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Home My WebLink AboutTR-4857JEAN W. COCHRAN SUPERVISOR OFFICE OF THE SUPERVISOR TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1889 To: Town Trustees & Planning Department From: dean VK. Cochran, Southold Town Supervisor Re: Neumann property - Mattituck Creek area Date: February 24, 1999 Please respond to the attached letter of Gerard A. Neumann, Esq. concerning property on Mattituck Creek that is owned by his family. /md enc.: survey 4. The Town's "cluster housinG" policy has led to out-of- character development on East Mill Road and Grand Avenue. The homes built there, while well maintained, are in marked contrast to other homes in the area. We received no notice regarding this development. Our property, which you seek to preserve, has been surrounded by town-approved expansions that have had just the opposite effect. It appears that the only way to offset our loss is to apply for rezoning to commercial use. We hereby demand notice of any additional applications for expansion of the marina or any other neighboring businesses and properties. We welcome your comments and evaluation. Sincerely yours, '~Gerard A. Neumann, Esq. cc. Kirk Guyton John Hallinan, James King Matituck Inlet Marina JEAN W. COCHRAN SUPERVISOR Town Hall, 53095 Main Road P.O. Box 1179 Southold, NewYork 11971 Fax (~16) 765-1823 Telephone (516) 765-1889 OFFICE OF THE SUPERVISOR TOWN OF SOUTHOLD February 23, 1999 Gerard A. Neumann, Esq. 13 Dater Lane Saddle River, NJ 07458 Re: Neumann property - Mattituck, NY Dear Mr. Neumann: I would like to thank you for your letter of February 16, 1999, bringing the concerns of your family's property along Mattituck Creek to my attention. A copy of your letter requesting future notification has been forwarded to the Town Trustees and Planning Department for their comments. If you should need to contact me on this or any other matter, please do not hesitate to call. Very truly yours, Supervisor /md cc: Town Trustees Planning Dept. New York State Department of Environmental ConservationJ~ J~ ~. ~ Building 40--SUNY, Stony Brook, New York 11794 (516) 751-7900 NOTICE OF INTENT TO MODIFY PERMIT January 10, 1989 Thomas C. Jorllng Commissioner CERTIFIED MAIL RETURN RECEIPT REQUESTED Mattituck Inlet Marina Dell Boacola, Jr., Pres. Mill Road Mattituck, N. Y. 11952 Re: Permit No. 10-85-0893 Maintenance Dredging Dear Mr. Boacola: The above referenced permit was issued by this Department on 2/11/86 based on information submitted by En-Consultants. An appli- cation submittal by En-Consultants on 7/13/88 proposes an expansion to the marina on the above referenced site. A field inspection was conducted on 8/25/88. At this time the Department determined that actual field conditions were substantially different than what was shown on the originally submitted plans (En- Consultants revised 9/9/85). A review of those plans and recently sub- micted surveys reveals the following: (i) Plan by Eh-Consultants 9,/9/85 (latest revision) indicates dredge area to be 1600 feet in length extending south from the northern property line. However, in comparison to the Young and Young survey of 5/16/85 which shows that the permittee's property extends only 1150 feet south from the northerly property line. (2) Plan by Eh-Consultants 9/9/85 (latest revision) shows the entire length to be dredged as marina water area but does not indicate an intertidal marsh and high marsh area which begins 900 feet south of the northern property line. (3) Survey of Young and Young dated 11/4/87 shows docks a maximum length of 160 feet (southern most dock), whereas plan by En-Consultants of 9/9/85 shows dock length of 210 feet; all other docks on En-Consultants plan vary from 45 feet to 105 feet greater in length than Young and Young survey. Telephone (516) 765-1801 Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York {.1971 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Advisory Conservation Council held Tuesday, February 16, 1999 the following recommendation was made: MATTITUCK 1NLET MARINA 106-6-13.3 to relocate existing southern float assembly 80' +/- to south and install new 6'X 20' ramp for access float, remove existing 30' float on southerly side and attach to south side of existing float assembly to north, install an additional 30' to west end of said float and install 10'X 310' of floating docks and a 20'X 20' float. Amendment to Permit #4857. West Mill Road, Mattituck The CAC did not make an