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Home My WebLink AboutTR-5095 . Board Of Southold Town Trustees SOUTH OLD, NEW YORK PERMIT NO. S09S DATE: Dec. 17, 1999 ISSUED TO . JOHN LARSEN J\utl1nrizutinu Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1893; and Chapter 404 of the laws of the State of New York 1952; and the South old Town Ordinance en- titled "REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and t.... REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;". and in accordance with the Resolution of The Board adopted at a meeting held on Dec. 15, 19 99, and in consideration of the sum of $ 150.00 paid by En-Consultants, Inc. for John Larsen ~ of ...... South"ld .... ... .... N. Y. and subject to the ~ Terms and Conditions listed on the reverse side hereof, Wetl RB~I!t%tlri Town Trustees authorizes and permits ~he following:. ' :>l a . t" fo construct a two-story , one-famIly dwellmg wIth ~ attached fIrst .& ~econd story decks; a per:ious driveway; sanitar~· system and dnnkmg water well, and establIsh & maintain two .. ~. non-dist./non-fert. buffers adjacent to freshwater wetlands. Fill creatäfi' i~rgg'co1t~'A¡¡~e e~i'H¡VittJ°c!l'et'fj¡IJdbspElèifrèafi'óh-s5W ~¡¡f(M'ift1ing . the oriainatinataDP':cation. Inaicatea on S1 f! plan. IN WITNESS WHEREOF, The said Board of Trustees I¥!re- by causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this dat.e. . . TERMS and CONDITIONS The Pecmittee John Larsen residing at pact of the lowing:· 9 Highland Ave., St. James N. y~ as consideratioll for the issuance of the Permit does under.;tand and prescribe to the fol· 1. That the said Board of Trustees and the Town of Southold are released from any and aU damages, or claims for damages, of suits arising directly or indirecdy as a result of any opec- atioll perfottned punuant to this permit, and the said Permittee will, at his or her own expense. defelld any and all such suits initiated by third parties, and the said Permittee assumea full liability "'ith respect thereto, to the romplete exclusion of the Board of Trustees of the Town of Southold 2. That this Permit is valid for a period of 24 mos. ",hich is consideœd to be the estimat'''! time required to complete the work involved, hut should årcumstaneeS wUtant, teqI1est for all extension may be made to the Board at a later date. .! 3. 11,.t this Permit should he retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that autha orization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board at its agents, and non-compliance with the provisions of the originating application, may be cause for revocation of this Permit by resolution of the said Board. 5. That there ",ill be no unreasonable interfereoee with navigation as a result of the work herein au·d1Orized. 6. That there shall be no interference with the right of the public to pass and repass along the be.ch between high and low water marks. 7. That if furuce operations of the Town of Southold tequire the removal and/or altuations In the location of the work herein authorized, or if, in the opiniOtl of the Board of Trusteet, the work shall cause unreasonable obstrucnon to free navigation, the said Petmlttee will be requifed, upon due notice, to remove or alter this work or project herein stated without expenses to the Town of Southotd. B. That the said Board will be notified by the Permittee 01 the completiOtl of the work auth. orized. 9. That the Permittee will obtaia all other þem1its and consents that may be required sup- plemental to this permit which may be subject to revoke upon fallure to obtain same. . ~.¿T:l':Z"<---;:>-: 'ý;J-~~UfFOl~ 'j.1'5:)',;.~ "'. ~(!~ ~\, ~ ~fj 'ð ~fj 4J:- ~V ~OJ . i-~~I ~ . 