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PATRICIA C. MOORE
Attorney at Law
51020 Main Road
Southold,New York 11971
Tel: (631) 765-4330
Fax: (631) 765-4643
www.mooreattys.com
email: pcmoore@,mooreattys.com
betsygmooreattys.com
EF!,
August 19, 2016
Board of TrusteesTown of Southold Main Road (Town Hall Annex) UG 19 2016
Southold NY 11971
hand delivered Sau,lo;d iosJ�,
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RE: Douglas A. Gerowski, Michelle Gerowski&Douglas J. Gerowski
PREMISES: 2570 Clearview Avenue, Southold
SCTM: 1000-70-10-29.2
Dear President and Board members:
Please Transfer the following permits to the new owners: Douglas A. Gerowski,Michelle
Gerowski &Douglas J. Gerowski...permit#5421,permit#5962, and 6952A.
-f 5241
The proposed elevated patio is set back from the side yard at the existing setback of the
house and because of the encroaching wetlands a 2.6% lot coverage variance is required. The
Zoning Board of Appeals held the public hearing and because of the wetlands, requested that we
make the application to the Trustees first.
The proposed patio is elevated approximately 4' (48") above natural grade and the
swimming pool will be inside the retaining walls of the patio. Enclosed is the cross section of
the concrete wall provided by North Fork Pool Care.
With reference to the above, enclosed please find an original and 3 copies of:
1. Application for Wetland Permit signed and notarized by owner together with
authorization from owner
2. Transactional Disclosure signed by agent and owner
3. LWRP
4. Short EAF
I have also enclosed four sets of the survey prepared by Peconic Surveyors
and last dated together with my client's check for the filing fee. Please place this
matter on your next available calendar.
Thank you and please call should you have any questions.
ery tr ours,
atricica C. Moore
encls.
Board of Trustees Application
County of Suffolk
Statc of New York
DOUGLAS A.GEROWSKI, MICHELLE GEROWSKI and DOUGLAS J. GEROWSKI,
BEING DULY SWORN DEPOSES AND AFFIRMS 'THAT HE/SI IE IS THE
APPLICANT FOR THE ABOVE, DESCRIBED PERMIT(S) AND THAT ALL
STATEMENTS CONTAINED HEREIN ARETRUE TO TILE BEST OF HIS/I IFR
KNOWLEDGE. ANT) BELIEF. AND THAT ALL WORK WILL BE DONE IN THE
MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY
TI IF SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANTAGREES TO
HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEF,S HARMLESS AND
FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDF,R OR BY
VIRTUE OF SAID PERMIT(S), IF GRANTED. 1N COMPLETING THIS
APPLICATION, I IiE,REBY AUTHORIZE THE TRUSTEES. THEIR AGF.NT(S) OR
REPRESENTAT'IVES(S), TO ENITR ONTO MY PROPERTY TO INSPECT-1-11E
PREMISES IN CON.IIJNCTION WITI I REVIEW OF TI IIS APPLICATION.
Oia'se ovxvski
Ay
Michele Gerot ski
Douglas f Gerowski
Sworn t before me this
day of . 2016
BETSY A.PERKINS
"Pu:Ut - Notary Public,State of New York
4I No.01 PE6130636
Qualified in Suffolk Coun �
Commission Expires July 18,�
Board of Trustees Application
AUTHORIZATION
(where the applicant is not the owner)
DOUGLAS A.GEROWSKI AND MICHELE;GEROWSKI
and DOUGLAS.1.GEROWSKI. as owners of premises 2570 Clearview Avenuse, _
Southold.NY (sctm: 1000-70-10-29.2) do hereby authorize our attorney. Patricia
C. Moore. to apply for permit(s)and appear before the Southold Board of Town
Trustees on our behalf.
i
(Owner's signature)
Douglas A. Gerowski
(owners signature)
Michele Gerowski
(owner's signature)
Douglas J. Gerowski
APPLIC AN I
I'R,\NSA( I1C)`AI.DISCLOSt IRI.I ORM
WOR SUIiM(SSIrNd BY OWNER uml OWNER'S GI:N I')
'rile I own of 5uuthold'a Code of Lthres prohibit,conflict,of uneresl on the part of 1 own ollicer."and emploveec I lie
purpose ol'this form is to provide information. %%htch can alert the Tonn ofpos",ihlc conflicts ofintercct and allots it
to take Whatever action is necessan to avoid scone
Y(WR NAMF- DOUGLAS A. GF,ROWSKI, MICHELE GEROWSKI . DOUGLAS J. GEROWSKI AND
MOORE.PA I RIC'IA C.
1La,t name. first name.muddle initial.unless fou arc appl\ing m the nano
orsomrune else ur Other cnnt.,such as a compan. If�O.indicate the
other pet son or curnpam name.)
NA R;RE OF AVP[ WA'l'ION:(Check all that appl} )
lax Gric%ance
Variance
Special E\eeption
It"Other''.
name the acti%it\
Change or/one
Approval or Plat
Exemption from I'lat
or Official Map
Other Trustees X
Do% personally.fur through Our cotnpam.spouse,sibling. parent,or child)have a relationship with an% officer or
cniployee of the form or Southold? "Rclationshrp" includes h% blood. marriage. or business interest. --Bu;rnes,
interest" mean", a business, including a partnership. in Which the loon olficer Or employee Iias even a partial
owner6ip of(ot employment by) a corporation in Which the I anti officer Or employee owns more than 5""o or the
shares
1 ES _ NO X _
Complete the balance of this form and date and sign bolo«W here indicated
Namc orperson employed b\ thc'Imen ol'Southold• _
I itle or position of that person:
Describe that relationship between yourself(the applicant) and the 'I'onn officer or employee Ether check the
appropriate line A through I)(below)and'or describe the relationship in the space pro%ided.
1'he I'onn officer or emplo%ce or his of her spouse,sibling.parent.Or child is(check all that apply)
A)the ow ner of greater than 5%of the shares or the corporate stock-
of
tockof the applicant(when the applicant is a corporation):
11)the legal or beneficial onncroram interest in a non-corporate entit;
(ashen the applicant is not a corporation):
_ C)an officer.director.partner.or employee of the applicant.or
D)the actual applicant.
DESCRIPTION OF RELATIONSI Ill'
Submitted this 6-L da} ofUG(.��Lt0
Signature-
Y
Doa,1 s Geromskt ---
Michele Geronskr
Douglas J 'croi�skt
encu C'.M1loore
Michael J. Domino,
President "N' Z01,
- Town Hall Annex
John M. Bredemeyer, III, Vice-President y` 54375 Route 25
Charles J. Sanders y z P.O. Box 1179
Glenn Goldsmith oy • �� Southold, NY 11971
A. Nicholas Krupski ��d dao Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
January 18, 2017
Patricia C. Moore, Esq.