inspection, therefore, it has no comment. J.M.O, Environmental Consulting Services February 9, 1999 Mr. Albert J. Krupski, President Board of Town Trustees Town of Southold 53095 Main Road, P.O. Box 1179 Southold, N.Y. 11971-1179 RE: Permit Id No. 4857 Mattituck Inlet Marina and Shipyard, II1C. Dear Mr. Krupski: AL the present time, we are respectfully requesting a modification to allow for the "Relocation of existing southern float assembly +_~80' to south and install new 6'x 20' ramp for accessing float, remove existing 30' floats on southern side of assembly and attach to south side of existing float assembly to the north. Install an additional 30' float to the west end of this float. To install .! 10'x +_310' of float docks and a 20'x 20' float." The purpose of this modification is so that the relocated float assembly will allow boats to access the travel lift so that they may be hauled in for repairs. new 310' of float is to store and work on boats. The I have enclosed copies of the plan and section for your review and files. Please contact our office if you have any questions regarding this project. GEJ:arh MO~ sincerely, Phone (516) 653-0607 · Fax (516) 653-3348 121 Jessup Ave · 2nd Floor · F:O. Box 447 Quogue, NewYork 11959-0447 PROJECT DESCRIPTION FOR MATTITUCK INLET MARINA AND SHIPY~tD Applicant proposes to relocate existing southern flo~t assembly A 80' to south and install new 6'x 20' ramp for accessing float, remove existing 30' floats on southern side of assembly and attach to south side of existing float assembly to the north. Install an additional 30' float to the west end of this float. To install £t0' x !310' of float docks and a 20'x 20' float. Albert J. Krupski, President James K/ng, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Main Road P.O. Bex 1179 Southold, New York 11971 Telephone (516) 765-18~2 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF $OUTHOLD January 22, 1999 John Hallinan Mattituck Inlet Marina P.O. Box 1408 Mattituck NY 11952 RE: SCTM #106-6-13.3 Dear Mr. Hallinan, The following action was taken at the Southold Town Board of Trustees meeting on January 22, 1999: RESOLVED, that the Southold Town Board of Trustees grant the request for an Amendment to Permit #4857 to reconstruct within 18" 200+' of bulkhead and backfill with 100 c.y. of clean sand trucked in from upland source. However, this does not constitute approval from any other agencies. If you have any questions, please call our office at 765-]L892. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK/djh cc. ACE DEC Telephone (516) 765-1801 Town Hall. 53095 Main Road P.O. Box 1179 8outhold, New York 11971 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Tuesday, January 19, 1999 the following recommendation was made: Moved by Bret Hedges, seconded by Richard Smith, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL of the Amendment Request of lVlATTITUCK INLET MARINA 106-6-13.3 to amend Permit #4857 to reconstruct within 18" 200+' of bulkhead and backfill structure with 100 c.y. of clean sand trucked in from upland source. West Mill Rd.. Mattituck Vote of Council: Ayes: All Motion Carried New York State Departmer~f Environmental Conservation Division of Environmental Permitsw LI {;I Z Igg I!5::! Building 40 - SUNY Stony Brook, New York 11790-2356 Telephone (516) ~.~.4-0365 Facsimile (516) ~.~?.-0360 AMENDMENT TO PERMIT Date: Sept.22, 1998 John P. Cahill Commissioner Mr. John Hallinam, Pres. Mattituck Inlet Marina &'Shipyard, Mill Road Mattituck, NY 11952 Dear Mr. Hallinam: Re: Inc. 1-4738-01843/00001 Mattituck Creek Your request to extend the above permit has been reviewed pursuant to 6NYCRR, Part 621. The expiration date is extended to Not ApPlicable X Your recent request to modify the above permit has been reviewed pursuant to 6NYCRR, Part 621. It has been determined that the proposed modifications will not substantially change the scope of the permitted actions or the existing permit conditions. Therefore, the permit is amended to construct approximately 114' of vinyl shear bulkhead with in 18" of existing bulkhead face and place approx. 100 cubic yards of clean upland sand as backfill. All work shall be in accordance with the attached NYSDEC stamped approved plans, dated Sept.18, 1998 as drawn by JMO Environmental Consulting Services. This letter is an amendment to the original permit and, as such, shall be available at the job site whenever authorized work is in progress. Ail other terms and conditions remain as written in the original ]permit. Very truly yours, Charles T. Hamilton Deputy Permit Administrator cc: B~MP · .