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Home My WebLink AboutTR-5834 '--. 'a'.. .. . .'.. . It .. . a .. .. . . . . '"a' " I. . '. ._.----!-.~~~~__..!_.~~~~_~.. TERMS IInd CONDITIONS 1'é~-è the Permittee Amp.li::t Mp"hnn.,.~ 38015 Main Road, Orient, ~" ~~u put of the coosideraâOll for the ¡...··nre of me Permit does uødemaod and prescribe to the fol- lðwiog: 1. That the said Boud of Trustees and !he Town of Soo·choId are ftIeased ~ aar and aU damages. or cWms for damages, of IIUks ariIiøc d/recdr « iDdirecd1 as a result of ..., 01*' adoa perfocmed puauaat to chis pamit, and !he laid p... nJ_ wI1I, at his or her own up t-. defead U11 and aU ouch saits -¡.,ItI.-ed by ch/rd 1>an/e$, and me said... 1'1' e ..__ fuUl/ah/Uq w/ch reSpect thereto, to the eompfete ._...L... of me Baud of T_ of me TOWIi. of ~ Z. That chis Peøait is·...net for a period of 24 mas. wbIc:b is ~ to be cbe esdmatcd åme· required to coiDpIete cbe work /nvolYeCl, butihoald ~....... waaaør, øqaest for U1 exœasI.on _y be made to cbe Boud at a IaIu dale. 3. '!bat chis Permit should be Rtaioed indefinitely, or u loag as che said l?u.mluee wishes to . Ð".;....;n the structUre or project involved, to provide evidence to anyoae œoœmed chit aach- orizatiOQ was originally obtaioed. 4. That me wodc/nvolved will be subject toche i~ and appronl of me Board or lis &pits, and ooø.-oomplW>ce w/ch. the prOYisioas of me ong¡-6", appliøtloa. may be couse for revocadOft of chis Pamit by resolution of che said Board. 5. That !here will be no unre&$OOIble /orerfercace w/ch aa~ u a result of the wodt . . "-/0 aåchorized. 6. '!bat there sbaU be DO /nterfereace w/ch tbe right of the pab/Jc to pus and repus aloag the bead1 between bIgb and 1_ _let' marks. . 7. 1bat if future openåoas of !he Town of 5outb9td require me remoYal and/or aIteradoøs in che Jocat/oa of !he work herein aacharired, Or if, in !he opIøioo of me Boud of 1iusœes, cbe. work sbaU cause unmo.....oble obsttucÞOn to free aaYigadoo, !he said P-nI_ will be nc¡uhed. apoo due DOIÍœ, to remove or alter chis work or project "-/0 statcd ~ ~.... to cbe Town of Soulbold. . . 8. '!bat the said Board will be nodfIecI by the p..nn;c- at che (oØl(ht!<Oo: Of me work aach- orbed. 9. That the Permittee will obtain aU other permits and coaseots diet may be nqu/red lOp- pletoeotal to chis permit wbIch may be subjeer to revoke upon failure to obtala -. .- .... .. .. I.....,. " .. .. '.",. .. .. .. .. .. .. .. '.'''.. .. " .. " .. .. .... .. .. .. .. ..... . . .., .. .. " .. " .. ,a.. \Io .. .. .' . . Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson \ Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 785-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD November 24, 2003 Mr. Bruce Anderson Suffolk Environmental Consulting, Inc. PO Box 2003 Bridgehampton, NY 11932 RE: SCTM#I5-02-I5.1 AMELIA MENDOZA 38015 Main Road Orient, NY Dear Mr Anderson: The Board of Town Trustees took the following action during a Regular Meeting, held on November 19th 2003 regarding the above matter. WHEREAS, Suffolk Environmental Consulting, Inc.. on behalf of Amelia Mendoza applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated October 29,2003 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 November 19'\ 2003 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, . 2 . 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 Approved the Wetland Permit for AMELIA MENDOZA to re-vegetate 4,900 sq. feet of disturbed area within the seaward edge of limit of clearing and disturbance and the landward edge of top of bluff, with Rosa rugosa (2 gallon pots). 