51020 Main Road
Southold, NY 11971
RE: DOUGLAS A. GEROWSKI, MICHELLE GEROWSKI & DOUGLAS J.
GEROWSKI
2570 CLEARVIEW AVENUE, SOUTHOLD
SCTM# 1000-70-10-29.2
Dear Mrs. Moore:
The following action was taken at the Southold Town Board of Trustees regular meeting
held on Wednesday, January 18, 2017:
RESOLVED, that the Southold Town Board of Trustees APPROVE the request for a
Transfer of Wetland Permit#5241 from Robert A. and Cheryl Scheidet to Douglas A.
Gerowski, Michelle Gerowski & Douglas J. Gerowski, as issued on November 15, 2000.
Any other activity within 100' of the wetland boundary requires a permit from this office.
This is not a determination from any other agency.
If you have any questions, please contact our office at (631) 765-1892.
Sincerely,
Michael J. Domino, President
Board of Trustees
MJD/dd
John M. Bredemeyer III, President 6foS�FFO( �; Town Hall Annex
Michael J. Domino, Vice-President ��o� oGy�i 54375 Route 25
Glenn Goldsmith o P.O. Box 1179
A. Nicholas Krupski Southold, NY 11971
Charles J. Sanders 'y,' ao�� Telephone (631) 765-1892
Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Date/Time: �� �'° Completed in field by: -
Patricia C. Moore, Esq. on behalf of DOUGLAS A. GEROWSKI, MICHELLE GEROWSKI &
DOUGLAS J. GEROWSKI request a Transfer of Wetland Permit #5241 from Robert A. and Cheryl
Scheidet to Douglas A. Gerowski, Michelle Gerowski & Douglas J. Gerowski, as issued on November
15, 2000. Located: 2570 Clearview Avenue, Southold. SCTM# 1000-70-10-29.2
CH. 275-3 - SETBACKS
WETLAND BOUNDARY: Actual Footage or OK=q Setback Waiver Required
1. Residence: 100 feet
2. Driveway: 50 feet
3. Sanitary Leaching Pool (cesspool): 100 feet
4. Septic Tank: 75 feet
5. Swimming Pool and related structures: 50 feet
6. Landscaping or gardening: 50 feet
7. Placement of C&D material: 100 feet
TOP OF BLUFF:
1. Residence: 100 feet
2. Driveway: 100 feet
3. Sanitary leaching pool (cesspool) 100 feet:
4. Swimming pool and related structures: 100 feet
Public Notice of Hearing Card Posted: Y / N
Ch. 275 Ch. 111 SEQRA Type: 1 II Unlisted Action
Type of Application: Pre-Submission Administrative Amendment Wetland
Coastal Erosion Emergency Violation Non-Jurisdiction
Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line
Additional information/suggested modifications/conditions/need for outside
review/consultant/applicationcrompleteness/comments/standards: /
b
r / d
p r
o �.
Present were: J. Bredemeyer /M. Domino Goldsmith N. Krupski
--/C. Sanders Other
Page 1 of 2
John M. Bredemeyer III, President , 'ogUFF04ea Town Hall Annex
Michael J. Domino, Vice-President ��o Gym - 54375 Route 25
Glenn Goldsmith o '` P.O. Box 1179
A. Nicholas Krupski o Southold, NY 11971
Charles J. Sanders 4, _ o� Telephone (631) 765-1892
���� Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Date/Time: ") l� Completed in Work Session by:
Patricia C. Moore, Esq. on behalf of DOUGLAS A. GEROWSKI, MICHELLE GEROWSKI &
DOUGLAS J. GEROWSKI request a Transfer of Wetland Permit#5241 from Robert A. and Cheryl
Scheidet to Douglas A. Gerowski, Michelle Gerowski & Douglas J. Gerowski, as issued on November
15, 2000. Located: 2570 Clearview Avenue, Southold. SCTM# 1000-70-10-29.2
Ch. 275-12 - STANDARDS FOR ISSUANCE OF PERMIT MET=X or Comment=*
A. Adversely affect the wetlands of the Town:
B. Cause damage from erosion, turbidity or siltation:
C. Cause saltwater intrusion in the fresh water recourses of the Town:
D. Adversely affect fish, shellfish or other beneficial marine organisms, aquatic
wildlife & vegetation or the natural habitat thereof:
E. Increase the danger of flood and storm-tide damage:
F. Adversely affect navigation tidal waters or the tidal flow of the tidal waters of the Town:
G. Change the course of any channel or the natural movement or flow of any waters:
H. Weaken or undermine the lateral support of other lands in the vicinity:
I. Otherwise adversely affect the health, safety and general welfare of the people of the Town:
J. Adversely affect the aesthetic value of the wetland and adjacent areas:
Ch. 111-9 - ISSUANCE OF PERMIT MET=X or Comment=*
A. Is reasonable and necessary, considering reasonable alternatives to the proposed
activity and the extent to which the proposed activity requires a shoreline location:
B. Is not likely to cause a measurable increase in erosion at the proposed site and at
other locations:
C. Prevents, if possible, or minimizes adverse effects on natural protective features
and their functions and protective values, existing erosion protection structures
and natural resources:
D. :525% Expansion/Calculation
Work Session Notes Application Complete
SEQRA Classification Confirmed Coordinated Review Y/N Pos/Neg Declaration
CAC:
LWRP:
Additional information on comments/to be discussed/Public Hearing:
Date: r 3 Completed By: ';1, , 9,4f�r *
Present: �✓% J. Bredemeyer `� M. Domino �XG. Goldsmith N. Krupski
Sanders E. Cantrell D. Di Salvo Other
Page 2 of 2
OPEN .
� t
Board Of Southold Jown Trustees
SOUTHOLD, NEW YORK
u . November . 200
PERMIT NO. . �� 7�.. DATE. .......... . .... .............: �
THOMAS & JEANETTE MEYER
ISSUED TO .................................................._............................. ...................................................
a
� ,�ufi�nxi�ttttnn
Pursuant to the provisions of Chapter 615 of the Laws of
the State of New York, 1893; and Chapter 404 of the Laws of the
' "State of New York 1952; and the Southold Town Ordinance an.
titled ."REGULATING AND THE PLACING OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS and the
REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN WATERS;" and in accordance with the
Resolution of The Board adopted at a meeting held on ...Oct. 25.,._.
190.W., and in consideration of the sum of ¢.150.:_00......... paid by
En-Consultants, Inc. for ThomasMeyer........ _..-
E pton N. Y. and subject to the
of ..._...........
....Southam................................... .
Terms and' ;Conditions listed on the reverse side hereof,
of Sduthot&'To" Trusteei authorizes and permits the %lowing.