¥~X 6#¢LAM P LENGTH BULKHEA SC OF 16' SHOREGLIA._~3 P~,S'flC... SHEATHIN6 · ' PROE AN UPLAND 50URCE BACKFILL z ,J O, 6~'M~U L' 0 I FoOO EXPRESS MAIL December 9, 1998 Mr. James King Southold Town Trustees 53095 Main Road, P.O. Box Southold, N.Y. 11971-1179 1179 RE: Mattituck Inlet Marina and Shipyard, West Mill Road, Mattituck Dear Mr. King: At the current time, we are seeking to modify this permit. The requested modification is to allow for the reconstruction within 18" of an additional~200' of bulkhead utilizing vinyl sheathing and to backfill structure with +i. 100 c.y. of clean sand to be trucked in from an upland source. For the Board's review, we've enclosed revised plans as well as recent photographs of the site. As always, should you have any comments or questions regarding this project, please contact our office as soon as possible. GEd:arh lennSt sinceg~ely, Phone (516) 653-0607 · Fax {5. 16) 653-3348 121 Jessup Ave · 2nd Floor · RO, Box 447 Quogue, NewYork 1195%0447 1"-2' ~'X~'CLAMP LENGTH OF 16' sHOREGUAI~) P~TIC, SHEATH~N6 PROP. AH W.$5.5~ LW 0 .~ o = . ,~,~ ._ ! ! J.M.O. £nvironmental Oonsultir Ouogue, New York Services Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Main Road P.O. Bc.x 1179 Southold, New York 11971 Telephone (5 [6) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD August 27, 1998 John Hallinan Mattituck Inlet Marina & Shipyard West Mill Road Mattituck NY 11952 RE: SCTM #1.06~-13.~ ..... Dear Mr. Hallinan, The following action was taken at the Southold Town Board of Trustees meeting on August 26, 1998: RESOLVED, that the Southold Town Board of Trustees approve the request for an Amendment to Permit #4857 to extend the bulkhead replacement approx. 106' further to the south 18" or in front of existing deteriorated bulkhead, and to build an 8' return connecting to existing bulkhead. However, this does not constitute approval from any other agencies. If you have any questions, please call our office at 765-1892. Sincerely, Albert J. Krupskt, Jr. President, Board of Trustees AJK/djh cc. Bldg. Dept. Telephone (516) 765-1801 Town Hall. 53(}95 Main Road P.O. Boz 1179 Southold, New York 11971 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL The following recommendation was made at the meeting of the Southold Town Conservation Advisory Council held August 24, 1998: A-lit2 Moved by Bret Hedges, seconded by Scott Hilary, it was RESOLVED to recommend to the $outhold Town Board of Trustees APPROVAL of the Amendment to Permit request of MATTITUCK INLET MARINA F, SHIPYARD 106-6-13.3 to extend the bulkhead replacement approximately 106' further to the south 18" +/- in front of existing deteriorated bulkhead; and build and 8' return connecting to existing bulkhead. End of West Mill Road, west side of Mattituck Creek. Vote of Council: Ayes: All Motion Carried Board Of $outhold Town Trustees SOUTHOLD, NEW YORK PERMIT NO. ~ ~ ~ 7 DATE: ..Jan. 28, 1998 ISSUED TO...JOHN. HA~.~H~+.I~/MATTITUCK INLET .MAi~INA Aulhorizalion Pursuent to the provisions of Chapter 615 of the Lews of the State of New York, 1893t and Chapter 40~ of the Laws of the State of New York 1952: and the Southold Town Ordinance en- titled "REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS:" end in accordence with the Resolution of The Board adopted et a meetincj held on Jan. Z8, .1998 19 98 , end in consideretion of the sum of $.150..00 peld by John Hall~han ~Qr MA~TITUCK INLET MARINA of . .. Ma~tltuck ........... N. Y. and subject to the Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the followincj: Wetland Permit to replace within 18" 94' of new bulkhead, exist, travel lift slip 7', replace exist, west & south sides of list with 48' of new blkhd, install dry well catch basin in apron,,&, a 2' wide pe~io, Bs ~f~r, on r%9.rt,h. & south sid, es, 9f ~:~ a. ,n accoraancew,tn me aera,~ea specmcat,on$ as presentea ,n ~'l"z~), the orig;natincj appl;cation, and maintenance dredge in travel slip area to 4' )~C~l~.h}s WHEREOF, The said Board of Trustees hera- by causes its Corporate Seal to be affixed, end +hese presen+s to be subscribed by · meiorlfy of the said Board as of +his da+s. Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1882 Fax (516) 765-1823 January 28, 1998 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD John Hallihan Mattituck Inlet Marina & Shipyard West Mill Road Mattituck NY 11952 Re: 106-6-13.3 Dear Mr. Hallihan, The following action was taken by the Board of Town Trustees during its Regular Meeting held on January 28, 1998, regarding the above matter: WHEREAS, MATTITUCK INLET MARINA & SHIPYARD, applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated January 12, 1998 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 January 28, 1998, 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 standard set forth in Chapter 97-18 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 approves the application of MATTITUCK INLET MARINA & SHIPYARD to replace within 18" 94' of new bulkhead, widen existing travel lift slip 7', replace existing west and south sides of travel lift with 48' of new bulkhead, install dry well catch basin in haul-out apron and a 2' wide pervious buffer on north and south sides of travel lift slip, and maintenance dredge in travel slip area to 4' below MLW. 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 e~ire 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/djn cc. DEC ACE Dept. of State Telephone (516) 765-1801 Tow~ H~II. ~309~ Ma~n Road P.O. Box 1179 So~thold, New Yo~k 11971 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL The following recommendation was made at the meeting of the Southold Town Conservation Advisory Council held Monday, January 26, 1998: No. 1527 Moved by Bret Hedges, seconded by Mary Griffin, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL of the Wetland Permit application of MATTITIJCK INLET MARINA & SHIPYARD 106-6-13.3 to replace within 18", 9~ feet of new bulkhead; widen existing travel llft 7 feet; replace existing west and south side of travel lift sllp with ~8' of new bulkhead; install dry well catch basin in haul out apron and a 2' wide pervious buffer on north and south side of travel llft slip. West Mill Road, Mattituck Vote of Council: Ayes: All Motion Carried STEEL BLDF-. lOX 310 FLOAT TOWN OF F -r om, SHEET ,",..~ ,' J.M.O. Environmental Consulting Services Quogue, New York 30F 3 0 u~ n Z .2) -Z c STEEL y BLDG. PROR lOX 310 FLOAT FE~ TOWN SHEET 3 OF 3 ,ti J.M,C). Environmental Consulting Services ~. '! Ouogue, New York Albert J. Krupski, President John Hohapfel, Vice President Jim King Martin H. Garrell Peter Wenczel Town I-{all 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 Office Use Only ~wOaStal Erosion Permit Application etland Permit Application Grandfather Permit Application ~'~e Waiver/Amendment/Changer ~-~ved Application: / omeived Fee:$ pleted Application Incomplete SEQRA Classification: Type I__.T!rpe II Unlisted__ Coordination:(date sent) ~___CAC Referral Sent:~ ~--'~te of Inspection~ Receipt of CAC Report: Lead Agency Determination: Technical Review: ~--'~ublic Hearing Held: Resolution: N~ne of AN I 2 1998 Applicant Address ~).~. ~'~,,~' ,d ~D~ Phone Number: Suffolk County Tax Map Number: 1000 - Property Location: ~ d~ ~ (provide LILCO Pole g, distance to cross streets, aM location) % (If applic~le) Address: Phone: Oard of Trustees Applicati~ Land Area (Ln square Area Zoning: GENERAL DATA feet): Previous use of property: Intended use of property: 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): ~rd of Trustees Applicati~ Purpose of the proposed operations: 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 wil~ 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 cubic yards cubic yards 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): PART I--PROJECT INFORMATION Wo 517.21 Appendix C Slate Environmental QuaJity Review SHORT ENVIRONMENTAL ASSESSMFNT FORM For UNLISTED ACTIONS Only De comoletec by Ao01icant Dr Projec: .~oonsor) SE :KS I--' MO if 'Jo. :escrloe =riedy ~ ~es~denl;al ['--:,'n~ustrlal '~.~ Commercial DOES ANY ASPECT OF THE ACTIOH HAVE A CURRENTLY VALIO Pc_RMIT OR APPROVAL? the ac:~on is in :he Coastal Area, sr, d you are e s~ate a~ency, complete Coast-~l .A$sessmen*. Form before proceeoin~ ',vltn ::'I~$ as~s, essmen~ OVER ASSESSMENT ~To ;e ,;om:i~!eo o',' a~eq PART III--OETERMINATION OF SIGNIFICANCE (To ;e c=moleted by Agency) INSTRUCTIONS; For eac,n adverse effect iclent~fied a~'ove, de[ermine whet[tar ~t is sucs~antJal, large, important or otherwise sign[fid Encn .