HomeMy WebLinkAboutTR-4923Albert J. Krupski, President
James King, ¥ice-President
Artie Foster
Ken Poliwoda
Peggy A. Dickerson
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
APPLICATION FOR ICE DAMAGE PE]
Town Hall
53095 Route 25
P.O. Box 1179
Sou~hold, New York
Telephone Iq31
Existing Permit Number
Creek
The purpose of this application: Re-driving or replacing openwork dock or openwork pier piling,
and mooring piles, removal of damaged piling, repair, resetting or replacement of floating docks,
ramps, or decking, all necessitated by ice and storm damage resulting during O _Er Winter.
Please complete form below and return to the Trustees Office along with a copy of your original
permit and drawing. Provided that all paperwork is in order, you xvill receive approval within a
week if not immediately.
Applicant's Name & Address ~.',.~,-(4--
Contractor's Name & Address ~' Ft. ¢~{,'k PO I,.~ox
~[/~r,~'[-cet._// i'L"t ticksz Tel. No.
2.
3.
4.
5.
SPECIAL CONDITIONS
No dredging or filling is permitted.
Repairs to existing structures are limited to replacement of timbers without change in design or dimension.
No repair or replacement of bulldaeads is permitted under this permit.
No fi'eshwater or tidal wetlands are to be disturbed under any circumstances.
A yellow permit sign provided by this office shall be displayed on the project at all times while under
replacement,
Groins and bulkheads are subject to inspection prior to issuance of permit,
This office must be notified upon completion of work.
Albert J. Krupski, President
James King, Vice-President
Henw 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
May 27, 1999
Patricia C. Moore
51020 Main Road
Southold, NY 11971
Re: Patrick Mortimer
SCTM#81-1-8
Dear Ms. Moore:
The following action was taken at the Southold Town Board of
Trustees Meeting on May 26, 1999:
RESOLVED, that the Southold Town Board of Trustees grant the
request for an Amendment to Permit #4923 to correctly reflect
the actual dimensions of the proposed deck and to conform to the
Zoning Board decision, and, to remove a shed.
However, this does not'constitue approval from any other
agencies.
If you have any questions, please call our office at 765-1892.
Sincerely,
Albert J. Krupski, Jr.
President, Board of Trustees
AJK:lms
05/13/1999 14:28 51G7654G LAW OFF;CES PAGE 02
APPEALS BOARD MEMBERS
Gerard P. Goehringer, Chairman
James Dinizio, Jr.
Lydia A. Tortora
BOARD OF APPEALS
TOWN OF SOUTHOLD
FINDINGS, DELIBERATIONS AND DETERMINATION
MEEq~NG OF MAY 5, 1999
Southold Town Hall
53095 Main Road
1~O. Box 1179
Southold, New York 11971
ZBA Fax (516) 765-9064
Telephone (516) 765-1809
Appl. No. 4636 - PATRICK MORTIMER PARCEL 1000-81-1-8
STREET & LOCALI'TY: 3895 Paradise Point Road, Southold
DATE OF PUBLIC HEARING: April 22, 1999
FINDINGS OF FACT
PROPERTY FACTS/DESCRIPTION: The subject property is located along the northerly side of Paradise Point
Road, Southold. The May 22, 1998 survey map shows that the subject premises contains a total area of
approximately 25,000 sq. ft. and is improved with the following buildings: (1) one-story single-family dwelling
37.5 feet from Robinson Road, at its closest point; (2) 16' by 32' inground swimmingpool with wood deck, all
shown at 20 feet from the westerly side property line; (3) 10' by 12' (approx.) accessory shed "as built" north
of the existing swimming pool, and (4) to the north of all buildings, a brick patio and wooden bulkhead.
BASIS OF APPEAL: The Building Inspector's July 23, 1998 Notice of Disapproval, under Article XXlII, Section
100-239.4B which states that all buildings located on lots upon which a bulkhead exists and which are
adjacent to tidal water bodies other than sounds shall be set back not less than 75 feet from the bulkhead.
AREA VARIANCE RELIEF REQUESTED: By survey amended February 2, 1999, prepared by Anthony W.
Lewandowski, applicant is requesting a variance for a portion of a proposed new deck addition at 52.8+- feet
from the bulkhead at its closest point. (The accessory shed "as built," which was the subject of a denial by
the Board on 9-30-1998, is to be removed and therefore a variance is not being requested for a location
within 75 feet of the bulkhead.)
No other variances are requested.