Wetland permit to construct a two-story, one-family dwelling with attached
garage and deck; connect to underground utilities, install a pervious driveway:
- " sanitary system, drywells, and drinking water well; and establish and maintain
a 50' wide non-disturbance/non-fertilization buffer adjacent to the tidal wetland
boundary, planted at it's landward limit with a row of native, non-fertiliser
dependent, woody shrubs, a fence set back a minimum of 35' from the tidal,
wetland boundary, and a 4' wide cleared path through the proposed buffer
and tidal wetlands, all as per approved survey dated June 13, 2000 and last
revised November 1, 2000.
IR.WJlPit b wntKeUl-. Ine said Board of Trustees_here-
by causes ita'Corporate Seal to be affixed, and'thesePresents to
be subscribed by a'majority of the said Board as of this dais.
FF
a
, � .
sent )
Trtatses
TERMS and CONDITIONS
y
The perms Thomas & Jeanette Meyer
8 Notch Court, Dix Hills, NY
residing at N. Y as
part of the consideration for the istma ce of the Permit does understand and prescribe to the fol-
lowing:
1. That the said Board of Trustees and the Town of Southold as released from any acrd
all damages, or chums for damages, of min arising directly or Indirectly as a result of any open,
adon performed pursuant to this permit, mad the acid Permittee will, at his or her own expense,
defend any and all such min'hddated by third patties, and the said Permittee assames foil liability
with respect thereon, to the complete nslosion of the Board of Tkusxes of the Town of Southold
2 That this Permit is valid for it period of 24 mos. which is considered to be the
estimated time required to complete the work Involved, but should cirwmstatim wamot, request .
for an extension may be made to the Board at a later data
3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes
m'maintain the structure or project involved, to provide evidence to anyone concerned that ants
initiation was originally obtained.
4. That this work involved will be subject to the inspection and approval of the Board or
in agents, and non-compliance with the provisions of the originating application,may be cense for
revoation of this Permit by resolution of the said Board
5. That there will be no unreasonable interference with navigation as a result of the wodc
herein authorized.
6. That there shall be no interference with the right of the public to pass and repass along
the beach between Thigh and low water marks.
7. That if future operations of,the Town of Southold require the removal and/or alterations
In the location of the work herein of,
or if, in the opinion of the Board of Trustees, the,
wade shall rause unreasonable obstruction to free mvigatioa, the said Permittee will be requited,
upon due notice, to remove or alar this wodc or project herein stated without expenses to the Town
of Southold.
& That the said Board will be notified by the Permittee or the completion of the work ants
orhed.
9. That the Perminee will obtain all other permits and consents that may be required sup-
ptemeatal to this permit which Cut be suZhject to revoke upon failure to obtain same.
0 9
-pgUFfO(,�-
Albert J. Krupski,President Qom" CQ Town Hall
James King, Vice-President � 53095 Route 25
Artie Foster - P.O. Box 1179
Ken Poliwoda • Southold, New York 11971-0959
Peggy A. Dickerson ,j�Q � Telephone(631) 765.1892
1 Fax(631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
CERTIFICATE OF COMPLIANCE
## 0027C Date March 8, 2005
THIS CERTIFIES that the single-family dwelling, garage & deck
At 2570 Clearview Ave. , Southold
Suffolk County Tax Map # 70-10-29.2
Conforms to the application for a Trustees Permit heretofore filed in this office
Dated 10/5/00 pursuant to which Trustees Permit# 5241 Dated 10/25/00
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 the single-family dwelling, garage & deck
The certificate is issued to Robert & Cheryl Scheidet owner of the
aforesaid property.
Allel ►`
Authorized Signature
Albert J. Krupski, President • • Town Hall
... James King,Vice-President -�ppgUFFO(,�A 53095 Route 25
Artie Foster Dov �G_ P.O.Box 1179
Ken Poliwoda = Southold, New York 11971-0959
Peggy A. Dickerson CO3Z Telephone(631) 765-1892
WOy Fax(631) 765-1366
�yol # Sao
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.
INSPECTION SCHEDULE
Pre-construction, hay bale line
15`day of construction
_ Yz constructed
✓Project complete, compliance inspection.31-) IDS
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Albert J. Krupski, Presidento�pS13FFO[,�-coG • Town Hall
James King,Vice President �`l` y� 53095 Route 25
Artie Foster p P.O. Box 1179
Ken Poliwoda W Southold,New York 11971-0959
Peggy A. Dickerson O.j �t� Telephone(631) 765-1892
Fax(631) 765-1366
BOARD OF TOWN TRUSTEES
Q TOWN OF SOUTHOLD
TO: 60t}Qtt 91- nn �C atria
Please be advised that your application dated '31 d has been
reviewed by this Board at the regular meeting of 3 and the
following action was taken:
L .,ZApplication Approved (see below)
Application Denied (see below)
L-) 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:
't,'50, CD I&0PzCt(_bA_, `F �✓lanp(}c� "I2sL
TOTAL FEES DUE: $ 5D,CX)
SIGNED: t?' )e,,..4
S
PRESIDENT, BOARD OF TRUSTEES
• gUFFO(,� •
Albert J. Krupski, President CO Town Hall
James King,Vice-President �`L`� zy 53095 Route 25
Artie Foster p P.O.Box 1179
Ken Poliwoda A T Southold,New York 11971-0959
Peggy A. Dickerson �.j O`er Telephone(631) 765-1892
Fax(631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
March 24, 2004
Mr. & Mrs. Robert Scheidet
560 Water Terrace
Southold, NY 11971
RE: 2570 CLEARVIEW AVE., SOUTHOLD
SCTM#70-10-29.2
Dear Mr. Scheidet:
The following action was taken at the Southold Town Board of Trustees regular meeting
held on Wednesday, March 24, 2004:
RESOLVED, that the Southold Town Board of Trustees APPROVE the request for a
Transfer of Permit#5241 from Marc & Anna Clejan to Robert A. & Cheryl Scheidet.
Permit issued to construct a single-family dwelling with attached garage and deck,
pervious driveway, sanitary system, drywells, and a 50' non-disturbance buffer with a 4'
wide cleared path, and with the condition a line of staked hay bales and silt fence are
installed along the 50' non-disturbance buffer before the project begins.
If you have any questions, please contact our Office at (631) 765-1892.
Sincerely,
Q �2 4 . (;w
Albert J. Krupski, Jr.
President, Board of Trustees
AJK:Ims
0hh ` • 1
I �g11FF0(�
Albert J. Krupski,President O C'� Town Hall
James King,Vice-President 53095 Route 25
Artie Foster P.O. Box 1179
2 Southold, New York 11971-0959
Ken Poliwoda G
Peggy A.Dickerson Telephone(631) 765-1892
Fax(631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
September 26. 2003
Patricia Moore, Esq.