~tfec: should de assessed in connection vwtll its (al setting (La. urban dr rural); (PI probacilit¥ of occ~'r'J.qg; (el duration irreversll~Hity; (el geograomc ~c~boe; and (0 magnitude. If necessar*/, add ~ttachment$ or reference supporzln(~ rnater~als. Ensure exDlana[icns C, on~aJrl sufficient oetail Id snow Ilia[ ~11 relevant &Overse ~mpacts nave dean identified and adequa[eiy addressed. ChecX this uo× if you have identified one or more dotendady large or sJgnifican[ Adverse imoacts whicR MA' occur. Then 2roceed direcdy to (~e FULL 8AF an~lor prepare a pos~tJv¢ declaration. ,bhecK ;his ~cx ~f you ~sve de~ermineQ, based on the information and analysis &bore and any suBoortJn~ ,:ocumen~uon. :hat :Me ¢ro¢osed action WILL ~4OT resul[ ~n~ny s~gmficant adverse environmen[al Jmpac:: NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEESr TOWN OF SOUTHOLD In the matter of applicant: SCTM%1000- YOU ARE ~W~LE~Y GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: 2. That the property which is the subject of Environmental Review is located adjacent to yo%Lr property and is described as follows: /~/~/~_ ~/~6 t~ ~/;r/~[;~Dr~/~ C~6~7~ 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. MAILING ADDP. ESS: ~,~WrrtTx/C~..,~',~ /t~--& ,. PHONE ~: ~.~ Enc.: Copy of sketch or plan showing proposal for your convenience. ~ard of Trustees Applicati County of Suffolk State of New York BEING DULY SWORN DEPOSES. AND AFFIRMS THAT HE/SHE IS THE A~PLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STAT~NTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HERKNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPRO~m 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 INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. .~S'ig~n~~~ SWORN TO BEFORE ME THIS DAY OF J//~/~/~/£~ Notary Public Qualified in Suffolk County 7 · Name: PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Address: ~66~- Ipdv '00~ ~u,~o.:J Scl STATE OF NEW YORK COUNTY OF SUFFOLK that on uhe IS day of , residing at'ILL ~4~ · being duly sworn~ deposes and says J~9 ,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 $outhold; that said Notices were mailed at the United States PoSt office at£ou~t0.f, ~,~u¢l~ ~, that said Notice~ were mailed to each of said persons by (certified) (registered~ Sworn to before me this day of ~A.~ .19 49 Notary~ Public Notary Public State of New York No. 01ES5076852 Qualified in Suffolk County y Commission Expires May 05, 1999 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: STATE OF NEW YORK COUNTY OF SUFFOLK JQha ~.~[L~ , residing at ~,Ld ~ R~+/~w¢;c ~V J~"~' , b~ing duly sworn~ deposes and says that on the I~ day of J~ ,19 ~g , deponent mailed a true copy of ~e Notice set forth in the ~-~rd 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~ou¢~.¢ /w~,~¢~/ , that said Notices were mailed to each of said persons by (certified) (registered~~ mail. ~~/ ~~ /~. ~ Sworn to before me this lh day of JAsper% ,19 ~9 NoEary~ Public Nota~' Public - State of New York 'No. 01ES5076852 Qualified in Suffolk County y Commission Expires May 05, 1999 The Town of Southold's Code of Ethios prohibits c0n[licts o[ interest on the parL of town officers and employees, Tile purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. (Last name, first name, midd.i~ initial, uniess' you are applyinG in the name of someone else or other entity, such as a company. I~ au, indicate the other person's or company's name.) NATURE OF APPbXCATION~ (Check all thai'apply,) Tax grievaace Variance change of zone ~pp~val of plat Exemption from plat or official map .. . other (If "other," name the activity.) -~O~T~· UJ,~TL~D ~I~ Do you pereonall~ (or through ~onr ~nmpeny~ ~po~ee~ e~bll~, parent, or child) have a relationship with any officer or ~mploy~e of time Town of Soubhold? 'R~latlonehip" lnelndes by blood, marriage, or business interest. 'Business interest" monna a bunineee~ ineludin~ a partnership, in which the to=n officer or employee has even a pattie! ownership of (or employment by) a corporation in ~hi~h NO If you answered "YES,".complete the balance o~ thin torn and date and axon where indicated. Name of person employed by the Town of So0thold Title or position of that per,on Describe the relationship between yourself (the spplleant) and the town officer or employee. Either che~k the appropriate line A) through D) and/or de~ertbe in the space provided. The town officer or employee or ht~ or her ~pouae, parent, or child is (check all that apply)~ --rA) the owner of greater tha~ 5% of the shares of the corporate stock of bite applicant (when the applicant· is a oorporation)~ B) the legal or b~ne~icial owner of any interest in a noncorporate'entity {when bite applicant is not a ~orporation)~ __.C) an officer, director, pa~tner, or employee o~ the applicant/ or __.O) the actual applicant. DESCRIPTION OF RELATIONSIItP