I/FfT solßl: (mai.linq address) "SOOfHø~t>. toIy do hereby authorize_~L6S (Agent) to apply for peadt{s) from the Southold Board on my bts-ha1f'. signature) I 8 617.21 AppendIx C Slate environmental Quality Review SHORT' ENVIRONMENTAL ASSESSMENT FORM For UNUSTED ACT/ONS Only PART I-PROJECT INFORMATION (To be completed by Applicant or Project sponsor) ,. APP CANT ¡SPONSOR '14\ ,'CIl 2. PRWEC':' NAME "T ~OUT MunícfcalllY Counry 4. PAEC:S£ LO~ nON (Street address 1M road ,~1tersltCtlonS. ørom;nenr lanamarxs. alC-. or ptOYIGe maø) .,,,,, 1'fIt 'þ 121 If ~ "Sc)lIfrr 501J-nI--ot-O. r-J 'í , I . 04-.-¿.' 5. IS PROPOSED ACTION: o New [Be..an...n 5. CESCRIBE PRWEC':' BRIERY: ~ 1"0...1 Tc:> '&r'Ic1 ~"'I~ ~~Iê.. ~f) 'S~. 1....t6~ (2f871-;f!XI 1% I PROJECr 1.0, NUMSEA . " SEt .- p'>A: &'M0C2ffcatIOnlalteratlon I ~""' (2., fl\'Z.Afoi F . ~þtNi 7. ......OUNr OF LAND AFFECT'ED: ,e .,.~ Inillally acres Ultimately acres a. WiLl ?FlO?CSE" AC~ON COMPl.Y 'NITH EXISTING ZONING OR OTHER exiSTING LAND USE ñESTRICitONS? ¡:¡""es 0 No If No. describe brletly , 9. WHA r IS PRESENT LAND IJsa IN VIC:NITY OF ?ROJECT7 ~Sldenlla Oo!nausrn.' C CJmmercial O.scrlbe: o A,9r1cultur. o PIltú'ForuUOaØft søace o OUter IC. COES ACrlON INVOLVE A PERMIT APPROVAL. OR FVNDING. NOW OR ULrlMArELY FROM ANY OTHER GOVERNME-~rAL AGENCY (FeDERAL. STArE OR LOCAU? ~s 0 No If yes. :ist agency'sl and øermfUaøørovals '3ùH.P1 PIrt2-M rí 112.0'1 -souffl-ø t.O íoo..n-.l. ". COES ANY ASPECT OF THE ACTlOI! HAVE A CURRENTI.Y VAUC PERI.UT OR APPROVAL? DYes" Œ"NO II'fft. list 8qettcy name and øerm.Uaøørøval 12. .AS A ReSULT OF PROPOSED ACTJON WILL ::<ISTlNG PERMIT/APPROVAL ñeOUIRe MOOIFlCAïtON? o Ve. [],<rõ I CERrlFY THAr ,HE INfORMAnON PROVIDED AeOVE IS T)1UE ,0 THE 3ESTOF MV KNOWL:OGE ...st~",- t-iw , OWic...Q. 0, , ' -'øøHCanusþonsor name; O.ue: Slgnalure: -z... z,.z... ø z- 1/ the action is in the COQ~ta Area. and you are a state açency, complete the Coastal Assessment Form beiore proceeding with this a~essmenl OVER 1 . ,. AttPtt~ANT . TRANSACTIONAL DISCLOSURB FORM ., ,: , The Town a! s~ukhold'. Code of Sbhics to ibibe con nterest on the part of town off cere and employeee. purpose of this form is to provide information which alert the town of possible conflicts of intereet and allow it to take whatever action is necesearv to avoid same. ~('á'^' Lie... , ~ ~ O«,,~ 'kor;.,,:,~[ "~I. A-(t L~ M ::,,:,.t . La8t name. fret name. m ~e n t a . un ee. you are applying in the name of 80meone 81se or other entity. such ~s a company. If 80, indicate the other person's or company'e name.) ¡ .. .~. . .'. ....,:,,,.:,...J..:. . ", .~ . .' .. ......' . ,. ......-t.. 'N'i!1- ¡'~. '.:.~ ." . "h.~ ";. ..,...... _'. . ...... NATORB 0; APPLI~TIONI (Check all thab apply.) .t tOUR NNtB. ., " :" . . Tax grievance Variance Change of zone Ap'pl¡~al of pht . Ex.~ption from plat or official map other . (If "other," name the activity.) ,.. of nUSí'E£6 Do you personally (or ~hrough your co.pany, øpouee. Bibltng, paren~, or child) have a rela~ionship vith any officer or employee of the Town of Southold? "Relationship" includes by blood. marriage. or business interest. "Business interesb" Means a business, including a parbnership, in vhich ~he bovn officer or employee has even a parbial ovnership of (or employment by) a corp.oration in vhich the town of ricer or employee owns more than 5% of the shares. YES NO v '. .::.~'! .. If you ansvered ·~ES,M. complebe bhe bålanae~f hhiø'form and date and sign vhere indicated. Name of pereon employed by thg Town of Soubhold ·tJ"- Title or poeition of that person ~~ Describe ths relationship between yourself (the applicant) and the town officer ør employee. Bither check the appropriate line ~) through D) and/or. describe in the space provided. The town officer or gmþloyee 6r his or her epoueBi sibling, parent, or child is (check all that apply), A) the owner of greater than 5% ~f the shareø of the , corporate etock of the applicant (when the applicant is a cor~oration), . B) the legal or beneficial owner of any inberelt in a noncorporate'entity (when the applicant i. not a corporation),' . c) an officer, director, p~rt~Br, or empløye8,ot the applicant I or D) the ~~tualapplicant.