51020 Main Road
Southold,NY 11971
Re: SCTM#70-10-29.2
Marc & Anna Clejan
2570 Clearview Avenue
Southold,NY
Dear Ms. Moore:
The following action was taken at the Southold Town Board of Trustees Regular Meeting on
September 24, 2003.
RESOLVED that the Southold Town Board of Trustees grant a One Year Extension to
Wetland Permit #5241 dated November 15, 2000 with the stipulation that the fence be moved
I5 feet—so that the 50 foot non-disturbance buffer will be completely non-disturbance. This
will be the final one-year extension.
However, this determination is not a determination from any other agency.
If you have any questions please contact our office at 765-1892
Sincerely.
Albert J. Krupski, Jr.
President, Board of Trustees
AJK: cjc
Cc: DEC
Building Department
Sep 08 03 04: 52p Moo VLaw Office 631 4643 p. l
PATRICIA C. MOORE
Attorney at Law
51020 Main Road
Southold. New York 11911
Tel: (631) 765-4330
Fax: (631) 765-4643
• Margaret Rutkowski
Secretary
September 8 , 2003 D E C E S V k
Southold Town Trustees 6 W D
P.o.Box 1179 SEP - 9 2003
Southold Town Hall
Main Road,
Southold, NY 11971 Southold Town
Board of Trustees
Re : SCTM#70-10-29 . 2
Extension of permit
2570 Clearview Avenue,
Southold
Dear President Krupski
and Board:
The owner, Marc & Anna Clejan respectfully request an
extension of their permit to construct single family
residence, sanitary, and cleared path, as amended by
Trustees on September 26 , 2002 .
The applicant could not start construccion until
public water was extended on Clearview Avenue . The water
authority has recently approved an extension of the water
line to this subdivision .
Public water to the property is more beneficial to
the environment and will not adversely impact the
environment . Therefore we respectfully request that you
grant the extension of the permit .
Vex�ly yours,
i
�
atricta C . Mc--re
cc: Mr. and Mrs . Clejan
Sep IS 03 02: 49p Moo Law Office
6317, 4643
P.
PATRICIA C. MOORE
Attorney at Law
51020 Main Road
Southold, New York 11971
Tel: (631)765-4330
Fax: (631)765-4643
September 18 , 2OD3
VIA FACSIMILE
Southold Town Trustees
P .O. Box 1179
Southold, NY 11971
RE : Clejan permit extension
Property: 2570 Clearview Avenue , Southold, NY
SCTM #1000-070 . 00 -10 . 00-029 . 002
Dear President Krupski and Board:
The above referenced property is vacant . The original
development plan and permit proposed a fence . The Board asked
that the proposed fence be moved 15 feet to which my client had
no objection. We wish to extend the permit as amended with the
same stipulation.
Very trLlkyours ,
C
`Patricia C . Moore
PCM/mm
Sep IS 03 02: 49p Moo
roLaw Office
631 4643 F. 1
PATRICIA C. MOORE
Attorney at Law
51020 Main Road
Southold, New York 11971
Tel: (631) 765-4330
Fax: (631) 765-4643
FACSIMILE COVER SHEET
The pages comprising this facsimile transmission contain
confidential information from Patricia C . Moore . This information
is intended solely for use by the individual entity named as the
recipient hereof . If you are not the intended recipient , be aware
that any disclosure, copying, distribution, or use of the contents
of this transmission is prohibited. If you have received this
transmission in error, please notify us by telephone immediately so
we may arrange to retrieve this transmission at no cost to you
T0: ��_e'eC(�jeYC( lie
RE: ( Itt 'C-k
DATE:
TOTAL NUMBER OF PAGES INCLUDING COVER SHEET =;;?
IF TRANSMISSION IS FAULTY OR INCOMPLETE, PLEASE CALL BACK AS SOON
AS POSSIBLE.
CLIENT NAME: L-If--1454uk
7—0
OPERATOR: /J��'(G J^�A
SENT BY: MOORE; • 631 765 4643; SEP-106 8:06; PAGE 1 /1
( moi
PATRICIA C. MOORE
AUurney at Law
51020 Main Road
Southold,New York 11971
Tcl: (631) 765-4330
Fax; (631) 765-4643
Margaret Kutkowski
Secretary
September 10, 2002
Southold Town Trustees
P.O.Box 1179
Southold Town Hall
Main Road,
Southold, NY 11971
By Fax
Re : 2570 Clearview Avenue
Soulhuld, NY 11971
1000-70-10-29 . 2
Dear President Krupoki
and Board:
On May 22 , 2002 a wetland permit was transferred to
my c.lientG who purchased the property in May, however,
the water moratorium prevents my client from obtaining
Health Departmt:nt approval and building their home .
Please extend the Trustees wetland permit for another
year in the hopes that the water will become available in
that time and my client can complete the Health
Department approval .
very .-truly yours,
Patricia C. Moore
cc ! Mr. Clejan
�P
SEP 1 0 2002
6
E .
L:
Albert J. Krupski, President i Town Hall
James King,Vice-President �ogUFFO(,r� 53095 Route 25
Artie Foster �o �G P.O. Box 1179
Ken Poliwoda Southold, New York 11971-0959
C
Peggy A. Dickerson M _
v, Of Telephone (631) 765-1892
Oy !� Fax(631) 765-1366
ay01 � Sao
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
September 26, 2002
Patricia Moore, Esq.
51020 Main Road
Southold, NY 11971
RE: SCTM#70-10-29.2
Marc & Anna Clejan
2570 Clearview Avenue
Southold, NY
Dear Ms. Moore:
The following action was taken at the Southold Town Board of Trustees Regular Meeting on
September 25, 2002.
RESOLVED, that the Southold Town Board of Trustees grant a One Year Extension to Permit
#5241 dated November 15, 2000 —with the stipulation that the fence be moved l5 feet—so
that the 50 foot non-disturbance buffer will be completely non-disturbance.
If you have any questions,please contact our office at 765-1892.
Sincerely,
t ,�,ert pski, Jr.
Presidenn t, Board of Trustees
AJK:cjc
Albert J. Krupski,President • Town Hall
James King,Vice-President �SUFF01/(C 53095 Route 25
Artie Foster �O C P.O.Box 1179
Ken Poliwoda Southold,New York 11971-0959
Peggy A. Dickerson OiD :
y, Telephone(631) 765-1892
4W Fax(631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
May 23, 2002
Patricia Moore, Esq.
51020 Main Road
Southold, NY 11981
RE: SCTM#70-10-29.2
Dear Ms. Moore:
The following action was taken at the Southold Town Board of Trustees Regular Meeting on
May 22, 2002.
RESOLVED, that the Southold Town Board of Trustees APPROVED the request for a Transfer
of Permit#5241 dated November 15, 2000 from Thomas &Jeanette Meyer to Marc & Anna
Clejan.—with the stipulation that the fence be moved 15 feet—so that the 50 foot non-
disturbance buffer will be completely non-disturbance.