REASONS FOR BOARD ACTION, DESCRIBED BELOW:
1. Grant of the area variance will not produce an undesirable change in character of neighborhood or a
detriment to nearby properties because the deck is not a fully enclosed addition and is open to the sky.
2. The benefit sought by the applicant cannot be achieved by some method, feasible for applicant to pursue,
other than an area variance because the lot is small.
3. The relief as requested in this application is not substantial. Only a small portion of the deck at the
northeast corner will need a variance, representing approximately 32 square feet of building area.
4. No factors are present to suggest that grant of the relief set forth below will have an adverse effect or
impact on the physical or environmental conditions in the neighborhood or district.
Page 2 - May 5, 1999 ~
Appl. No. 4636 - P. Mortimer~
Southold Town Board of Appeals
5. Grant of the relief set forth below is the minimum necessary and adequate to enable applicant to construct
a deck on his property while preserving and protecting the character of the neighborhood, and the health,
safety, welfare of the community.
RESOLUTION/ACTION: On motion by Member Collins, seconded by Member Tortora, it was
RESOLVED, to GRANT the variance as applied for, SUB.lECT to the CONDITION that the deck shall remain
unroofed and "open to the sky."
VOTE OF THE BOARD: AYES: MEMBERS GOEHRINGER, TOB-~q~)R~,, COLLINS.
NAY: MEMBER DINIZIO. (Member Hor~li~r~Pishers Islan.~,)~ma~bsent-excused.)
duly adopted (3-1). ,.-~' /
......' /: ,.,..
/,GERARD P~-GOEHP~NGER/ .,//
~'CHAIRMAN
/ For Filing 5/7/99
This Resolution was
Board Of Southold Town Trustees
SOUTI~OLD. NEW YORK
PERMIT NO. a-/~7~,,j DATE: May 29, 1998
ISSUED TO
PATRIC MORTIMER
Pursuant to the provis~ons of Chapter 615 of the Laws of
the State of New Yorlq 187]; end Chap"er 404 of the [aw~
State of New York 1952: and the Southo~d Town Ordinance en-
fltled "RE~ULATIN~ AND T~E PLACIN~ OF OBSTRUCTIONS
IN AND ON TOWN ~ATERS AND PUBLIC LANDS ~nd the
RE.OVAL OF SAND, ~RAVEL OR OTHER ~ATERIALS
LANDS UNDER TOWN WATERS(' and ~n accordance with the
Resolution of The Board adopted af~meeHng heldon M~y 28, 1998
I? 98 , and ~n conslderaHon of the s.m of $150.00 pa~d by
Stephen Perricone fro' PATIUG MORTIMER
of Southold N.Y. ~nd subiecf ~o fhe
Terms and CondlHons llsted on ~he reverse slde hereof,
of Southo[d Town Trustees authorizes ~nd permifs the following:
~etland Permi~ for exist, deck and brick patio around pool, a
shed, walkway to water, fencing around proper. ~ pool, a 10~ X
51' deck attached to back of house and bay window, & transfer
permits fro n Alfred ~adel tq p~tric Mo :timm- for blkhd. ,_c~twalk,
ram~" in accordance wHh fhe aetmled specd~cehons as pre.riled ~n
f~'he originating a llcaNon ......
and PP '~loat w~th 2 mhngs and brink patio,
based
by causes ifs Corporafe Seal fo be afl;xed, and fhese presenfs fo
be subs?ibed by e me,or,fy of.fha sa~d 8oord es of fh~s
Albert J. Krupski, President
James King, Vice-President
Henry Smith
Artie Foster
Ken Poliwoda
Town Hall
53095MainRoad
P.O. Box 1179
Southold, New York 11971
Telephone (516) 765-18q2
Fmx (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
TO:
FROM:
RE:
DATE:
$outhold Town Zoning Board
Southold Town Trustees
Patric Mortimer
October 26, 1998
RESOLVED, that the Southold Town Board of Trustees 'authorizes
and approves the structures as shown on the survey prepared by
Anthony W. Lewandowskt dated and received by the Trustees at the
May 28, 1998 Public Hearing, and showing the extension to the
deck to be even with the existing pool deck, issued to Patric
Mortimer. Due to a clerical error this deck was inadvertently
omitted on the permit. Attached is Permit #4923 and the new
survey.
cc. Bruce Anderson
Patric Mortimer
Board of Trustees 16 May 28, 1998
happens. If you don't want it to happen you have to do
something about it.
