HomeMy WebLinkAboutTR-5495
Aprlicant: Carol Clancy -
Location: 280 Oak A venue, SOlJ.llold
Purpose: Bulkhead reconstruction
Photogra hed: 13 Jan '02 at 1541 hrs.
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J.M.O. Environmental Consulting Services
Quogue, New York
Applicant: Carol Clancy -
Location: 280 Oak Avenue, SOlunold
Purpose: Bulkhead reconstruction
Photogra hed: I3 Jan '02 at 1541 hrs.
Applicant: Carol Clancy-
Location: 280 Oak A venue, Sou,hold
Purpose: Bulkhead reconstruction
Photogra hed: 13 Jan '02 at 1541 hrs.
J.M.O. Environmental Consulting Services
Quogue, New York
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CON$W.T YOUI' L#.WY'UI .IfOIII, SJ~ THtIlNSf'IIUMINT_THIS fHfTltUMIHT SHOULD .. WID ." IAWY., OflIlY,
1143'iPC535 '""~>'(:l'!'':'-!H2'''
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THIS lNDE.VTURE, mall(' thl:' 21st d.yof Fi':BIWARY
IlE1WEErI
,t;U'I'I""11 hundr~'<i;wd flJllt'ty-t....o
MARGARET t:. Bll:\I.E, rl':,o!d1!lj', .It 21:50 O,lk AV':llIJ.,. :,nui:l,,,}d, St'w Y<Jrk IJ971.
{If; I'lJrvivlnr. tl'!l.lnl hy tll<~ "rot Jrl'ty.
party t)f the fir!>t part, &fld
ZZ79S
CA~OL A. CLANCY, residing nt 333 Bright~~ Road,
Norri5to~~, PA 19401
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$ RECEg9>
RE.Gl fSUTE
party of lh~ S('r')~d part,
WITNESSETH. thai thl' par.:-' .,{ lhl' lir~l J~l". in ~(J~hi,kra:i~'n 01
liAR 23 ,',',',
TRIJiSff,R 11.;(
SUUf;U~
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------------------- TEN .:Jnd 00/1011 (SIO.OO)
lawful TIliJ'WY of \hl;.' UnilM St~ll'"
by th~ party of llit" .~(,("OI1,J lIar:, 'k..., I.t"rt"by ~;r;H:1 and ll.ll'.hl' IWl) th~ part: f)f !!it" jITond part. rhr- ht"j,~ or
SllC(:t"S:>1'I.', a!"lG a~<;igl" of dw jJlr:y "j 11:l" _-t'((lnd par. i"ft"H'r.
ALL 11;'11 ('('r1;!.i:l plul pil'CC llf l'.Jf::d ili bll'J. \\i:h Ill<' building" .Jlld il1lpr')\'f"1l11'llh t!wr"'JII frt~':...d. '.nuall",
lying and l".iT:~ jll the Town of Southold, Suffolk county, New York f
kno_n and desi~nated as and by the plots Nos. 183 ~o 187 bc~h
inclusive on a certaln nap entitled, ~Map of Goose Bay
Estates,. in the 70wn of southold, Suffolk county, New York,
said map being made by Lewis N. waters, L.S., of oyster Bay,
L.I., New York, dated Septe~ber 12, 1934, and filed in the
office of the Clerk of the county of Suffolk on the 13th day
o( Nov~mber, 1934, as and by the Hap No. 1176 (Abstract NO.
1197) .
TOGETHER with all t~e righ~, ':itle and interest of :he
sellers of, in and to that portion of the road or roads
adjacen' to said plots above mentioned, to the center line
thereof, subject to ~he right of other owners of plots on the
said Map to pass over and reasonably Ilse the same.
TOGETHER with all the right, tit~e and interest of the
sellers of, and to that portion of land lying in :ront of and
adjac~nt to said plot to the mean high water line of Goose
Creek, subject to the right of other owners of plots on said
Map to pass over and use the same.
TOGETHER with the right to use for all reasonable
purposes all tha~ por~ion of land lying in front of plo~s Nos.
53 to 58, both inclusiv~, plots N08. 168 to 195, both
inclusive, and plots Nos. 277 to 310, both inclusive, said
right to be in common with other plot owners on said Map or
owners who may hereafter acquire said plo!s on said Map,
subject to such reasonable rules and regulations with respect
to the use thereof as the Oliver Bros., Building ~
Construction Corporation may from time to time put into
effect, it being understood that should o.ner or owners of
plots facing Goose Creek desire to erect a dock on said land,
said owner or owners may do so providing said dock does nct
prevent other owners of plots on said Map passing over and
reas0nably using the land herein referred to, and providing
proper legal provisions are complied with, and the cons~n~ of
the former own~r herein is s@cured.
TOGETHER with a right to do the use of the streets,
avenues or roads shown on said map, said right to be in com~on
with,other plot owners on said Map.
BEING AND INTEN~ED TO BE the same premises c~nveyed ~o
the grantor herein by Deed dated 1/8/74 and recorded 1/ll/7~
in Liber 7567 page 401.
Con':inued...
doll.1f:i.
pailj
11437r~536
, The grantee her('in, carol A. Clency, h~reinb~lo'",' affiy.~::;
r ~ignature to this ins~rument evidencin~ h~r agreerner.~ ~o
sume and pay the exis!ing Notes and Mortga9cs as
nsolidat(>d, Extended ."lnd Modifit:d by ~<;r~~re€'nt on the
emises descrlbed herein which was made to "he Southold
vings Bank by Margdre~ r. eibl@, .he grantor herein, dat~1
~uary 31, 1990 and recorded February 6, 1990 lfi ~r.e Suffolr.
unty Clerk's Office in Liber 15762 page 225, on which the
esent remaining principal balance is $43,512.72 with
tercGt patd to date.
~ SUBJECT TO a lite estate hereby reserv~d by the grantor,
rgaret K. ~ible, for her~elf, for her life use and occupancy
d all purposes.
THIS IS A CORRECTION DEED to correc~ deed dated Augus~
, 1991, recorded in the Suffol~ county clerk's Office on
ptember 20, 1991 in Liber 11337 page 569. WHEREIN said Deed
QuId have stated rhat the grantor, Margar~~ K. Bible,
serves unto herself a lif~ e3~at@ for all ourpo5~s.
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TOGETHER wilt! all rirl,!, lillt' IInd jIlIN"\l, jf any, rJ/ Ih.. p.l~l t,( !~ fir., ~:&r! in Vi'1 !/} rt~.} Ioir..~t ':I~,~
roadll abutting Ill(' ah')\'(' dt".'>crihl"fl prcn1i~n III ll~ ('!"nltr Jill"~ lhrrrvf,
TOCEIltER wilh 111(' al'lHHll"n;Uln:~ ,ll,.L,1l tho t"""!\ll" ~~ r.Lh ,,~ tilt' 1),Il1y (If lfu:. li,.1 l,:m ill iln<:t to
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~:Ji(1 I'rl"rnit('s,
TO HAVE AND TO HOLD tIll': prl"11ti~5 h('r{"ill frallled unt... the pany (If lilt' Kl.."O'1d pa.rt, thr friu Cf'
~U(c('sY>r5 and assigns of lilt' part)' of the S('{:ond put {Or'M'ef".
AUD Int" pan:" ..f till' lir"! J>:lrt n>lrn<l:lts Ihill the r.ar1y (,f Tht' iJr_! l(lrl hdS not d('lnr or suff,.r!"'l: aTl~'lhing
wht'rl"hy t~{' said ~.rt"l11i_.r~ halt ht('Jl in,umbeted ill any \\"!I)" "'hal\\'':f, CI.re-pl ;l.S alor('.....ud
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AND (It' p;lnv n: thl" fl~'! I':H:, :n ',:Q1l1j'liJf1q. With Sc(:inn 1.\ nl thl' jjr-n Law. ('<'I'l"n,ln!s fh:!t th(' r....rty cf
!h.. fj.st I'J.:-: w:1! T('Cri\'('" :h~ ("rl~idtri!.;i{ln fur li-.l~ <,"I"-r-ya:lf(' alld wilJ nnld !~~ righ: 1(, ~M'('jv.. ~lXh (nn~id.
(,f:ilion a.... a 'r'lq Im1'\ I', i>l" J.l'l':;'.,j r,r~l lo: \11.. l'llfl-':ls" "f payil1J,: lhr {"'I~l "f r:,(" ;r'-;l':.,.(-mrl': J.:J'1 ....if! J.i'pl~.
Ih(" <;.;\n1{' fir.,lln lho:" i~'y:nt''11 of lh~ "J': of the ImpfoH>l!1I:'n! '-"'for~ u~jll;: ;HI.'". p.H1 (If tilt. 101....1 01 t!~ ....a..'1l!'" fOf
.1ny othcor pllipO~.
IN WfTN"E:SS WHEREOF, lhr ;'.lrn oi In!'" fir'l Ildn h., dul~. t"J(('i;utl'f1 thi, drt"li t~ ~y ;;r.-d ~~.u tir,t ..!.o'IYt'
wnt1l'n.
1111: wm,l "f'<I~," ,I\..I.lll.... (l.n'llll(',I ;" if il :rall "JhIrtll..... .....111'"1I(",.(.r th~ M"n.... "~lhi~ 1Il,I~ur" !>" ~"'I!.Jir':"S
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Margaret K. Bible
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Carol A. Cl;mc~. J
, 11.13'iPi:5,)8
nA.~ TC:a, COMTY Of
SUFFOLK
-, ITAn Of.... "oa. COWJft'Y OJ
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On the 21st da,. of. tebruun 19 '-11, ~fol't' I'Dt On thr day of
pt"f"iOnaJly ~~ M,;jr,:arl't K. 1\jl'1.' IIlltl lJf'n("lIU,c.Drl~
(,1I"l>l ^. C\'Il1\ \
19 . t.rfM~ Jr,tIf'
to me known to be th~ individlAl s lk$('ribN in and "'00
cx<<utro tJx. rorqc.lIIn.t- 1nstnjlnnlt, and ~lIflMced UoAt
they e.ueuttd tbt '''''''''-, /.' /' /',')
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1D me Icnc.wlI 10 ~ the indj~idtW dncnbM in .and 111'00
~~ ,~ forr;:oing in.trumml, Md .adu":""r~cl thai:
Otcut'!'d the same.
P\I'I~1P11 ~.~' 'r"
NOr.;P.~ :',"., ';'" ~.!'.'/ <:RI(
NO :,> j.:G'.'.3u, $:___r;'JtJl W'';l1rY .,
COMMI~$~ D\Pl~.l: A..ffCH j1,'~ .J
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STATE OF NEW YORK
55,:
County of Suffolk
!
I, EDWARD p, ROMAINE, Clerk of the County of Suffolk and Clerk of the Supreme Court of the State
of New York in and for said County (said Court being a Court of Record) DO HEREBY CERTIFY that I
have compared the aunexed COPY.Jf
Deed Iiber 1 '137 at Page 5"3 S Recorded 3 'J.- 3, f1 'j L-
and that it is a just and true copy of such original Deed and
of the whole thereof.
IN TESTIMONY WHEREOF, I have hereunto set m~and ?1d affixed the seal of said County
and Court this / Cj fi day of ~ 20
Form No, 104'''''''''''''''''''''''''''''''''''''''''''~ ~ t~...<;.. ~ -"Ci~;k"""'"''''''''''''
BIBLE
0JUt.'l Y Oil lOW:.
T..\:\ ll~i.U>':G AlIDRES"
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Rtw;urdllo:lAlReQuo$lolTlCOfrl'll6G-~~
UTUUf DT KAI1. TO;
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Rudolph H. Br~er. Esq.
Edson and Bruer
P.O. Box 1466, ~ain Road
Southold. New York 111971
.
TICOR TITLE GUARANTee
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Board Of $outhold Town Trustees
SOUTHOLD, NEW YORK
PERMIT NO. .',~'~'~.. DATE: ....F.,eb.... 2.~:.t...;~9o2
CAROL CLANCY
ISSUED TO .........................................................................................................................
Pursuant to the provisions of Chapter 615 of the Laws of
the State of New York, 1893; and Chapter 404 of the ?ws of the
State of New Yore 19S21 and the Soufhold ToWn Ord,nance en-
titled ."RE~ULATIN~ 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 B6ard adopted at a meeting held on ....~:~tZ~...~[.~_
~0.~.~ ....... and in consideration of the sum of $..~.(~.~.....~.P. ........ paid by
Carol Clancy
............... ............................................. N. Y. and su iect to the
Terms and Conditions listed on the reverse side hereof,
of Southold Town Trustees authorizes and permits the fo~owlng:
Wetland Permit to reconstruct in place +/-62' of existing concrete
bulkhead,to const. +/-38' section bf new bulkhead in place of
dilapidated concrete bulkhead. Exist. concrete bulkhead would be
rcmlaced with C-LoG 4500 Vinyl Sheathing .and s~ru~ture backi~lle,
with '1.'-20 c . ofc~e n ' . ' in
· the odgi.&fing ap[~a~(~l, from an upland source, with the
condition that a 10' non-turf buffer is .established behinc~ the
bulkhead. IN WITNESS WHEREOF, The said Board of Trustees here-
by ceuses its Corporate Seal to be affixed, and these ~esent$ fo
be subscribed by ;a'majorlty of the said Board as of this darn.
' ? '.K~n~dh'-'P~liw'oda < Ahs en~)
Trustees
'IT:RIdS ,,nd CONDITIONS
C~rol ~lancy .
333 Brighton Rd., Plymouth Meeting PA 19462
the COml~U'~ o[
2. Th~ dgs ~ is' ~slid fo~ a perled of . · 24 mos. ,whkh b comtde~ed to be d~
csdms~d r~--'r~qui~d to eomldete d~e wodc iavol~d, but should ci,*anmm~ ,~---;~r., n~lues~
for ~n e:mmslon m~y be m~le to ~he ~ ~ a I.*~. ,!_'_~.
~,. Tb~ ~ t~m;t should !~ retsbx~l iadei'mlt~y, or ts loa~ os the said Pe~gl~c wishes
~ msim~ d~e s~ucmre or l~jec~ involved, to pmylde evlda~ m sayoae co~',,~d d~ md~-
4. Tb~ .the wo~: l~vdved will be mbjea: to the im~ ~ q~pmv~l of' the Bo~d e~
ks s,b,~u, trod noa-com~lhtx~ wl~h.the
rev~cs~io~ of ~ P,~,~t b7 ~soludo~ of ~he uid Boerd.
wod:~ sbsll ~__ urn'returnable ~ to fmc ~ Ihe ~1 Pm~tm~ ~ill I~ mlMmi.
ufxxi due nod~ to remove o~ 'alte~ rids wo& or projec~ here~ suted wld*~ eztm~ses to ~ T~
8. Th-, ~he said Boerd will be ri°tiffed by the Peflnitt~ ot dee c0mlded~ o[ ~he wqxk amh-
That the Pex'mi~ will ~ ~11
plm~ ma,;, pet~lt ~ may
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
February21,2002
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Mr. Glenn E. Just
J.M.O. Environmental Consulting
P.O. Box 447
Quogue, NY 11959-0447
RE: CAROL CLANCY
280 Oak Ave., Southold
SCTM#77-2-3
Dear Mr. Just:
The Board of Town Trustees took the following action during its regular meeting held on
Wednesday, February 20, 2002 regarding the above matter:
WHEREAS, J.M.O. Environmental Consulting on behalf of CAROL CLANCY applied to the
Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town
of Southold, application dated January 28, 2002, and,
WHEREAS, said application was referred to the Southold Town Conservation Advisory Council
for their findings and recommendations, and,
WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on
February 20, 2002, at which time all interested persons were given an opporttmity to be heard,
arid,
WHEREAS, the Board members have personally viewed and are familiar with the premises in
question and the surrounding area, and,
WHEREAS, the Board has considered all the testimony and documentation submitted
concerning this application, and,
WHEREAS, the structure complies with the standards set forth in Chapter 97 of the Southold
Town Code,
WHEREAS, the Board has determined that the project as proposed will not affect the health,
safety and general welfare of the people of the town,
NOW THEREFORE BE IT,
RESOLVED, that the Board of Trustees approve the application of CAROL CLANCY to
reconstruct in place +/-62' of existing concrete bulkhead, to construct a +/-38' section of new
bulkhead in place of dilapidated concrete bulkhead. Existing concrete bulkhead would be
replaced with C-Loc 4500 Vinyl Sheathing and structure shall be backfilled with +/-20 cy. of
clean sand which shall be tracked in from an upland source, with the condition that a 10' non-
turf buffer is established behind the bulkhead.
BE IT FURTHER RESOLVED that this determination should not be considered a determination
made for any other Depashnent 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.
Presidem, Board of Trustees
DEC
'r ograph'
GP. APHIO SCALE I"= 50'
Sit-.uo~.e: Goose Cceek
Town: Sou~hold
SufFolk CounE~
Tid~ ~on~: 2.~'+/-
SEA LEVEL
MAPPING
Sheel-. I Of I
N
Telephone
(631) 765-1592
Tovm Hall., $11095 ~ Road
P.O. Box 11'79
6outhold, New York 119'71
$OUTHOLD TOWN
CONSERVATION ADVISORY COUNCIL
At the meeting of the Southold Town ConserVation Advisory Council held Tuesday,
February 12, 2002, the following recommendation was made:
Moved by Bob Ghosio, seconded by Drew Dillingham, it was
RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH
A CONDITION of the Wetland Permit Application of CAROL CLANCY to reconstruct in
place +/-62' of existing concrete bulkhead, to construct a +/-38' section of new bulkhead
in place of dilapidated concrete bulkhead. Existing concrete bulkhead would be
replaced with C-Loc 4500 Vinyl Sheathing and structure shall be backfilled with +/-20
cy. of clean sand which shall be trucked in from an upland source.
Located: 280 Oak Ave., Southold. SCTM#77-2-3
The CAC recommends Approval with the Condition of a 10' non-turf buffer behind the
bulkhead.
Vote of Council: Ayes: All
Motion Carried
SECTION
ALW'~,
~TTOM IM
2'"x ~'~
FOLLOY~F:
SCALE I"; 2j
2"x IZ"CAP '
G4 t
15~ )5FD
~' LIMIT OF
/ DEADM AN
T,E I~OD~__ ~.._
· ' ' 5AHD Ff~ AN
UPLAND SITE AS
~ACKFI LL
Applicant: Carol Clancy
Location 280 Oak Avenue
Purpose: Bulkhead reconstruction
Datum: Apparent Low Water
S.C.T.M.No. 1000-77-2-3
Locus: ~t2~25' 41°03,
Suffolk County
Hagstrom Map 24
Scale !"=3,000'
't_co'
PROP, C-LOC
71N.Y L SHEATHItlG
't~* X 12%8'
JAN 2 8
Applicant proposes to reconstrnet:!n plat6-
_+62 of existing concrete bulkhead, to conSlruct
a ~_-38 section of new bulkhend in plpce of
dilapidated concrete bulkhead. Existing concrete
bulkhead ~ould be replaced with C-Loc 4500
Vinyl Sheathing and structure shall be backfllled
With +_20. c.y. of clean sand which shah be
Tracked in fi.om an upland so.me. For Ooose
Creek, Southold, Town of Sonlhold, Suffolk
Co.nty, New York.