If you have any questions,please contact our office at 765-1892.
Sincerely,
Albert J. Krupski, Jr.
President, Board of Trustees
AJK:cjc
I
PATRICIA C. MOORE
Attorney at Law
51020 Main Road 0
Southold, New York 11971 _ n
Tel:(631)765-4330 J
Fax:(631)765-4643 LLLSSS
April 30, 2002
Town of Southold
Board of Town Trustees
P.O. Box 1179
Southold, NY 11971
RE : 2570 Clearview Avenue, Southold, NY
SCTM #1000-70-10-29 .2
Dear Sir or Madam:
Please transfer the Trustees Permit for the above referenced
premises from Thomas Meyer and Jeanette Meyer, former contract
vendees to Marc Clejan and Anna Clejan. The current owners of
the premises, Ezio Vlacich and Giuliana Vlacich, are under
contract to sell the premises to the Clejans . We expect the
closing to take place this month. Please place this matter on
the May 22nd calendar.
Enclosed please find my check in the sum of $10 . 00 for
payment of the transfer fee .
If you have any questions, please do not hesitate to contact
me . Thank you.
Very truly yours,
Patricia C. Moore
PCM/mm
Enclosure
i
Albert J.Krupski,President • ��gUFFO(,�c • Town Hall
James King,Vice-President �� �(� 53095 Route 25
Henry Smith oP.O.Box 1179
Artie Foster H Z
Southold,New York 11971-0959
Ken Poliwoda Oy �� Telephone(631) 765-1892
Fax(631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OFSOUTHOLD
November 15, 2000
Mr. Robert E. Herrmann
En-Consultants, Inc.
1329 North Sea Rd.
Southampton, NY 11968
Re: THOMAS & JEANETTE MEYER
2570 CLEARVIEW AVE. , SOUTHOLD
SCTM#70-10-29 .2
Dear Mr. Herrmann:
The following action was taken by the Board of Town Trustees
during its regular meeting held on October 25, 2000 regarding
the above matter:
WHEREAS, En-Consultants, Inc. on behalf of THOMAS & JEANETTE
MEYER applied to the Southold Town Trustees for a permit under
the provisions of the Wetland Ordinance of the Town of Southold,
application dated October 5, 2000, and
WHEREAS, said application was referred to the Southold Town
Conservation Advisory Council for their findings and
recommendations, and,
WHEREAS, a Public Hearing was held by the Town Trustees with
respect to said application on October 25, 2000 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,
0 r
WHEREAS, the Board has determined that the project as proposed
will not affect the health, safety and general welfare of the
people of the town,
NOW THEREFORE BE IT,
RESOLVED, that the Board of Trustees approve the application of
THOMAS & JEANETTE MEYER to construct a two-story, one-family
dwelling with attached garage and deck; connect to underground
utilities, install a pervious driveway, sanitary system,
drywells, and drinking water water well; and establish and
maintain a 50 ' wide non-disturbance/non-fertilization buffer
adjacent to the tidal wetland boundary, planted at it' s landward
limit with a row of native, non-fertilizer dependent, woody
shrubs, a fence set back a minimum of 35 ' from the tidal wetland
boundary, and a 4 ' wide cleared path through the proposed buffer
and tidal wetlands, all as per approved survey dated June 13,
2000 and last revised November 1, 2000 .
BE IT FURTHER RESOLVED that this determination should not be
considered a determination made for any other Department or
Agency which may also have an application pending for the same
or similar project.
Permit to construct and complete project will expire two years
from the date it is signed. Fees must be paid, if applicable,
and permit issued within six months of the date of this
notification.
Two inspections are required and the Trustees are to be notified
upon completion of said project.
Fees : None
Very truly yours,
Albert J. Krupski, Jr.
President, Board of Trustees
AJK/lms
cc: DEC
Building Dept.
1329 North Sea Road
Southampton, New York 11968
A.�
631-283-6360
Fax: 631-283-6136
E-mail:
EN-CONSULTANTS, INC. www.enconssultantscom
ENVIRONMENTAL SERVICES
November 6, 2000
Albert Krupski, Chairman
Board of Trustees
Town of Southold
53095 Main Road
Southold, NY 11971 NOV 8 1000
Re: Thomas& Jeanette Meyer
Dear Mr. Krupski:
Pursuant to our discussions during the public hearing on the captioned application held 25 October 2000,
please find enclosed a site plan revised to depict the following: a 50' non-disturbance buffer adjacent to
the tidal wetland boundary, planted at its landward limit with a row of native, non-fertilizer dependent,
woody shrubs (8' O.C.); a proposed fence set back a minimum of 35' from the tidal wetland boundary;
and a 4' wide cleared path through the proposed buffer and tidal wetlands to Goose Creek.
Although I trust these modified plans will allow your office to issue the Meyers' permit, please contact
me at your earliest convenience if you require any additional information.
Respectfully yours,
Robert E. Herrmann
Coastal Management Specialist
Enclosures
cc: Thomas& Jeanette Meyer
t
ELIZABETH A.NEVILLE ��� OGy� _
Town Hall,53095 Main Road
TOWN C P.O.$ox 1179
*" '' ` r
"'" -7-nS3nthold,New York 11971
a• - .� -
REGISTRAR OF VITAL STATISTICS' - • Fax(516) 765-1823
MARRIAGE OFFICER 0 Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER y�/fl- �a!
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OSOUTHOLD NOV Q
F
APPLICATION FOS PUBLIC ACCESS TO RdCORDS
INSTRUCTIONS: Please complete Section I of this form and give to Town Clerk's
Office agency Freedom of Information Officer) . One copy will be returned to you
in response to your request, or as an interim response.
SECTION I.
TO: 11�C4F1
(Department or Officer, if known; that has the information you are requesting.
RECORD YOU WISH TO INSPECT: (Describe the record sought. If possible, supply
date, file title, tax map number, and any other pertinent information.)
- ( s 00 `rtes s iyY
Signature of Applicant:
Printed Name• /� Gcyjrl-
Address: {riwy Orr S7 i �s l( 7ffG
Mailing Address (if different tfr�om above)
Telephone Number- ��/� SSTfr7H �f Date:
[ ] APPROVED
[ ] APPROVED WITH DELAY* [ ] DENIED* RECEIVE D
NOV 14
ElizabiKh A. Neville aoathoid 9OVa Clerk
Freedom of Information Officer
* If delayed or denied see reverse side for explanation.
FO(K(01- 6
s �a
Town Hall. 53095 Main Road
U + P.O. Box 1179
Telephone
(516) 765-1892 O�y� Southold, New York 11971
`101 � ra��
SOUTHOLD TOWN
CONSERVATION ADVISORY COUNCIL
At the meeting of the Southold Town Conservation Advisory Council held Monday, October 23,
2000, the following recommendation was made:
THOMAS & JEANETTE MEYER 70-10-29.2 to construct a two-story, one-family dwelling
with attached garage and deck; connect to underground utilities; install a pervious driveway,
sanitary system, drywells and drinking water well; and establish and maintain a 35' wide non-
disturbance/non-fertilization buffer adjacent to the tidal wetland boundary.