TRUSTEE SMITH: You can have the Bay Constable look at it and
issue a violation that it was done prior to approval.
TRUSTEE KRUPSKI: There's a motion on the floor to table this.
Is there a second?
TRUSTEE FOSTER:
TRUSTEE KRUPSKI:
get a violation.
TRUSTEE FOSTER:
MR. HELSE: Yes,
TRUSTEE FOSTER:
MR. HELSE:
Second. ALL AYES
We'll send the Bay Constable down and we'll
It wasn't posted either.
we posted it.
Where?
I don't know where, but I know
it was posted.
15. PATRIC MORTIMER requests a Wetland Permit for existing deck
and brick patio around pool, a shed, walkway to water, fencing
around property and pool, a 10' X 51' deck attached to back of
house and bay window. Also to Transfer Permit #649 from Alfred
Nadel to Patrfc Mortimer for bulkhead, catwalk, ramp, and float
with 2 pilings and brick patio. Located: 3895 Robinson Road,
Southold. SCTM #81-1-8
TRUSTEE KRUPSKI: Is there anyone here who would like to speak
in favor or against this application?
TRUSTEE SMITH: I looked at this and everything is there and
it's on the survey and all behind the bulkhead.
STEVE PERRICONE: The Mortimer's have asked me to add an
extension to the deck to be even with the existing pool deck.
TRUSTEE KRUPSKI: Could you just draw that on the survey for
us.
STEVE: I have a new drawing here.
TRUSTEE SMITH: I'll move to close the hearing.
TRUSTEE KING: Second. ALL AYES
TRUSTEE KRUPSKI: I'll make a motion to approve the application
based on the new submitted plan give, at the meeting of 5-28-98.
TRUSTEE KING: Second. ALL AYES
16. JOHN & JACQUELINE ANDREJACK requests a Wetland Permit to
construct a 2 story single family dwelling with septic, driveway
and brick patio. Located: 1970 Ole Jule lane, Mattituck. SCTM
#122-4-7
JOHN ANDREJACK: We went to great lengths to keep it inside and
outside of the 75' wetlands setback. However, we feel due to
the cost of construction when they dig the foundation probably
because it is so close to that water we will b~ in the
wetlands. Also upon looking in the 75' wetlands setback there's
been some significant dumping in there. There are weeds and
Christmas trees and other garbage. We'd like to clear out some
of the leaves and the garbage in the middle area there and
actually plant a lawn.
TRUSTEE KRUPSKI: Our standard procedure on these is that we
don't have a problem with most of what you are saying but we
· would want a 10' non-turf area between the top of the bank and
the upland. So during construction we are gonna require you'to
put a row of haybales along ...... measure back from the bank 10'
Board Of Southold Town Trustees
SOUTltOLD, NEW YORK
PERMIT NO. L/~...~ DATE: May 29, 1998
ISSUED TO PATRIG MORTIMER
Pursuant to the provisions of Chapter 615 of the Laws of
the State of New York, 1893; and Chapter 404 of the Laws of
State of New York 1952; and the Soufhold Town Ordinance en-
titled "REGULATINC= 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;" ~nd in accordance with the
Resolution of The Board adopted at a meeting held on May 28, 1998
19 98 , end in consideration of +he s.m of $150.00 peid by
Stephen Perricone for I AFR]G MORTIMER ..
of Southold N.Y. ~nd subject to the
Terms ~nd ~ondifions listed on the reverse side hereof,
of Soufhold Town Trustees euthorizes end permits the following:
Wetland Permit for exist, deck and brick patio around pool, a
shed, walkway to water, fenc[ng around proper. & pool, a ~0~ X
5P deck attached to back of house and bay window, ~ transfer
permk~s, from ~lfred ~d~l tq p~tr~c Mol;~im~r for blkhd~,~c~twalk,
f~'he originating application '
and 'float ~ith 2 ~ilin~s and brick patio,
q~ESS~E~O~'~.fd~f Trustees ~re-
by c~uses its Corporate Se~l to be ~ffixed, ~nd ~hese presents ~o
be subscribed by ~ m~iority of the s~id Board ~s of this d~.
Albert J. Krupski, President
James King, Vice-President
Henry. Smith
Attic 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 TOWNT~USTEES
TOWN OFSOUTHOLD
BOARD OF TRUSTEES: TOWN OF SOUTHOLD
In the Matter of the Application
of
m_ _c ........