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) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD December 17, 1999 Mr. Robert Herrmann En-Consultants, Inc. 1329 North Sea Rd. Southampton, NY 11968 RE: ,JOHN LARSEN SCTM#59-5-23 Dear Mr. Henmann: The following action was taken by the Board of Town Trustees during its Regular Meeting held on Wednesday, December 15, 1999 regarding the above matter: WHEREAS, En-Consultants, Inc. on behalf of JOHN LARSEN applied to the Southold Trustees for a permit under the provisions of the Wetland Ordinance of the Town of South old, application dated November 26, 1999, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Coundl for their findings and recommendations, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on December 15, 1999, 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 suhmitted concerning this application, and, 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 approved the application of JOHN LARSEN to construct a two-story, one-family dwelling with attached first and second story decks; a pervious driveway; a sanita.'Y system; and a drinking water well; and establish and maintain two non-disturbance/non-fertilization buffers adjacent to freshwater wetlands, all as depicted on the site plan prepared by Joseph A. Ingegno, last revised October 22, 1999. Fill created from house excavation will be used on-site for regrading as indicated on site plan. BE nr FURTHER RESOLVED, that this determination should not be considered a determination made for any othe.· department or agency which may also have an appli,:ation 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, {ltL~ Ç7. /~~. fh· Albert J. Krupski, Jr. President, Board of Trustees AJK!lms cc: DEC Dept. of Health Building Dept. . . J'1gHre 1. ú)(ming mndlwest from ¡oemion ofpmptJ$ed house o~'('r .~IIIJJea J1IUœi and l&wllrd LIIK/! Drwe. L --- . . hOU$1! ød Ilt Figun 3. Looking mJrth flCl'(JS$ subþ!d Figure 4. £00!.1I1g solltlt flCrosS ,~ubjed . . Telephone (516) 765-18"\2. Town Hall. 53095 Main Road P.O. Box 1179 Southold. New York 11971 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL A meeting of the South old Town Conservation Advisory Council was held Monday, December 6, 1999. The following recommendations were made: Moved by Richard Smith, seconded by Abby Cochran, it was RESOLVED to recommend to the Southold Town Board of Trustees DISAPPROVAL of the Wetland Permit Application of JOHN LARSEN 59-5-23 to construct a two-story, one··family dwelling with attached first and second story decks; a pervious driveway; a sanitary system; and a drinking water well; and establish and maintain two non- disturbance Inon-fertilization buffers adjacent to freshwater wetlands. Fill created from house excavation will be used on-site for regrading. 175 Lake Dr., Southold The· CAC recommends Disapproval because the proposed construction is too close to both sets of wetlands which would have an adverse impact on the wetlands, as well as the site being an important part of an important ecological system. Vote of Council: Ayes: All Motion Carried . . ~ EN- CONSULTANTS, INC. 1329 North Sea Road Southampton. New York 11968 516-283-6360 Fax: 516-283-6136 E-mail: encon@peconic.net ENVIRONMENTAL SERVICES November 24, 1998 Town of South old Board of Trustees Post Office Box 1179 Southold, New York 11971 Attn.: Diane Herbert Re: John Larsen 175 Lake Drive, Southold SCTM # 1000-59-5-23 Dear Ms. Herbert: In regard to the above referenced property, enclosed are the following for the Board of Trustees review: 1. Three (3) Wetland Permit Applications, ( including Notice and Proof of Mailing to adjacent owners). 2. Three (3) Short Environmental Assessment Forms. 3. Three (3) copies ofauthorization & disclosure forms. 4. Three (3) copies of site plan/survey. 5. One (1) set of site photographs. 