2570 Clearview Ave., Southold
The CAC did not make an inspection but recommend a 50' non-disturbance/non-fertilization
buffer adjacent to the tidal wetland boundary.
Vote of Council: Ayes: All
Motion Carried
Mar 15 04 10: 02a Moore Law Office 5317 54643 p. 2
•
PATRICIA C. MOORE
Attorney at Law
51020 Main Road
Southold,New York 11971
Tel: (631) 765-4330---
Fax: (631) 765-4643
--Fax: (631) 765-4643
March 15, 2004 D E C E I `M
E
Southold Town Trustees YAR 15
2004 D
P .O .Box 1179
Southold Town Hall Southold Torre
Main Road, Board of Trustees
Southold, NY 11971
Att : Lauren
Re : SCTM#70-10-29 . 2
Transfer of permit #5241
2570 Clearview Avenue,
Southold
Dear President Krupski
and Board :
The owner, Marc & Anna Clejan authorize you to enter
onto their property and respectfully request a transfer
of their permit to construct single family residence,
sanitary, and cleared path, as amended by Trustees on
September 26, 2002 , and extended on September 26, 2003 to
the contract vendees :
Robert A. Scheidet and Cheryl Scheidet
560 Water Terrace, Southold, NY 11971
If you need anything further please do not hesitate
to contact me .
Very.tri4y yours,
L-Patricia C. Moore
cc: Mr. and Mrs . Clejan
Mr. Bruer, Esq. attorney for Scheidet
Mar 15 04 10: 02a Moor Law Office 63654643 p. 1
PATRICIA C. MOORE
Attorney at Law
51020 Main Road
Southold, New York 11971
Tel: (63 1) 765-4330
Fax: (631) 765-4643
FACSIMILE COVER SHEET
The pages comprising this facsimile transmission contain
confidential information from Patricia C. Moore. This information
is intended solely for use by the individual entity named as the
recipient hereof . If you are not the intended recipient, be aware
that any disclosure, copying, distribution, or use of the contents
of this transmission is prohibited. If you have received this
transmission in error, please notify us by telephone immediately so
we may arrange to retrieve this transmission at nno�cost
ttto you.
TO: i
RE:
3
DATE:
TOTAL NUMBER OF PAGES INCLUDING COVER SHEET
IF TRANSMISSION IS FAULTY OR INCOMPLETE, PLEASE CALL BACK AS SOON
AS POSSIBLE.
CLIENT NAME :
OPERATOR : �J /GYir�pide�P
Albert J. Krupski. President �O�OSUFFD( ( CG
Town Hall
John Holzapfel, Vice President y= 53095 Main Road
y x
P.O. Box 1179
Jim Bing
Martin H. Garrell O r C;`i Southold. New York 11971
Peter Wenczel y�1p aO�i Telephone (516) 765-1892
1 "= Fax (516) 765-1313
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
office Use Only
Coastal Erosion Permit Application
%4etland Permit Application
_Grandfather Permit Application
waiver/Amendment/Cha ges
eceived Application: ASS (/b
✓Received Feer
✓Completed ApplicationOCA -
Incomplete
SEQRA Classification: (
Type I Type II Unlisted_ i
Coordination: (date sent)
✓CAC Referral Sent: /01 10
Dateof Inspection:
Receipt of CAC Report:
Lead Agency Determination:
Technical Review:
ublic Hearing Held:
—Resolution:
Name of Applicant Thomas & Jeanette Meyer (Contract Vendees)
8 Notch Court
Address Dix Hills, NY 11746
Phone Number: (631 427-1040
Suffolk County Tax Map Number: 1000 - 70 - 10 - 29 .2
Property Location: 2570 Clearview Avenue, Southold
(provide LILCO Poie # , distance to cross streets , and location)
AGENT: En-Consultants, Inc.
( If applicable )
1329 North Sea Road
Address : Southampton, NY 11968
Phone : 631-283-6360
FA: #
1
Lard of Trustees Application
GENERAL DATA
Land Area ( in square feet) : 29 ,687 . 55
Area Zoning: R-40
Previous use of property: Vacant
Intended use of property: One-family residence
Prior permits/approvals for site improvements:
Agency Date
X No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspended by a
governmental agency?
X No Yes
If yes, provide explanation:
Project Description (use attachments if necessary) :Construct a
two-story, one-family dwelling with attached garage and deck;
connect to underground utilities; install a pervious driveway,
sanitary system, drywells, and drinking water well; and establish
and maintain a 35 ' wide non-disturbance/non-fertilization buffer
adjacent to the tidal wetland boundary, all as depicted on the
site plan prepared by Joseph Ingegno, last dated 1 October 2000 .
0 0
Board of Trustees Application
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: Develop vacant parcel with
one-family dwelling.
Area of wetlands on lot: 13 ,480 square feet
Percent coverage of lot: 45 %
Closest distance between nearest existing structure and upland
edge of wetlands: N/A feet
Closest distance between nearest proposed structure and upland
edge of wetlands: 75 feet
Does the project involve excavation or filling?
No X Yes
If yes, how much material will be excavated? 150 cubic yards
How much material will be filled? 200 cubic yards
Depth of which material will be removed or deposited: ±6 from existing
feet surface o�l1—mound.
Proposed slope throughout the area of operations: N/A
manner in which material will be removed or deposited:
Existing fill mound to be leveled and used as fill required for
sanitary system.
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) :
The project will maintain a 75 ' minimum structural setback from
the adjacent tidal wetlands and establish a 35 ' wide non-
distur—bance/non-fertilization b ,ffpr adjacent to the tidal wotland
boundary. As proposed, the project should have no significant
adverse impacts on the adiacent wetlands and Town waters.
NOTICE TO ADJACENT PROPERTY OWNER
301-RD OF TRUSTEES , TOWN OF SOUTHOLD
In the matter of Thomas & Jeanette Meyer (Contract Vendees)
s.TM#1000- 70-10-29 .2
';OU ARE HEREBY GIVEN NOTICE:
1 . That it is the intention of the undersigned to request a
Permit from the Board of Trustees to:
SEE ATTACHED
That the property which is the subject Environmental Review
is Located adjacent to vour property and is described as
follows : 2570 Clearview Avenue, Southold
3 . That the property which is subject to Environmental Review
under Chapters 32 , 37 ,or 97 of the Town Code is open to public
comment. You may contact the Trustees Office at 765-1892 or in
writing. open for ublic comment October 25 , 2000
a or about 7 P.M.