COUNTY OF SUFFOLK)
STATE OF NEW YORK)
I, Bruce A. Anderson
AFFIDAVIT OF POSTING
· residing at Suffolk Environmental Consulting,
Main Street, BridgehamDton, NY
being duly sworn, depose and say:
That on the 12thday of Oct. , 1998, I personally posted the
property known as Patrick Mortimer
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 seven days prior to the date of the
public h~aring. (date of hearing noted thereon to be held ~_~_,~11~9~~
on or o.~xu~ 9~O 9~.
Sworn to before me this
2 day
~N6tary' ~blic ' [' KlM ~ARIL CORHZZ.
Telephone
(516) 765-1801
Town Hall, 53095 Main Road
P.O. Box 1179
,%uthold, New York 11971
SOUTHOLD TOWN
CONSERVATION ADVISORY COUNCIL
At the meeting of the Southold Town Conservation Advisory Council held
Monday, October 19, 1998, the following recommendation was made:
A-lU,8
RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL
of the Amendment to Permit request of PATRICK MORTIMER 81-1-8 to extend
a deck.
3895 Robinson Road, Southold
Vote of Council: Ayes: All
Motion Carried
Suffolk Environmental Consulting, Inc.
Newman Village, Main Street. EO. Box 2003. Bridgehampton. New York 11932-2003
(516) 537-5160 Fax: 1516) 537-5198
Bruce Anderson. MS.. President
September 29, 1998
Southold Town Trustees
Town Hall, Main Rd.
P.O. Box 1179
Southold, NY 11971
Attn: Artie Foster
Re~
Patrick Mortimer
Situate: Robinson Rd., Town of Southold
SCTM# 1000-81-1-8
Dear Mr. Foster,
This firm represents Patrick Mortimer who applied for and received a Wetlands Permit
from your Board (Pem~i~84~Y~3), a copy &which is annexed hereto. The Wetlands Permit
authorizes, among other things, a 10' x 51' deck and a shed.
Enclosed herewith please find a survey prepared by Anthony Lewandowsky last revised
May 22, 1998 showing the deck and the shed. As can be seen from the survey, the center
portion of the deck bows outwards toward the existing bulkhead. This is the deck that Mr.
Mortimer wishes to construct.
My inspection of subject parcel reveals that the deck will be placed over an existing turfed
area. Accordingly, I can see no environmental consequence of constructing the deck Mr.
Mortimer desires. I note that the existing dwelling is 50' from the bulkhead at its nearest
point and the center portion of the deck is 46' from the bulkhead at its closest point. This
amounts to only a minor encroachment towards the existing bulkhead.
By way of this correspondence, I hereby request that the in force permit be ~ a
manner consistent with the enclosed survey. Your prompt attention to this matter is
greatly appreciated.
A. Anderson '
BAA/mis
cc: P. Mortimer
S. Perdcone
THIS PERMIT IS CONDITION~
PAINT,~
AGAINST THE uSE OF TBT OR OTHER ORGANO-TIN BOTTOM
EXCEPT WHERE EXPRESSLY PERMITTED IN WRITING BY THE TOWN TRUSTEES.
Bosrd Of Southold lown lrustees
~ }~ SOUTHOLD, NEW YORK
Pursuant fo 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 Soufhold Town Ordinance en-
titled "REC=ULATING AND THE PLACINC= OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS and the
REMOVAL OF SAND, C=RAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN WATERS;" and in accordance with the
Resolution of The Board adopted at a meeflncj held on ...(~.~.~.1...~.'...
88
I? ............. and in consideration of the sum of $...9.(~.]:.:..~.(~ ........ paid by
ALFRED NADEL
of ........ ..S.~t~..~..q~.? .................................................. N. Y. and subiect to the
Terms and Conditions listed on the reverse side hereof,
of Southold Town Trustees aufhorlzes and permits the following:
Permit for bulkhead, catwalk, hinged ramp, float and
2 pilings ~-
ail in accordance with the detailed specifications as presented
{'he originating appilcation.
IN WITNESS WHEREOF, The said Board of Trustees here-
by causes ifs Corporate Seal fo be affixed, and these presents fo
be subscribed by a majority of the said Board as of this date.
.) .... ., -~ ._.. /,
...... _.¢ ......................
....