22 JAN'OZ
*Plan based upon topographic survey prepared by Sea t.evel Mapping 12129/01 SHFET
J.M.O. Environmental Consulting Services
Quogue, New York
®~APHIC ~d_.,ALtE I"=
~it:uQ~.~: ®oos~ Cr'~k.
Town: .~ou~.ho Id
SuFFolk C, oun ~.y ,
IDol. urn: MSL N®VID 2q
Tid~ Range:
.JAN 2
N
IISEA LEVEL
IMAPPIN~
GOOSE CREEK
~ FLO01) E F.3 B --~
wi D T H~I,O00'
Applicant proposes to reconstruct in place
=t:62 ofext~fin$ concrete bulkhe~], to construct
u :t38 section ofnew bulkheed in place of
dilapidated concrete bulkheed. Existing concrete
bulkbeed would be replaced with C-Loc 4500
Vinyl Sheathing md slructure shall be beckf'dled
With..+20 c.y. of clean sand which shall be
Trucked in from an upland source. For Goose
Creek, Sonthold, Town of Sonthold, SntTolk
County, New York.
.4)
4/
Applicanti Carol Clancy
Location 280 Oak Avenue
Purpose: Bulkhead reconslrucfion
Datum: Apparent Low Water
S.C.T.M.No. 1000-77-2-3
Locus: 22°25, 4 !'03'
Suffolk County
Hagstrom Map 24
Scale 1"=3.000'
SCALE I"-- 30' 22 JAN'OP
J.M.O. Environmenlal Cons[#ting Services
Quogue, New York
SHEET
I OF2
Albert J. Krupski, President
Jame~ Kin'g, Vice-President
Henry Smith
Artie Foster
Ken Poliwoda
Town Hall
53095 Main Road
P.O. Box 1179
Southold, New York 11971
Telephone (516) 765-18,~2
Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only
Coastal Erosion Permit Application
~-Wetland Permit Application
Grandfather Permit Application
Waiver/Amendment/C~anges
~"Received Fee:$~~_~~
Application
~-Received
~,Completed Application_~__
Incomplete
SEQRA Classification:
Type I Type II Unlisted
Coordination: (date
~,-CAC Referral Sent:
~ate of Inspection:_~~___
Receipt of CAC Report/ ~--
Lead Agency Determination:__
Technical Review:
~,'Public Hearing Held:~L~___
Resolution:
Name of ApplicantCarol Clancy
Address 333 Brighton Road, Plymouth Meeting, PA 19462
Phone Number:(610) 279-7220
Suffolk County Tax Map Number: 1000 -77-2-3
Property Location: 280 0ak Avenue~ Southold
(provide LILCO Pole #, distance to cross streets, and location)
AGENT: Glenn E. Just/ J.M.0. Environmental Consulting
(If applicable)
Address: P.O. Box 447, Quogue, N.Y.
11959-0447
Phone: 653~0607
F~D~#: 653-3348
Boa~f Trustees Application
GENERAL DATA
Land Area (in square feet):
Area Zoning: Residential
Previous use of property: Single family dwellin~
Intended use of property: same
Prior permits/approvals for site improvements:
Agency Date
~/ No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspended by a
governmental agency? /No Yes
If yes, provide explanation:
Project Description (use attachments if necessary):
Boar~ Trustees Application
3
Purpose of
WETLAND/TRUSTEE LANDS APPLICATION DATA
the proposed operations:
Bulkhead reconstruction
Area of wetlands on lot: ~' .square feet
Percent coverage of lot: ~_ %
Closest distance between nearest existing structure and upland
edge of wetlands: ~ ~ feet
Closest distance between nearest proposed structure and upland
edge of wetlands: ~ ~ feet
Does the project involve excavation or filling?
No ~- Yes
If yes, how much material will be excavated? ~ cubic yards
How much material will be filled? ~k<D cubic yards
Depth of which material will be removed or deposited:
feet
Proposed slope throughout the area of operations:
Manner in which material will be removed or deposited:
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):
As proposed~ the pro,ject shall have no negative impacts
upon the waters or wetlands of the Town of Southold
3
Bo
of Trustees Application~
State of
CLa o\ C\ m cq BEING DULY swoRN
DEPOSES AND AFFIRMS THAT HE/SH~'IS THE APPLICANT FOR THE ABOVE
DESCRIBED PERMIT(S) AND TIIAT ALL STATEMENTS CONTAINED HEREIN ARE
TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL
WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION
AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES.
TIlE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN
TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS
ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN
COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES,
THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY
TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS
APPLICATION.
Signature
SWORN TO BEFORE ME THIS
DAY OF
F NOTARIAl- ~EAL
KIMBERLEY A. STINGLE, Notary Public
AUT}IORIZATION
(where the applicant is not the owner)
I, ~ residing at~
property)
~F~.~o~~l~.~d ~t6~' do hereby authorize ~.~.O
'(Agent)
~.~.~o apply for permit(s) from the
Southold Board of Town Trustee~ on my behalf.
Name:
PROOF OF MAILING OF NOTICE
ATTACH CERTIFIED MAIL RECEIPTS
Address:
U.S. Postal Service
CERTIFIED MAIL RECEIPT
~ITE FtAIN5, NY 10606-3901 F'*~';~'
STATE OF NEW YORK
COUNTY OF SUFFOLK
~-Ax~.,g .., residing at
~0~ ~ .~ £ ~ c,~, being duly sworn, deposes and says
~at o~ the Z~ day of jT-~t~ ,~__~, deponent
mailed a true cbpy 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
of said persons as shown on the current assessment
th~.a~r~ m ..... ~f ~outhold; that s. id Notices were ma~ at
nited States Post Office a~ _
the U -,,-~
said Notices were ma~u
(registered) mall.
Sworn to before me this
day of ,19__
Notary Public
~ame:
PROo~ OF HAILING OF NOTXc~
ATTACH CERTiFiED ~AIL RBC~PTS
Addreas=
U.S. Postal Service
CERTIFIED MAIL RECEIPT
COUNTy OF SUFFOLK
g duly sworn, der
Trustees Annl,-.~ Of the~,_~9~, d .... says
persons at the addresses set opposite there respective names;
..... eu to each of t~ ~e BOard of
the address of said Persons as shown o ',= =uove named
that the addresses set opposite the names of said Persons are
roll of the Town of SoUthold; that s ia the current asses
the United States p
~aid NOtices ...... cst Office a ~ d Notices wet- .... S~ent
(reglstere~ S~ mailed to e--~ ~ ~ ,,,aiieo at
SWorn to before me this
day of
~,19
NOtary Public
Albert J. Krupski, President
James King, Vice-President
Henry Smith
Artie Foster
Ken Poliwoda
Town Hall
· 53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
BOARD OF TRUSTEES: TOWN OF SOUTHOLD
In the Matter of the Application
of
COUNTY OF SUFFOLK)
STATE OF NEW YORK)
AFFIDAVIT OF POSTING
I ~~+ residing at ~ ~~ ~La, k&3~
being"d-ul, y ~wolAn, 'depose and say:
That on the~y~ o~, ~0~ personally posted the
property known as ( '6L~ ( '~ ~%~e~
by placing the Board-~f Tru'ste~s~)ffi~ial 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 hearing. Date hearing thereon to be held~
~~{ ']"C~ ~.~. noted ~
Dated:c~/~/O=~ /' ~ ~/ ~-~ -
(sign~ ~ure) ~ ~
Sworn to before me this
~O~L.,~ day of/--7J~3~00 ~
ROBIN McKENNA
NOTARY PUi3' '. ,";, CT,','! ~ OF NEW YORK
NO: 01MC~,~,~. SUFFOL~COUNT~L.
TERM ~PIR[18~712~[~~