The above referenced proposal is under review of the Board of
Trustees of the Town of Southold and dose not reference any
other adjacent that might have to review same proposal.
OWNERS NAME: Thomas & Jeanette Meyer (Contract vendees)
MAILING ADDRESS: 8 Notch Court
Dix Hills, NY 11746
PHONE # : 631 -427-1040
Enc. : Copy of sketch or plan showing proposal for your
convenience.
PROJECT DESCRIPTION
THOMAS&JEANETTE MEYER
2570 CLEARVIEW AVENUE
SOUTHOLD,NY
SCTM#1000-70-10-29.2
Construct a two-story, one-family dwelling with attached garage and deck; connect to
underground utilities; install a pervious driveway, sanitary system, drywells, and drinking water
well; and establish and maintain a 35' non-disturbancelnon-fertilization buffer adjacent to the
tidal wetland boundary, all as depicted on the site plan prepared by Joseph Ingegno, last dated 2
October 2000.
a7IWO,MSM
-----TEST HOLE DATA
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tTae81 NL IapRe roou Mo]FPnc wR nru RE
• / i /� ' _ N.Y.S. Lx. No. 9666
/ n.
4 DE 14'R YDIXAST TIF —
S ; LNIF
toPh A. Ingegno
THE WN 3�IMMED�N
N op OEAMID M[ Lry Land Surveyor
<•3 j. -�_�_� "- i" (� Iql�'.RIU17m 7 SHLMRIN _
MY R)THE ralliom FOR IIIHOM THE
Tmr DaRMMY,w60IMURW Agl Y No __--_- -_-_
CO �R GRMD)LSM, Imo r'"" Survh'e - Sub"Mv u - She PAms - CoraUucti tO t
ASSIGNED;OF THE
�, �T 'W� ��E PHONE (631)727-2(MD
THE E%ISTENCE OF RONT OF WAYS Tax (631)727-1727
AMD/OR EASEIRMS OF RECORD. IT (YT10E5 IOG7ED AI
NOT SHONM ARE MOT WAMMMrOHO
. 13W RGAME AVFNUC '�M '�ESS
PO Box 1931
RN ;7 "). New Turk 11901 kirmMeoG. mer o. 111 -0965
- i
PROOF OF MAILING OF NOTICE
ATTACH CERTIFIED MAIL RECEIPTS
Name: Address :
Stanley Chase 143 Centre Island Road
Oyster Bay, NY 11771
Ann & Troy Baydala 1600 Parkway
Southold, NY 11971
Nancy Hilbig 1700 Parkway
Southold, NY 11971
STATE OF NEW YORK
COUNTY OF SUFFOLK
doing business En-Consultants, Inc.
Robert E. Herrmann xranjajj=g at 1329 North Sea Road
being duly sworn, deposes and says
t at on the day of October , gg 2000 deponent mailed
a true copv 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 asses pent roll of the
Town of Southold; that said Notices were mail d at the United
States Post Office at Southampton , t at said Notices
were mailed to each of said persons by ( c ed) ( X2u}Nxt%ligd)
mail.
Robert E. Herrmann
Sworn to before me this 4th
day of October
OctoojJber , lW ZUU --
Nota y Public
KIM H.STEPHENS
Nctzy Publi on No of Ne:•i ycrlt
r Cemrt msslon No.6015^:I
."y COU208
Cc.r.miesian Ex Ira,r.0 ust 2,�.-
:t "
h
1478^1(2/87)—Teri 72
PROJECT I.D.NUMBER 61 7.21 SEQR
Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART I—PROJECT INFORMATION (To be completed by Applicant or Project sponsor)
1 .APPLICANT/SPONSORTHOMAS&JEANETTE MEYER BY 2.PROJECT NAME
EN-CONSULTANTS, INC.
3.PROJECT LOCATION:
Municipality SOUTHOLD county SUFFOLK
4.PRECISE LOCATION(Street address and road inamusations,prominent landmarks,etc.,or provide map)
570 CLEARVIEW AVENUE,SOUTHOLD;SCTM#1000-70-10-29.2;MAP PROVIDED.
5.IS PROPOSED ACTION:
R New ❑Expansion ❑ModiBcationiaheration
e.DESCRIBE PROJECT BRIEFLY:
Construct a two-story,one-family dwelling with attached garage and deck;comtect to underground utilities;install a pervious
driveway,sanitary system,drywells,and drinking water well;and establish and maintain a 35'non-disturbancehwn-fertilization buffer
adjacent to the tidal wetland boundary,all as depicted on the site plan prepared by Joseph Ingegno,last dated 2 October 2000.
7.AMOUNT OF LAND AFFECTED-
Initially 0.682 acres Ultimately 0.682 acres
8.HALL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
®Yes ❑No If No,Cesoribe briefly
9.WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
®Residential ❑Industrial ❑Commercial ❑Agan iture ❑Park/Forest/Opan space ❑Other
Describe:
10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING,NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL,
STATE OR LOCAL)?
®Yes ❑No If yes,list agency(s)and permiVapprovals
SCDH,DEC
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
Elyse ®No If yes, list agency name and permit/approval
12.AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION?
Dyes ®No
I CERTIFY THATZMANN,
RMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant/sponsor name: ROB COASTAL MGMT.SPECIALIST Data: OCTOBER 3, 2000
Signature:
If the action is in the Coastal Area, and you are a state agency, complete the
Coastal Assessment Form before proceeding with this assessment
OVFR
Albert J. K.upski, President • ��g%jFFU(,fco • Town Hall
James King, Vice-President 53095 Gy .53095 Route 25
Hen , Smith C P.O.Box 1179
ry
Arti,:Foster W Southold, New York 11971-0959
Ken Poliwoda � � �� Telephone 1631) 765-1892
'1J�1 �a0 Fax(631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
BOARD OF TRUSTEES : TOWN OF SOUTHOLD
In the Matter of the Application
of
COUNTY RF SUFFOLK)
STATE OF NE9: YORK)
AFFIDAVIT OF POSTING
DF,A'
�, �•. �af►�e.-wrv,�, 11168
beinguly sworn,/
c}el a and say:
That or. the day of Ou , 2004, I personally posted the
pr.cperty known as_ aj� acnc-frw Av£- SovYN.s Q _
by placing '.he Board of TrusteesofficiAl poster where it can
aa:sily be seen , and tat T_ have checkea to be sure the post;;--
has reR:a'_aed i;: place for eight days prior to the date of�,,�,j�,���
public lhear:.na. Dat of hearing noted thereon to be held Q (p1Sf
�norabru.+ '7:ob P
Dated:
(sign re)
Sworn to before me this
,�f4-A,day of 6grj -_zt 200 d
Notary Public
KIM H. EFHT1S
- eu York
.V. ,- I��Ca�mt„ion EsEf 2,`
PHONE rJ-. . 63'28761;E Ort. Z2 2900 10:21R^. P.z
3oard o. ::'=sees A2pi=ca�=cn
AMORI2±ATI00
I, -4A(2maS_ - residing at T
(Print D'me= of F perty) ma5.11a7 dremil, �
do hereby authorize.