A,
Albert J. Krupski, President
John Holzapfel, Vice President
Will/am G. Albertson
Martin H. Garrell
Peter Wenczel
Town Hail
53095 Main Road
P.O. Box 1179
Southold, New York 11971
Telephone (516) 765- 1892
Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
May 26, 1995
Caminiti & Gibbons
54075 Main Road
P.O. Box 846
Southold, NY 11971
RE: Alfred Nadel
SCTM #81-1-8
Dear Mr. Caminiti:
The following action was taken by the Southold Town Board of
Trustees on Thursday, May 25, 1995:
RESOLVED that the Southold Town Board of Trustees grants an
amendment to permit %649 to add a 25' X 10' +/- brick patio as
per drawing received May 11, 1995 behind bulkhead. Located
Robinson Road at Bayview, Southold.
If you have any questions, please do not hesitate to contact
this office.
~Sincerely,
Albert J. Krupski, Jr.
President, Board of Trustees
AJK:jmd
Patricia C. Moore
Attomey at Law
51020 Main Road
Southold, New York 11971
Tel:(516) 765-4330
Fax:(5161765-4643
Margaret Rutkowski
Secretary
May 12, 1999
Southold To~vn Trustees
Town of Southold
Main Road
Southold, New York 1197l
Re: Patrick Mortimer
Permit # 4923
Dear Mr. Kmpski, President
and Board of Toxvn Trustees;
Your board previously issued a permit to Stephen Pen-icone for the oxvner, Patrick
Mortimer to build a 10' x 51' deck, as well as other, as built, structures. However, the deck
design was modified from the diagram shown on the survey in your file. The enclosed sur~,ey
shows the final proposed deck. This deck, as shown on the sutw'ey, has obtained approval from
the Southold Town Zoning Board of Appeals. We wish to amend the previously issued Trustees
permit to correctly reflect the actual dimensions of the proposed deck and to conform to the
Zoning Board decision.
Also, please note that the owner is removing a shed which was originally listed on tile
permit. Enclosed for your convenience please find a copy of the Trustees permit #4923 and
copy of Zoning Board decision.
Very tmJcyours,
Patricia C. Moore
cc: Patrick Mortimer
PCM/mr
PATRICIA C. MOORE
Attorney au Law
51020 Main Road
Southold, New York 11971-4616
Tel: (516) 765-4330
Fax: (516) 765-4643
May 21, 1999
Southold Town Trustees
Southold Town Hall
Main Road
Southold, NY 11971
Re: Patrick Mortimer
SCTM # 1000-91-1-8
Dear Ladies/Gentlemen:
Enclosed please find a Notice to Adjacent Property Owners
together with Affidavit of Mailing and Certified Mail Receipts for
the above referenced matter.
Very truly yours,
Patricia C. Moore
PCM/mr
Encls.
I
I000-81-1-16.10
I000-81-1-7
1000-81-1-9
1000-81-3-8
Paradise Point Assoc.
Edward Boyd
Henry C. Elfers
Jessica Barnard
c/o Peter A. Cooper
4800 Paradise Point Road
Southold, NY 11971
P.O. Box 243
Southold, NY 11971
Paradise Point
P.O. Box 1136
Southold, NY 11971
200 Ocean Road
Vero Beach, FL 32963
Albet/J. Krupski, President
John Holzapfel. Vice President
Jim King
Nlartin H. Oarrell
Peter Wenczel
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall
53095 Main Road
P.O. Box I 179
Southold. New York 11971
Telephone (516) 765-1892
Fax (516) 765-1823
Office Use Only
Coastal Erosion Permit ApplicationF~
-~-Wetland Permit Application ;.
Grandfather Permit Application
Waiver/Amendment/Changes
Received Application:
Received Fee:$/~-O -
Completed Application ~-
Incomplete
SEQRA Classification:
T~;pe I__~T!rpe II Unlisted
Coordination:(date sent)
CAC Referral Sent: ~-~ O--J-~'--
Date of Inspection: ~-~o -
Receipt of CAC Report:
Lead Agency Determination:__
Technical Review:
~--Public Hearing Held:~-~7-
Resolution:
Hame of Applicant hitS. ~ I'&~. t3/4 Ti~,'~.- /~ORTiP4~R
Address l0 ~m~Sr~m~-Ln~O ~fR.
~--/ 6 -- c~ 3 ~-- ~ ~-15- Phone Nu/nber: (5'/6)
Suffolk County Tax Map Number: 1000 -
/~oO ~4$rot:
(provide LILCO Pole-43- distance to cross streets, and location)
(If applic~l~ ' - '
Address:
Phone:
FAX~:
~d of Trustees Applicatiol
GENERAL DATA
Land Area (in square feet):
Area Zoning: ~
Previous use of property:
Intended use of property:
Prior permits/appr~%als 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 attacnments if necessary):
!
of Trustees Applicatior
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: 7D (',~,~1'-I)1{.I'~1 ~Vi'~-H
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: 9~ ' ~ ' feet
Does the project involve excavation or filling?