6. Application fee of$150.00. I trust this information shall allow you to process our permit request. Should any additional information be required, please do not hesitate to contact our office. Ro E. H nn Coasr.al Management Specialist Ikhs Enc. ¡qn ~ r ; 'Ii _!: II u , : ~J I, , IP'II ¡ -' I'; , . , ' ! ;: , ~ ~ f J i ; ~ j ~ ¡ i ~ I I I II I ." ~ . , II í i i' ,. I ¡III/I r r J ~ .1" , ;¡iii I' III ~ ~ ~ ~ : II! II ff~_ip~ I' ~l~ ¡; IIII'. HH~ ~~ ¡ I Î " Ili;1 ;!i~"~( ¡'HI' ,-,"' ~ ~ ~ ~ ::;; ~ 'iI:" 'Z :.. - ~.~ Q ¡d;~~ j:j 9...91' ¡¡\it" ..... .'ÍI , . e , = [~n ~~o ,0 c ..~-~ ~ ~It~-< ~1'e:'~ , ~ ~c ,,~ z< ~ _n'O ~r '§-;:><: ~8 ~.:~ ..,~>< ~"'¡ ' , ¡, ,+-;;;\~ ~ ~ ¡ ! ..-... I I ¡I " I Ei I "¡ ~e !~ ,, ; j I ¡I I I ~ë i / ¡:h V 1\" '~ I'l'l //"''''''- / ß / ~I/ "[ / / "/ ~, / / "/.~ '" / \~'t ~ ~j~ W e . ~,. ~<J¡, r ~'11~ ~ ''I---- ' i ~- // ~,i, l/ ~- // /" ~I.' C,.. ~ J /~/ ®/'- /" V' ~ ~'~ d~\\ ~ :~ \~~ r~\ ..~ (>~~ " .' ~ , . t: ~ . ,r~ '1$:)\,;.~"". §;i'~ ~";, ::" :...c:. ':, , Q ~ N ~: ~§ ~O. ~r, '" +..1. $:)~ o:r ,,! -~~# ,$ Albert J. Krupski, President John Hol;~apfel. Vice President JIm King Martin H. Garrell Peter Wenczel BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 0ffice Use Only COdstal Erosion Permit Application ~Wetland Permit Application Grandfather Permit Application ---waiver/Amendment/Changes Received Application: 1/- ;1.&, -po, Received Fee: $/. \" 0 Completed Application II~ ,;¿, - fp Incomplete -SEQRA Classification: 1;{pe I_Type II_Unlisted~ Coordination: (date sent) =CAC Referral sent:~ Da te of Inspection: -- -Receipt of CAC Report: _Lead Agency Determination: Technical Review: )ublic Hearing Held: 1J..-1'~-'9 ßesolution: ' Name of Applicant John Larsen 9 Hlghland Avenue Address St. James, NY 11780 . Town Hall 53095 Main Road P.O. Box 1179 Southold. New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 NOV 2 b 1999 IJ~ 0 NOV 2 6 1999 u. .J Phone Number: (516 ) 862-7532 Suffolk County Tax Map Number: 1000- 59-5-23 Property Location: 175 Lake Drive, Southold (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) En-Consultants, Inc. Address: 1329 North Sea Road Southampton, NY 11968 Phone: 283-6360 FAX#: 283-6136 1 ~ard of Trustees APPlicatitIÞ . GENERAL DATA Land Area (in square feet): 22,992.82 Area Zoning: R-40 Previous use of property: VtA.""::ant. Intended use of property: Residential 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 gove·rIUTlental agency? x No Yes If yes, provide explanation: Project Description (use attachments if necessary): SEE ATTACHED 2 . . PROJECT DESCRIPTION JOHN LARSEN 175 LAKE DRIVE SOUTHOLD,NY SCTM #1000-59-5-23 Construct a two-story, one-family dwelling with attached first and second story decks; a pervious driveway; a sanitary system; and a drinking water well; and establish and maintain two non- disturbance/non-fertilization buffers adjacent to freshwater wetlands, all as depicted on the site plan prepared by Joseph A. Ingegno, last revised 22 October 1999. Fill created from house excavation will be used on-site for regrading as indicated on site plan. 4Ihrd of Trustees APPlicati~ WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Improve vacant parcel with two-story, one-family dwelling. Area of wetlands on lot: t1360 square feet Per=ent coverage of lot: t5.9 .. o Closest distance between nearest existing structure and upland edge of wetlands: nla feet Closest distance between nearest proposed structure and upland edge of wetlands: 47 feet Does the project involve excavation or filling? No x Yes If yes, how much material will be excavated?t250 cubic yards How much material will be filled? nla cubic yards Depth of which material will be removed~~: t8' feet Proposed slope throughout the area of operations: nla Manner in which material will be removed or deposited: Excavated fill for house construction to be used on-site for regrading as indicated on site plan. Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): The footprint of the proposed house meets the minimum allowable living area requirement of Chapter 100 of the Town Code, and the ~'elopment ot the parcel wlll include the establishment and maintenance of two non-disturbance/non-fertilization buffers, pursuant to the recommendatlons of the NYS DEC Bureau of Environmental Protection. As proposed, the lot improvement will note cause any slgnltlcant adverse lmpacts to the subject wetlands or 'rown waters ~ 3 DROJECT I.D "'lUMBER , . I . 14-16-4 (2/87)-Text 12 61 7.21 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I-PROJECT INFORMATION (To be completed by Applicant or Project sponsor) SEQR , APPLICANT ISPONSORJOHN LARSEN BY I 2. PROJECT NAME EN-CONSULTANTS. INe. 3. PROJECT LOCATION. Municipnlity SOUTHOLD County SUFFOLK 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks. etc., or provide map) 175 LAKE DRIVE, SOUTHOLD, NY; SCTM #1000-59-5-23; MAP PROYIDED 5. IS PROPOSED ACTION: ~New D Expansion D Modification/alteration 6 DESCRIBE PROJECT BRIEFLY: SEE A IT ACHED 7. AMOUNT OF LAND AFFECTED: Initially 0.528 acres Ultimately 0.528 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ~Ves D No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? g ResidentIal D Industrial D Commercial D Agriculture D Park/Forest/Open space o Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING. NOW OR UL TIMATEL Y FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL. STATE OR. LOCAL)? ~V"s DNO If yes, list agency(s) and permit/approvals DEC, SCDH 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? DVes g No If yes, list agency name and permiUapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? Dves ~NO I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE APPI;c.nvspon~' JBERT E. HERRMANN Date: NOY. 24, 1999 S;gnature, / ()!; ì [ If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment nVFR . . NOTICE TO Þ~JACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of John Larsen SCTM*1000-59-5-23 YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: SEE ATTACHED 2. That the property which is the subject Environmental Review ~s located adjacent to your property and is described as follows: 175 Lake Drive, Southo1d 3. That the property which is subject to Environmental Review under Chapters 32,37,or 97 of the Town Code is open to public comment. You may contact the Trustees Office at 765-1892 or in writing. Open for public: December IS, 1999 The above referenced proposal is under review of the Board of Trustees of the Town of Southald and dose not reference any other adjacent that might have to review same proposal. OWNERS NAME: John Larsen (Contract Vendee) MAILING ADDRESS: 9 Hiqhland Avenue St. James, NY 11780 PHONE *: 516-862-7532 Enc.:: Copy of sketch or plan showing proposal far your convenience. . f.G-~'_:'-'-:';':¿;~- /~ c¡,I1HOL.t ;:~ '..'."'!. ~." <.~'~.. ;: .:§ ~ I;~ ,I;'::;' ~r:, .; Q 4 ~ :.j cI) ~ ,~ '~ "Õ -., ~ i! ,. ",. - '- ' ';'~ ~'" ,\ ""-0",-'0./ + ~~"{).yr ~"':<....,""T.cc.::;...,p-. . 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) 765-18f2 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD ----------------------------------- In the Matter of the Application of _~~t\_~~~_________________ COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I,__~ .~ ,rQ¡¡PIÌ~3:at 6- ~ul~~ (\\AL.) -~ ~ ~I ~.)'>\~ being duly sworn, depose and say: Tha.t on theØ" day of "þ6C. , 1991, I -R,ersona].ly posted the property known as 175 LAlt6 j¿(4\IE) '":x:>unIùLi~ 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 ~e ~grQ\)ñ1-ng. .(~¡..te of hearing noted thereon to be held J.)OI'.,S,ICJqCJ "" Il.uum. Dat:ed: SW01íll to be~re me this ¡A1vday of ..l)fCP~!x. 1997 c~~~~f,~~y~ '--No.a y Public . f"'''"'''~ KI~,111. STEPHENS ..--.. Not2'Y Pubiio-Slato of New York I'''~ ....,'\ C~"'rTi;ssiQn No. 6015931 ) . Suffalk ) . :' OJ ;.~~~ . . PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: Gerald Cruise 30 Barston Road, Apt. IF Great Neck, NY 11021 Mario DiSanto 1919 West 8th Street Brooklyn, NY 11223 STATE OF NEW YORK COUNTY OF SUFFOLK doing business En-Consultants, Inc. Robert E. Herrmann ,xJt""'",,,RJ""'Ç" at 1329 North Sea Road SOU1:hampton, NY , being duly sworn, deposes and says that on the 24th day of November ,19 99 , 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 addrE~sses 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 Southampton , that said Notices were mailed to each of said· persons by (cer ied) (~ð~~~~ð~ð~) mail. Sworn to before me this day of _ /Ic.ì ," - -L bc' ,19 , , ,9- 'I -/--J..... 'tq Robert E. Herrmann ~ ~~lhé / ~,/o ~.¿. Notary Public' '--... Kill H. STEPHENS @) Notary Publlc·State of New VIIIII C~mrr:is:i:Jn No. 60159J1 Qu¡!¡:;ed 1.1 0:1f'011l: Coun ~ie!l Cc~m:~sjon Emirss t.;,;.;i.1c.l 2, J)J., 6 . r;I.., .:, ,.'\~..l. Z 218 040 033 us Postal Service Receipt for Certified Mail No Insurance Coverage Provided. 00 not use for Intemational Mai! See reverse n to /" -}-r' ,;L{ ./.:;( ("[ l~f ' JC Slreet&>o¡jnbel ~ I " :fL) DGr<:,~-ir') !1>r:{/' ~.i?-I. f oS(,Office. Slat!, ~ liP COde ^ /y . Lr··,--- /V.-(~ '.. l/dcJ/ Postage $ '>~\ ( ,( J Certified Fee Special Delivery Fee 1.;>- .:: $ '3Y0 ¡[ 4,1 ~ 0'",--. Z 218 040 032 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse 'j"f1!l7Iù bl &µjtN'uT't!;.)~ if-h [+2,-,. I 'n~ce. Stale. & lIP CCX(r . 'Ct)/< /, ''-' 1/ d ·¿.3 Postage $ !PI Certrfied Fee I lfJ SpeCIal Delivery Fee \ ?-() . ¥ 38arè 8f Tr~stees Application . . County of Suffolk StatE: of New York :I61,-f^-.) DEPOSES AND AFFIRMS THAT HEI 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 WORKio1ILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. TP.E APPLI CANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ;'.P.ISING UNDER OR BY 'TIRTUE OF SAID PERMIT ( S), IF GRANT"'...D. IN CD:1PLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT ( S) OR REPRESENTATIVES ( S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PRü·ITSES IN CONJUNCTION WITH REVI OF THIS APPLICATION. F 1-AXSf:þ.._! BEING DULY SWORN S·,.;C?N TO 3E:?C?..E :1E 7¿:S F 1..01."',.-.1.... .'...932- II (;'~nJ¡.l ~..lU,M~JÎ";.::' ~: ;:~·j;¡:.'V '~J, ".'I.'! :--~ :.: ,. ',~ ,. : Oi: u.: ~;:.':- ';:":'~~, '.~".._.:~ l.~. '-,j' '·';:.;¡<·Iol'l\ ;:.'t~ ........ * 1IJrd of Trus~ees APPlicatìIÞ AUTHORIZATION I. _ ------ _Jü j-ilV r-=. Lrl7¿SJ¿N tpr~nt owner of property) residing atq 1--IICo,Jf¿NAJ) KV£ (mailing address) I 01.-S- (~ ......,""s. L-- /V.I. I 17C{;v do hereby authorize EAJ ~~~;,~c. , (Agent) to apply for perrnit(s) from the Sou,::hold Board of Town Trustees on my behalf. /-----------. ( ',,-- (, 'I ~:J- c s~gnature) ......... . . To Whom it May Concem: I, Elizabeth O. Lawther am the owner of property located at 175 Lake Drive, Southold, SCTM#10000-59-5-23. I hereby authorize John La,sen as contract veudee and En-Consultant, Inc. as his agent to apply for all necessary permits trom the Southold Town Board of Trustees. I hereby authorize the Trustees, their agents or representatives, to enter onto my property to inspect the premises in conjunction with review of his applications. ~~Si!lrer~ . . AUTHORIZA nON I, ELIZABETH O. LAWTHER (print owner of property) , of 142 Freeman Avenue. (mailing address) !slip. New York do hereby authorize EN Consultants. Inc. (Agent) to apply for permits(s) rrom the Southold Board of Town Trustees on behalf of JACK LARSEN, as contract vendee with respect to property I own identified as SCTM #1000-59-5-23. ::tfnh-<:07 & ~11~ t (Owner's sIgnature) .....-,--¡-.., ...w- i , New York State Department of Environmental Conservation Notice of Complete Application ~ -... ~ Date JANUARY 31, 2000 JOHN LARSEN 9 HIGHLAND AVE SAINT JAMES NY 11780 1-4738-02501/00001 1 . ARTICLE 24: FRESHWATER WETLANDS in SOUTHOLD in SUFFOLK COUNTY. ApP'icant ApplicatIOn ID Permir(s} Applied Proje.:::t IS located Project Descnption The applicant proposes the construction of a 2 story single family dwelling with decks. pervious driveway and septic system at 175 Lake Drive in Southold. The propsed septic system will be located approx. 75 linear teet from NYSDEC regulated Freshwater Wetland SO-5. SCTM 1000-59-5-23. State Environmental Quality R9iliew (SEOR) Determination SEQR - 1 Project is not subject to SEQR because it is a Type II action. SEQR Lead Agency None Designated State Historic Preservation Act (SHPA) Determination SHPA - 0 The proposed activity is not subject to review in accordance with SHPA. The permit type is exempt or the activity is being reviewed in accordance with federal historic preservation mgulations. Availab.ility For Public Comment Comments on this project must be submitted in writing to the Contact Person no later than 02/25/00. Contact Person SUSAN ACKERMAN, NYSDEC SUNY @ STONY BROOK BUILDING 40 STONY BROOK NY 11790-2356 'B' (631) 444-0365 rO' [:D-;œ ® Œ 0 'L[,m lot FEB 2 -~Jj \ SUPERIIISO'1S 0,' CI~E --I(~\_·~:,-,('F SOUTHOl:} . ... . . l\I'rLtcANT TRANSACTtONAL DISCLOSURIt FOIIH The Town of Sout;hold's Code of El;hics prohibil;s conflicl;s of int;erest on t;he par\; of town officers and employees. The ~pose of t;his fDrm is t;o provide informat;ion which can alert t;he town of possible confllct;s of Int;erest; and allow It t;o take what;ever act;lon Is necessary 1;0 avoid same. YOUR NAHEI ,.-,--. , l-A7<S~/u JCiHN F. (Last; name, llrst name, middle Initial, unless you Are applying In the name of someone else or other entity, such as a company. If so, indicate t;he ot;her person's or company's name.) NATURE 01" ArPLICATI0N. (Check: all t;hat; apply.) Tax grievance Varhmce Change Of zone ^p.p'L"val of plat Exemption from plat or official map Other ""'--1 '':;> , . (If "other," name the act;ivity.) 12~ IL-J)<eJ(y- p'¡~ rL Iv, .~ Va you personally (or through .youc co..pany, "pouRe, ..ibllng, pacent, or child) have a relationship with any officer or employee of the Town of Soul:hold? wnølatlonehlpw Includes by blood, marriage, oc buRine.... intere..t. -nuøineøø Interest- means a business, including a partnership, in which the town officer or employee has even a partial ovnerøhlp of (or employment by) a corporation In vhlch I:he I:ovn officer or elllployee ovnn lIIore I:han 5% of I:he shares. YES ',- NO~ tf you answered ·YES,· completel:he balance of I:his form and dal:e and Bign where indicated. flame of person employed by the Town of Southold Title or position of that person Describe the relal:lonshlp between yourself (the applicant) and the town officer or employee. Either check the appropriate line h) through D) and/or describe In the space provided. The town officer or employee or his or her spouse, sibling, parent, or child Is (check: all that apply). h' the owner of greater than 5% of the shares of the corporate stacIe of the applicant (when the applicant Is a corporation), 8) lone legal or beneficial owner of any Interest in a noncorporate'entlty (when the applicant is not a corpora ti on) I c) an officer, dir@ctor, par~~er, c: ~mpljfes of ~ha applicant I or D) the actual applicant, DESCRIPTION OF RELhTIONSJ/IP 1:) SUbmltted~~ d_ay ~(~E-C 199'G signature' r. ~- ,_, ~~___ '--~ _1 ' ^/ ~- £1 <7 Print name ~,-. /'-J \ ' L~"Té-S.ErV --~ Ii -~ ---------- ~ .' LAK£;~--__ ---------_________~, ~~ . "". .; D l?!VE; ----- OF.....t.: ---- ._ .o"'1T. .:$ IV , 7':tf¡:o . ~9.(J5.o E: .... .............. ~I\t, "-. " z ~! ' ft . '/ ~, ; 'I .., , ~ I ~ ... c::r: , ~ ~ '\ B ~ ¡¡ ;;! i " . '- ~ ~ d . , " " , '" , '- <'-... '\, \ ",j ~' f/ ,oß . f. f.. ~"'~ ~ ~~"'t~ :,p,,~ ~\~ \~ " ~"'~\() /' :.~4o~... () -- ". 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