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. Fee must be paid, if applicable and permit issued within six months of the date of this notification_ If inspections are required, at a fee of$5.00 per inspection (See attached schedule). FEES: None Very truly yours, blH·j r¡. ~.(}- Albert J. Krupski, Je. President, Board of Trustees AJK/cjc cc: DEC . . Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTH OLD COASTAL EROSION MANAGEMENT PERMIT Pennit Number: 5834 Date: November 24, 2003 Name of Applicant/Agent: Suffolk Environmental Consulting, Inc. Name ofPennittee: Amelia Mendoza Address ofPennittee: 38015 Main Road Orient, NY Description of Activity: to re-vegetate 4,900 sq. feet of disturbed area within the seaward edge ofIimit of clearing and disturbance and the landward edge of top of bluff with Rosa rugosa (2 gallon pots). . Date of Penn it Issuance: November 19th, 2003 This pennit is valid for a period oftwo years trom the dates of issuance. SPECIAL CONDITIONS: _Bluff restoration through a re-vegetation agreement is a necessary special condition of this pennit. _A relocation agreement is attached hereto and is a necessary special condition to this pennit. _A maintenance agreement as attached with application and is a necessary special condition of this pennit. ~'1 0 d:Í i.. 11- Albert J. KTu'ps ., r: .,t/ - r . President, Board of Trustees AJK:cjc . . . . Telephone (631)765-1892 Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD At the meeting of the Southold Town Conservation Advisory Council held Monday, November 17, 2003, the following recommendation was made: Moved by William Cook, seconded by Don Wilder, it was RESOL VED to recommend to the South old Town Board of Trustees DISAPPROVAL of the Wetland Permit application of AMELIA MENDOZA to re-vegetate 4,900 sq. ft. of disturbed area within the seaward edge of limit of clearing and disturbance and the landward edge of the top of bluff, with Rosa Rugosa, (2 gallon pots). Located: 38015 Main Rd., Orient. SCTM#15-2-15.1 The CAC recommends Disapproval of the application because the area should be restored to the original condition. Vote of Council: Ayes: All Motion Carried . . . Suffolk Environmental Consulting, Inc, Newman Village. Main Street, P.O. Box 2003, Bridgehampton. New York 11932-2003 (631) 537-5160 Fax: (631) 537-5198 Bruce Anderson. M.5., Pre,ident October 23, 2003 Mr. Albert J. Krupski, President Town Hall 53095 Main Road P,O. Box 1179 Southold, NY 11971 ~EO: ~91 :,~~ j Re: Situate: MENDOZA property 38015 Main Road Orient; Town of Southold, NY 1000-015-02-015.1 SIIIIIeId Town Ioan/ " TI1tS,"" SCTM # Dear Mr. Krupski, As you know, this Firm represents Mr. and Mrs. Mendoza, owners ofthe above referenced property, who have recently received a Notice of Violation concerning the clearing of vegetation within 100,0' of the wetlands located thereon. In order to resolve this situation, re-vegetation of this area with native plantings is proposed. Accordingly, approval rrom your Department is required. Enclosed herewith please find a completed Wetland Permit Application. Application contents are as follows: (I) Town of South old Trustees Wetlands Permit Application; (2) Short Environmental Assessment Form; (3) Location Map of subject property (two [2) copies); (4) Proposed Planting Plan concerning this matter, prepared by Creative Environmental Design, dated October, 2003, indicating (two [2] copies); and (5) Check made payable to the Town of South old in order to cover the requisite application fee. By way of this correspondence, and on behalf of Mr. and Mrs. Mendoza, I request that you commence review of this application and issue the requested approval. Should you have any questions or require additional information, please feel rree to contact this office at any time. Thank you in advance for your cooperation. .