..,~/~ NO Yes
If yes, how much material will be excavated?
How much material will be filled?
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:
cubic yards
cubic yards
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):
of Trustees Applicati~
COASTAL EROSION APPLICATION DATA
Purposes of proposed activity:
Are wetlands present within 75
No ~ ~5 Yes
feet of the proposed activity?
Does the project involve excavation or filling?
/~0 No Yes
If Yes, how much material will be excavated? (cubic yards)
How much material will be filled? (cubic yards)
Manner in which material will be removed or deposited:
Describe the nature and extent of the environmental impacts
reasonably anticipated resulting from implementation of the
project as proposed. (Use attachments if necessary)
../J , ---'
Appendix S
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNL;STED ACTIONS Only
PART IIPROJECT INFCRMATION (To ~e commle*.ec ;y AoolJcan[ $r R-oiec'; .~mcnsor)
SEC
New U ExDans,on
~. ~ESCRIBE P~CJECT BRIEFLY:
'~c I1 NO, :escr¢ae briefly
if ~he action is in the Coos:al Ares, and '/cu 3re a Stem ac. enc'r', complete the
Coastal .Assessment Form 2efore proceeoing ',vitn this as~essmen;
OVER
NOTICE TO ADJACENT PROPERTY OWNER
BOARD OF TRUSTEESt TOWN OF SOUTHOLD
In the matter of applicant:
SCTM#1000-
YOU ARE HEREBY GIVEN NOTICE:
1. That it is the intention of the undersigned to request a
Permit from the Board of Trustees to: dL~,,-~F-~/~.~l
2. That the property which is the subject of Enviro~ental
Review is located adjacent to your property and is described as
follows: (vu~f~ ~13~ J~O ~
3. That the project which is subject to Environmental Review
under Chapters 32, 37, or 97 of the Town Code is open to public
comment. You may contact the Trustees Office at 765-1892 or in
writing.
The above referenced proposal is under review of the Board of
Trustees of the Town of Southold and does not reference any
other agency that might have to review same proposal.
OWNERS NAME:
MAILING ,ADDRESS
PHONE ~ : .~-I ~
Enc.: Copy of sketcq~'~r plan showing proposal for your
convenience.
PROOF OF MAILING OF NOTICE
ATTACH CERTIFIED MAIL RECEIPTS
Address:
STATE OF NEW YORK
COUNTY OF SUFFOLK
, being duly sworn, deposes and says
that on the __ day of ,19 , 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 assessment roll of the
Town of Southold; that said Notices were mailed at the United
States Post Office at that said Notices
were mailed to each of said persons by (certified) (registered)
mail.
Sworn to before me this
day of _~.9__
Notary Public
6
~ard of Trustees Applicat~
County of Suffolk
State of New York
/~ ~ ~4~. i)~r~,'c,~ Mo~ri~. BEING DULY SWORN
DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE
DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE
TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL
WORK WILL BE DONE IN THE MAITNER SET FORTH IN THIS APPLICATION
AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES.
THE APPLICANT AGREES TO HOLD THE TOWN OF SOU~q{OLD AND THE TOWN
TRUSTEES ~ESS KND' 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
,19
Notary Public
~rd of Trustees Applicatio0
AUTuORIZATION
(where the applicant is not the owner)
(print owner of property)
residing at
(mailin ad. ess)
do hereby authorize
(Agent)
to apply for permit(s) from the
Sou~ld Board of Town Trustees on my behalf.
[Owner] s' s~r~atu~e )
8
PART [I--~?,IVIRONr~IENT~qSESS~IE.NT ,To ~e corn;le!ed 3y
PART III--OETERMINATION OF SIGNIFICANCE ~To ~e comole[ed by Agency)
INSTRUCTIONS; For eac.'l a~verse erfec,* ~dennfied zcove, aetermlne wnet~er it is SUDStantiaJ, Jarge. ;moor[ant or otherwise $1gnlfiC.
=aCh eCfect should be assesse,~ ;n connection Wl[h ,ts la) setting ¢.e. urban or rural); (b) 2rooaodJfy Of OCC~"~rlg; I~C1 duration: