HomeMy WebLinkAboutTR-6080Albert J. Krupski,
James King, Vice-President
Artie Foster
Ken Poliwoda
Peggy A. Dickerson
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall
53095 Route 25
P.O. Box 1179
Sputhold, New York 11971-0959
Telephone (631) 766-1892
Fax 0331) 765-1366
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
1st day of construction
¼ constructed
__ Project complete, compliance inspection.
Board Of Southold Town Trustees
SOUTHOLD, NEW YORK
PERMIT NO. .6QS.Q ........
DATE: ..~.e.~) .. ]:.,s .,....;~.c~5
A, ut'harizatio
Pursuant fo the provisions of Chapter 615 of the Laws of
the State of New Yorlc, 1893= and Chapter 404 of the Laws of the
State of New YoM 19521 and the Southold Town Ordinance en-
titled ."RE~ULATINC~ AND THE PLACINC~ OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS and the
REMOVAL OF SAND, ~RAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN'WATERS:~.~. and in accordance with the
Resolution of The Board adopted at a meeting held on .?.~.,..~.6 .........
2~.~.~...., and in consideration of the sum of $..~.~.,.~.~ ...... paid by
Skunk L~ne Trust c/0 Brad a~d ~_r~z..K~a~ ..................................
of ............... ~?.~H~. ................................ N. Y. end subject to the
Terms and Conditions listed on the reverse side hereof,
of Southold Town' Trustees authorizes and permits the following:
Wetland Permit to construct a single-famiLy dwelling with deck, sanitary system, and pervious driveway,
with a non-disturbance, non fertilization buffer from the 9' contour line seaward, a non-turf area from fl-,e
9'centour Line to [he deck, gutters and dryweils to contain roof runoff, and a 4' path to [he dock and all as
depicted on [he plan surveyed by Joseph Ingegno and last dated February 17, 2005.
all in accordance with the defaiJed Specifications es presented in
the originating appr~afion.
IN WITNESS WHEREOF, The said Board of Trustees here-
by causes ifs Corporate. Se. al to be afl)xed, and these ffesenfs to
be subscribed by a 'malor~fy of the said Board as of th~s daf~.
TERk4S and CONDITIONS
TbeP~
Skunk Lane 'Trust c/o Brad and Mary Krau~e
~l~as Cutchogue N. ¥.
[~ut of the conside~ion for ~e ts~-,~_ of ~he pomW¢ do~ ~ and ~m~'~be ~ the
· ,~ ~ tla~o, to the ~ exdaskm of the Board o~ Tnmm ot the Town of ~udmld
2. That fl~ Permit is' vafid for s pet-lod of 24 mae. '~nk~ ~ eomMeted to be d~e
e~ed tlme'tequlmd m Camlge~ ehe work ~avolved, but 'should ~mim~azes wammt, request
for an ~on may be made to the Bo~d at
3. That ~ Permit should be re~flned indefinitely, or as lot~ as the ~ Pern~oee wishes
to ~n~, the stmct~e o~ project involved, to provide evidence to anyone concerned that auth-
That d~e wo~ .involved will be ~ject to t~e imt~t/on and al~tOval of the
agents, and non-o~apllance with the provisions of the o~ apldicatio~ may be ca~e
5. ~nac there wiH be no unteasomble interfef~ce w/th navigation as · ees~t of the wo~
he~dn an~odzed.
7. That if futme olmragom of the Town of 5outhold requite the removal md/~ slmt'a~om
In the location of the woflt hetdn nuds0tta~ or lf~ in the opinkm of the Bostd of T~ the
w0dt shall cause unreasonable o~tzuc~on to free navigasio~ t~e ~aii IN~tni~ee will be vequit~
upom doe no~_~, to remove o~ alter tt~ work o~ project herein stated without e~penses to the Town
8. TI'sas the said Board will bo. notified by the Petmlttee os ,ebe ~nlpl~i~n.of the wot'k
odzed.
9. That the Pex-mittee will ob~l,~ aH other pemgts and conses~a ~hag may bo requlved sup-
plemental to this permit wl, t~ may be subject to revoke upon fallu~ to
Albert J. Krupski, President
James I<Jng, Vice-President
Artie Foster
Ken Poliwoda
Peggs' A. Dickerson
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631j 765-1366
BOARD OF TOWN TRUSTEES
TOWN OFSOUTHOLD
February 16, 2005
Land Use Ecological Services, Inc.
P.O. Box 1060
Riverhead, NY 11901
RE: SKUNK LANE TRUST CIO BRAD & MARY KRAUSE
9105 SKUNK LANE, CUTCHOGUE
SCTM# 104o3-18.1
Dear Ms. Cantara:
The Board of Town Trustees took the following action during its regular meeting held on
Wednesday February 16, 2005 regarding the above matter:
WHEREAS Land Use Ecological Services as agent for SKUNK LANE TRUST C/0
BRAD & MARY KRAUSE applied to the Southold Town Trustees for a permit under the
provisions of Chapter 97 of the Southold Town Code, the Wetland Ordinance of the
Town of Southold, application dated January 25, 2005, 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 16, 2005 at which time all interested persons were given an
opportunity to be heard, and,
WHEREAS, the Board members have personally viewed and are familiar with the
premises in question and the surrounding area, and,
WHEREAS, the Board has considered all the testimony and documentation submitted
concerning this application, and,
WHEREAS, the structure complies with the standards set forth in Chapter 97 of the
Southold Town Code,
WHEREAS, the Board has determined that the project as proposed will not affect the
health, safety and general welfare of the people of the town,
RESOLVED, that the Board of Trustees approve the application of SKUNK LANE
TRUST C/0 BRAD & MARY KRAUSE to construct a single-family dwelling with deck,
sanitary system, and pervious driveway, with a non-disturbance, non fertilization buffer
from the 9' contour line seaward, a non-turf area from the 9'contour line to the deck,
gutters and drywells to contain roof runoff, and a 4' path to the dock and all as depicted
on the plan surveyed by Joseph Ingegno and last dated February 17, 2005.
Permit to construct and complete project will expire two years from the date the permit
is signed. Fees must be paid, if applicable, and permit issued within six months of the
date of this notification.
Inspections are required at a fee of $50.00 per ~nspection. (See attached schedule.)
This is not a determination from any other agency.
Fees:S100.00
Very truly yours,
Albert J. Krupski, Jr.
President, Board of Trustees
AJK/hct
LandUse
February 28, 2005
Town of Southold
Board of Toxin Trustees
?O Box I 179
Southold, NY 11971
RE:
Application for Permit
Skunk Lane Trust (Krause)--Cutchogue
SC'FM # 1000-104-03-18.1
Dear Sir or Madam:
Enclosed please find a check for the $100.00 permit fees for the above application. If
you have any questions or require further information, please contact this office. Thank
yOU.
Ecologist
Eric.
209 West Main Street, 2nd Floor · P.O. Box 1060 · Riverhead, New York · 11901
631-727-2400 · FAX 631-727-2605
Albert ? Krupski, President
James King, Vice-President
.~,t ie Foster
Ken *Poliwoda
Peggs' A. Dickerson
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631)
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Please be advised that your application dated ~n ~ ~, ~oo
reviewed by this Board at the regular meeting of ~ I ~, ;oo
following action was taken:
('~) Application Approved (see below)
( ) Application Denied (see below)
( )Application Tabled (see below)
has been
and the
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: ~a~-~ I~,~
§0
TOTAL FEES DUE: $ /00' O0
SIGNED:
PRESIDENT, BOARD OF TRUSTEES
Telephone
16311 765-1892
Towa Hall
53095 Route 25
P.O. Box l 179
Southold. New York 11971-0959
CONSERVATION ADVISORY COUNCIL
TOWN OF SOUTHOLD
At the meeting of the Southold Town Conservation Advisory Council held Mon.,
February 14, 2005, the following recommendation was made:
Moved by William Cook, seconded by Jack McGreevy, it was
RESOLVED to recommend to the Southold Town Board of Trustees DISAPPROVAL of
the Wetland Permit application of SKUNK LANE TRUST CIO BRAD & MARY
KRAUSE to construct a single-family dwelling with deck, sanitary system, and pervious
driveway.
Located: 9105 Skunk Lane, Cutchogue. SCTM#104-3-18.1
The CAC recommends Disapproval of the application until a plan for the disposition of
the trees ever 8" DBH is submitted (three (3) 24" DBH).
Vote of Council: Ayes: All
Motion Carried
Albert J. Kvupski, President
James t~ng, Vice-Pres/dent
Henry Smith
Attic Foster
Ken Poliwoda
Town Hall
53095 Rou~;e 25
P.O. Box 1'179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only
__~etltal Erosion Permit Application
and Permit Application . Adminiswative Permit
Amendmant]Trans fer/Extansion
__~¢ceiv~d Application:
~Receivcd Fce:$ ~ ~-Lh' '
~6mpleted ApplicaUon
__Incomplete
SEQRA Classification:
Type I Type II Unlisted
__Coordination:(dam sent)~
~'-AC Referral Sent: I
~>ate of Inspection: c~]
__Receipt of CAC Report:
Lead Agency Determination:__
Technical Review:
Ue ng u¢la:
Resolution:
7 % J
Name of Applicant Skunk Lane Trust cio Brad & Mary Krause
Address 12120 New Suffolk Avenue, Cutchogue, NY 11935
Phone Number:( )
Suffolk County Tax Map Number: 1000 - t04-03-16.1
Property Location: 9105 Skunk Lane, Cutehogue. NY 11935
(provide LILCO Pole #, distance to cross streets, and location)
AGENT: Land Use Ecological Services, Inc./Kelly Cantata
(If applicable)
Address: 209 West Main Street (2nd Floor), PO Box 1060, Riverhead, NY 11901
Phone: 631-727-2400
~oard of Trustees Applicatioe
GENERAL DATA
Land Area (in square feet): 69,600 s.f.
Area Zoning:. residential
Previous usc of property: vacant
Intended use of property: residential
Prior permits/approvals for site improvements:
Agency Date
(please see attached) 2004 (docks)
NYSDEC Permit #15271-0051 t974 (dredging)
__ 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):
Please refer to the attached project description.
Krause Dwelling (Skunk Lane Trust) Cutchogue
Project Description
Applicant proposes to construct a single family dwelling with deck, sanitary system and
pervious driveway. The dwelling will measure approximately 50' x 55' and the deck 25'
x 50', for a total impervious area coverage of 4,000 square feet (5.1%).
Previous Permits
Permits have been issued previously for construction ora recreational dock. Infom~ation
on these permits is below:
NYSDEC Permit #1-4738-03323/00001
Issued 8/26/2004
Modified 11/4/2004
Expires 8/26/2009
USACOE Permit #2003-01467-L2
Issued 12/14/2004
Expires 12/l 4/2007
N¥SDOS Coastal Consistency Certification F-2004-0017
$outhold Trustees Permit #5995
Issued 9/22/2004
Expires 9/22/2006
of Trustees Applicatio~
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: single family dwelling
Area of wetlands on lot: 31,000+/- 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 thc 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:
Proposed slope throughout the area of operations:
Manner in which material will be removed or deposited:
cubic yards
cubic yards
feet
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):
Proposed dwelling meets all setbacks for wetland protection. In addition, a
non-disturbance buffer area of 50' will be created for the protection of tidal wetlands.
PROJECT ID NUMBER
PART 1 - PROJECT INFORMATION
1. APPLICANT I SPONSOR
Land Use Ecological for Krause
3.PROJECT LOCATION:
Cutchogue (Southold)
Municipality
617.20
APPENDIX C
STATE ENVIRONMENTAL QUALITY REVIEW
SHORT ENVIRONMENTAL ASSESSMENT FORM
for UNLISTED ACTIONS Only
( To be completed by Applicant or Project Sponsor)
2. PROJECT NAME
Krause Dwelling--Cutchogue
Suffolk
County
4. PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc -or ;)rovide ma;)
9105 Skunk Lane, Cutchogue, NY 11935
SCTM # 1000-104-03-18.1
5.1S PROPOSED ACTION: [] New [~Expansion [~Modiflcation/alteration
SEQR
6. DESCRIBE PROJECT BRIEFLY:
Please refer to the attached project description.
7. AMOUNT OF LAND AFFECTED:
Initially 1.8+/- acres Ultimately 1,8+/- acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS?
[-~Yes [] No If no, describe briefly:
9. WHAT PS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose asmanyasapply.)
~----"]Residentia[ [~lndustdal r~Commercial [-'-]Agriculture [~Park/Forest/OpenSpace [~Other (descdhe)
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 name and permit I approval:
Town of Southold, Suffolk County Health Department
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ]Yes [~No If yes, list agency name and permit I approvak
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION?
I CERTIFY THAT THE iNFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
IApplicant ~/S//ponsor Name Kelly Cantara/Land Use Ecological Services, Inc. Date: January 20, 2005
If the action Is a Costal Area, and you are a state agency,
complete the Coastal Assessment Form before proceeding with this assessment
PART II - IMPACT ASSESSMENT (To be completed by Lead A~lenc¥)
A. DOES ACT ON EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.47 If yes, coordinate Ihe review prccess and use the FULL EAF.
r"-] Yes [~No
B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative
declaration may be superseded by another Jnvolved agency.
I--l es
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible)
C1. Existing air quatity, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal,
potential for erosion, drainage or f~o<:~rting problems? Explain bdefly:
C2. Aesthetic, agricultural, archaeciogical, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly:
C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain bdefly:
C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain b~iefly:
C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly:
C6. Long term, short term, cumulative, or other effects not identified in C1-C57 Explain briefly:
C7. Other impacts tincludin~l chanties in use of either quantit~ or t,/pe of energia'? Explain bdefl¥:
D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMI-'NT OF A CRITICAL
ENVIRONMENTAL AREA ICEAI? Ill ~/es, explain bpafl~/:
i--lYes r--]No [
E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If [/es exptain:
E~] Yes r~N° I
PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency)
INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, la,ge, important ~ otherwise significant. Each
effect should be assessed in connection with i~s (a) setting (i.e. urban or rural); (bi probability of occurring; (c) duration; (d) irmversibility; (e)
geographic scope; and (fi magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain
sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked
yes, the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA.
Chec~ this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULl
FAF and/or prepare a positive declaration.
Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed actior
WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi!
determination.
Name of Lead Agency
Date
Title of Responsible Officer
Print or Type Name of Responsible Officer in Lead Agency
Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer)
of Trustees Applicatio~
County of Suffolk
State of New York
Kelly Cantara (Land Use Ecological Services, Inc.) 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 MANNER 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 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 1NSPECT THE
PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION.
~'~ii~amre
SWORN TO BEFORE ME THIS DAY OF ,rb~./~¢ b2( ,20
PROOF OF MAILING OF NOTICE
ATTACH CERTIFIED MAIL RECEIPTS
Name: Address:
Donald & Ellen Ball, 142 Darrow Lane, Greenlawn, NY 11740
Peter & Patricia Larson, 21 Hunt Road, Brookville, NY 11545
Krause Family Trust c/o Brad & Mary Krause, 12120 New Suffolk Avenue, Cutchogue, NY 11935
STATE OF NEW YORK
COUNTY OF SUFFOLK
Kelly Gantara , residing at 22 Hirsch Avenue, Coram, NY 11727
, being duly sworn, deposes and says that on the
4th day of February ,20 05, 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 Riverhead
~(registered)mail.
Sworn to before me this
Day of ~:~//z~ ~3, 20~
, that said Notices were mailed to each of said persons by
CYNTHIA ALVAREZ
NOTARY PUBLIC, STATE OF NEWYORK
No. 01AL6080878
..._-QUALIFIED IN SUFFOLK COUNTY
,ar UOMMISS/0N EXPIRES SEF[ 23,
NOTICE TO ADJACENT PROPERTY OWNER
BOARD OF TRUSTEES, TOWN OF SOUTHOLD
In the matter of applicant:
Skunk Lane Trust cio Brad & Mary Krause
YOU ARE HEREBY GIVEN NOTICE:
1.
SCTM# 1000-104-3-18.1
That it is the intention of the undersigned to request a Permit from the Board of Trustees
to:
Construct a single family dwelling with attached deck and sanitary system.
That the property which is the subject of Environmental Review is located adjacent to
your property and is described as follows:
9105 Skunk Lane, Cutchogue, NY 11935
That the project which is subject to Environmental Review under Chapters 32, 37, and/or
97 of the Town Code is open to public conunent on: Fobmary 16, 2005 . 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: Skunk Lane Trust c/o Brad & Mary Krause
MAIL1NG ADDRESS: 12120 New Suffolk Avenue, Cutcho9, ue, NY 11935
PHONE #:
Enc: Copy of sketch or plan showing proposal for your convenience.
Albert J. Krupski, President
James King, Vice-President
Artie Foster
Ken Poliwoda
PeggS' A. Dickerson
Town Hall
53095 Raute 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
, residing at _ ~ ~ ~-~\ ~' 8c~
being duly swum, depose and say:
That on thet~ day of ~O~o ,20(~, I personally posted the property known as
by placing the Board of Trustees official poster where it can easily be seen, and that I have
checked to be sure the poster has remained in place for eight days prior to the dat.e of the public
hearing. Date of hearing noted thereon to be
Dated:
Swum tp-before me this
~fi~tblic /
YNTHIA ALVAREZ l
NOTARY PUBUC, STATE OF NEWARK
No. 01ALB0808Z8
_QUALIFIED iN SUFFOI.J( OOUN~ _/I
COMMISSION EXPIRES SEF'[ 23. ~..~
~oard of Trustees Applicati9
Cutchogue, NY 11935
AUTHORIZATION
(where the applicant is not the owner)
Skunk Lane Trust c/o
~2120 New Suffolk Ave.,
Brad & Mary Krause residing at
(print owner of property) (mailing address)
do hereby authorize
Land Use Ecological Services
(Agent)
to apply for permit(s) from. the
Southold Board of Town Trustees on my behalf.
(Owner' s signature~--
8