(Agent)
spply =or pe-mit( s) from: the
southold Board of Town ^rustess ori:my behalf.
, l'
(owrens Qnatsrs)
1
•j,1 '1ly
i F
cF,�f9 E'.:CaaSUL"-;t % Itis:. • FHaE 740. . 6;Sin'd:.bhiv 0 'Jct. ❑z. -MV 1Q.WQMI .e
boars of Trustees Application
county of Suffolk
State of New York
n nay tzpasmAl AND ��� grM DUSWORN
LY
DESCRIBED PB,RMIT(S) AND THAT = STA'T'EMENTS CONTAn= MMEIN ARE
TRUE TO TM BEST OF SIS/HER MOWLEDGS AND MMM, ANO T8AT ALL
WORK WILL BE DONE IN THE MANNER SET PORTS IN TRIS A"LICATION
AND AS MAY SE AVZROVED EY =E SOUTHC= TOWN BOARD Or TRUSTEES.
THE
� APVLI�CAXT��A1GGMSS}20 BOLD TTH1 TOWN OF`'SOU',��"1�{yOLD��}�1� THE TOWN
ri�Y y HARM=S AIM rM �WY � AM ASW ✓i WZZ MM CYXTM
ARISING UN= OR BY V== OP SAID VERVIT(S) , Zr =AN=. IN
COMPLETING THIS APPLIC.ATIOH, I REMY ALYTHORIZE THE TRUSTEES,
THEIR AGM S) OR REMSENTATIVE9(3) , TO MITER MUO MT 2ROPERTY
TO 'NSPSC'." TAE PREMISES IN CONnKCTION WITH REVIEW OF ME
APPLICATIGN.
signAt R
SWORN TO REFOPZ N.E TdTS __,__BAY OF OCTA
Notary pliblIc
M .
APPLICANT
TRANSACTIONAL DIdCLOSSURE BURR
e Nn 9 's ! a of
rite 0 n r O! wR [Ia an
jyXit2all 09 this a to 12rovion al, a
a Ee rn b to s nd w
n ver n is nqagsmqry
YOUR NAN21 P UAJ[ r, S 1rt
( aeE amsamj,pl f rs naMa►o, M d 1a Inihia , un ass
you ■cs a plying in the name of someone vise or
abhor entity, such as a oompeny. if ao, indicate .
the other person's or company'* name. )
NATURE OF APPLICATI.ONe (chec8 al'l'� bhat apply. )
Tax grievance
Change
Changs o! inane
ARP Val of plat
6xedlption from pl or official map
other
(If "Other," nano t e activity. )
Do you personally (or bhcouph Tour company, spouse, oibling,
parent, or ahlld) have a relationship with any .orejaer or
employee of the *town of soatholdT 'Rolabionship" includes
by blood, marriage, or business interest. "feusinoss
inbereeb" weans a busiaese, •dnaluding a porbaership, in
which the town officer or employee ban %van a partial
ownership of (or employment by) a Corporation in which
the town officer or employee owns mora than 5% of the
shares.
TES NO
If you answalted "7ES,". complete the balance of this force and
data and 'sign where indicated.
Name of person employed by the Town of Southold
Title or position of bhab person
Describe the relationship between yourself (the applicant)
and the town officer or employes. tither cheak the
appropriate line A) through D) and/or describe in the apace
provided.
The town officer or omployae or his or her spouse, sibling,
parent, or child is (cheek all that apply) ,
A) the owner of greater than !i% of the shares of the
corporate stock of the applicenb (when the applicant
Is a corporshion) ,
� 3) the legal or beneficial ownor of any interest in a
noncorporate "entity (when the applicant is nob a
' carvoration) t
C) an oflioerr director, partner, or amplayec y, .he
applicantf of
D) the gq, 041* .a_pplicsnt.
DESCRIPTION 6P''RZLATI0N8111P
Submitted this dj,
lofeV_1"da
Signature
Print, name .-' C
- -------------------- --------
aul TEST HOLE DATA
M` (16Y NaF oUC Br 11�MP-®�aw,rsr r4 zoml
».�aaaE �awNN.a SURVEY OF PROPERTY
C) SITUATED AT
m O®�
zz PINE NECK
d� rOF
SUFFOLKNCOUNTYO,U NEW OYORK
�i N1E wa rE1 n awi:.
.r S.C. TAX No. 1000-70-10-29.2
z ° wNc
d Q LEw
JUNE 13, 2000
M"1
r�+t pED By a �„�.. ININIM 29. 2000 ADDED PROPOSED REVISED PROP SEPM SE
SEPTo �.. za�00 An COMAGE raT
i h °0'Ta G
NOJEIIBm 1. 2D00 RENSED Plot PLA!
CLEAR17 1� J 0�7RUST e y v AREA = 29,687.55 sq. ft.
A (To Tc uNE) 0.682 oc.
IE °moo ��'EN UE 0Wt4 0 SOU o PROPOSED GONGRETAINING WALL DETAIL
S et•o6'30• E S 81'06.30 \
w.00 9 .00 E - o °� Fes— CERTIFIED T0:
"�
pO.�, ® THOMAS MEYER
Z Rd Y
N
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0;p `\ y c°asOOE°° icT s a AiE IMTy TO MGt !4 T�IF�YTCTSYSIEY.
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ma DAaom O PI 5ED %?T4C SYSTEM -UTAIL T[ y0s�T1°ass oRl iawAom o THE ramal a mE
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/ �/ 11,/ ,i i /* SEMIC TANKS .��OFV;`.;+.Ir:;;
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' IDENTIFlED 11-16-90 ,/ wlt r lac.•-r lot r-r av �iFAow Haul pal•1 w a�rna1 wusE n YO..n�I AfA 1 1 '
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O a A YNYY T 1Q a 4 mMOa 1110 a1� W r W. 49668
i / 6 A IC M.O{YR■1�1 11R Owl MD NT1! MAa
ONFAILL
/ ! 3Y D InY it LAWE Land Surveyor
""'° / " / ' ' NOV 82000T;HI lY. -- - -
�"ylep N Loran
3 TAN s✓.ar+ - 51e*,viwY - sr. Pa - Calwnl.+:al
ell
GOO js• ?•/S. w\\� To^p7 NIN mrn Ams Na PHONE (631)727-11190 ro. (631)727-1727
SE CRLI� OFFICESLOIAT . MFAVOFFS585.1j =.pmpO ''
HIT? 3""N AK NOT NDIE P6YR EAD AV RMOWM , 9D
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