~ Hammarth/ s;~ Matt D. [vans enc. cc: N. Mendoza D. Cichanowicz \ -q 2 ~JE (f; Ie I WI [E rn~: U-~l ocr 1 9 2DOJ ~ Southold Town Board of Trustees . NOTICE . ... . . ' Police Dept. - Bay Constable Town of Southold . Peconic, New York 11958 NOTICE OF VIOLATION Date: (¡ctûber ~) _;jl)~ To; ¡,;,,'.ïi.d '=ichcinowic~ (Owner or authorized agent of owner) Address: .\~~¡tíU ~{!.: ~:~}, [It;:Cvh-lC) ~¡.1. li9~-\S:: (Address of owner or authorized agent of owner) Please take notice there exists a violation of the Code of the Town of Southold, Chapter 97 Article II, Section 97-20 a premises hereinafter described in that IUU art.: c~:'a(I'_,;':';:_L'_J¡: IC.·~:""I :_.,' '....·Lt~~i;~ 1;)(\ [L'e~ (-~: ,-' ·""t'tL..hli.L, ·;.·J..t~H:..U·-_ first o~~L~i.,"L;~.;:: j. (:'U.,l.-;I :.}...rr.1~ t. You are therefore directed and ordered to comply with the following: Cc;,',Cc;, L: ,ur"he, :-!~_:c L. ".:"" ,·:~t.;-~ilì tnu 1ètè't 'Jf ~-7¡...;tl~u:Ú3. Ap~¡li r,.1Y .1 T.L·li~~,,-·~ ':er.~j~Lt ~n~ ~~·:_'rk.: r.."Lr',itdv .Jc~~".:. on or before the 5 ! day of ('otnL'er , 20~. The premises to which this Notice of Violation refers are situated at: 'š:-)<\i5 :-1.~j.;-. ;'0.:1(:, 01-.i.i~;lt. ;.:.Y.. llY57 Town of South old, Suffolk County, NY (Suffolk County Tax Map Designation: Dist. 1000 Section: l c Block: '.,:. Lot: i 'i. I ) Failure to comply with the applicable provisions of the law may constitute an offense punishable by fine or imprisonment or both. NOTICE: You have the right to apply for a hearing before the Board of Trustees of the Town of Southold, provided that you file a written request with the Clerk of the Trustees within 10 days after service of the Notice of Violation. Such request shall have annexed thereto a copy of the Notice of Violation upon which a Hearing is requested and shaH set forth the reasons why such notice of viola- tion should be modified or rescinded, ., ¡<'..J-.::t: 1'). f'-") < ~~ Ba1Constable, TO:wn of South~, NY . . . . - - --- - - -- ---------- --- --- -- -A·2036 Town of Southord Suffolk County, NY The People 01 the Slate 01 New York ¥s. lAST NAME (DEFENDANT) FIRST NAMf CIUlI\t.1(\AI~%.. 1:)",,/1 h SUlEET ADORESS 3CH'-O ~.. t\N~c:.. MIDOLE II.¡ITIAL APT. NO. " COY flT STATE ., 1/951'. T1if oPEAATOA OR FtEGIS~ED ONNER OF VEHICLE DESCRIBED BELOW PLATE NO. DATE EXPIRES STATE """'- ON.Y. CJN,J. OH.Y o N.J. 0 -- 0'''' o COMM 0 ""''''-'MAKE 0 OOOGE 0 "'OK 0 CHEV 0 """u..o.c 0 """'AC 0 FORO 0 0lDS 0 f'I.'" 0 TOYOrA 0 'OU<$ 0 001" 0 2I)R 0 'DR 0 B\JS 0 Mev 0 s.w. - 0 TRUCK 0 "'""LEA 0 W.N 0 ''/IN NUMBER """"''''"'''"'"' '7't:..- q?-33 A Sf'EeO\NO MPH IN A """" ."..,.., MPI-IZONE MISDEM~ 0 FACTUAL PART (NOT FOR TVB¡ ¿ THE A80VE NAMED DEF£ND.ANT DID ON :::J¡TAT&( DATE, ilME AND PLACE &o;A..~ ~O"C!:Lrt' ITl-hN IOð Fr 0 . I.-ù.,... Co WI'rHrZl....,- ..~U~T"£E..~ FE1P}\""" Artl.!.u~ TO '1, - 2~ - nwF~.bMedDl'l~~..........¡ llM-.rceÞ81.....trw~IWOtT\~JoI ...... PAR1<lNG SCHEDULED FINE S CONTACT COURT 0 ONI THE PeRSON DUCRIBED A80YE" SUMMONED TO APPEAR AT SOUTHOlD TOWN dusnœ COURT. 53011 ROUTE 21. 8OUTHOI.D, NY 11811 ~"'''-.,''~''''' I ",,"0 117'1 ðc.~~kIL 31~.3 . AT 9:30 -- FA1..8£ STATEMEHfS ¡.£I'IEIN ARE PUNSHABl.E AS " Cl.ASS A IIILSOEUEANOA I'V'ISUANf TO SECTION 210.45 OF T1-IE P kN.V.S. COMPlAINANT ~ ~IDA"'/ohl.s "ß, I") <. .....,... £ 1'1.-" COURT COpy ~c. '. Albert J. Krupski, preside~t James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson December 17, 2003 . . Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD w t..-t\o."C\ .JCO- Cft-tot - ¡DO doJ.btl-l>IO~h .tr I'GI\, Cðro. $ / Mr. Bruce Anderson Suffolk Environmental Consulting, Inc. PO Box 2003 Bridgehampton, NY 11939 Dear Mr. Anderson: Re: Amelia Mendoza 38015 Main Road Orient, NY SCTM#15-2-15.1 Please be advised that there is a balance owing of $300.00 on the above noted matter. Since there was a violation involved it means that the pennit fee is doubled. We received payment in the amount of $300. on October 29'h, 2003 but the charges would be $600. We infonned you by telephone on October 29th, 2003 that the fee would be doubled. rfyou require any additional infonnation, please do not hesitate to contact this office. Sincerely, ~~iªam Clerk Board of Trustees Fax #631-537-5198 CJC ~ .O~~_" ~\\O' ').I{1v Field Inspection 11111 --- . . . Albert J. Krupski, President John Holzapfel, Vice President Jim King Martin H. Garrell Peter Wenczel Town Hall 53095 Main Road P. O. Box 1\79 Southold, New York 1\97\ Telephone (63\) 765-\892 Fax(63\) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD n _ L:-~ ¡)µ-~ J ¥ ,;' I¡~ / Office Use only x Coastal Erosion Permit Application Wetland Permit Application Grandfather Permit Application Waiver/Amendment/~haQges Recei ved Applica ion: I 0 I~ 10 b Received Fee: $ . Completed Application ,~ Incomplete SEQRA Classification: Type I Type II Unlisted Coordination: (date sent) CAC Referral Sent: I''), - ," ?,2 Date of Inspection: II I'¡ . i, ., Receipt of CAC Report: Lead Agency Determination: Technical Review: Public Hearing Held: II II q ~0 , Resolution: OCT _ Southol Tow" 'oard of rlJste~'~ Name of Applicant:Ame1ia Mendoza Address 99 Jane Street, Apt 7F, New York, NY 10014 Phone Number(212) 784-9608 Suffolk County Tax Map Number: 1000-15-02-15.1 Property Location: 38015 Main Road, Orient, NY 11957 ~ provide LILCO Pole #, distance to cross streets, and locatiOn)~ AGCN', SuU01k "vi~ta1 Conøu.1t1nQ. ,=. ~~-, ,~"J' Address: P.O. Box 2003; Bridqehampton, NY 11932 ~~~' 'hono N=boo, (631) 537-S160 .~, 1631) 537-5198 ~~~~ . . Board of Trustees Application GENERAL DATA Land Area(in square feet): 1,162,605.00 square feet (VE) Area Zoning: A - C Previous use of property: Private sinq1e family dwellinq with related appurtenances. Intended use of property: Private sinqle family dwellinq with related appurtenances. Prior permits/approvals for site improvements: Agency Date IE ~ W lE .!~ 1:/1/ ocr 2 9 200J l.!:U Town of Southold Trustees Auqust 5, 2002 NYS Dept. of Env. Conservation July 19, 2002 Southo'" Tr:\\'fl R.. ... 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: Prolect Description (use attachments if necessary) Applicant proposes to re-vegetate 4, 900 square feet of disturbed area within the seaward edge of limit of clearing and disturbance and the landward edg'e oftop of bluff, with Rosa rugosa (2 gallon pots). 2 . . Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Applicant proposes to re-vee:etate 4. 900 square feet of disturbed area within the seaward ede:e of limit of clearinQ and disturbance and the landward ede:e of top of bluff. with Rosa rUl!osa (2 e:allon pots).: Area of wetlands on lot: 13.200 ± squ u '=,~: :03~ ~ Percent coverage of lot: 1.14% ± 9- o and upland Seutlløld Town Board of Trustees and upland Closest distance between nearest existing stru edge of wetlands: 170.0 feet Closest distance between nearest proposed structure edge of wetlands: N/A feet Does the project involve excavation or filling: x No Yes If yes, how much material will be excavated? N/A cubic yards How much material will be filled? N/A ± cubic yards Depth of which material will be removed/deposited: N/A ± feet Proposed slope throughout the area of operations: N/A ± Manner in which material will be removed or deposited: N/A 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) : No impact to the wetlands are anticipated by the re-vegetation of native plant species within this area. All efforts will be maximized in order to mitigate this pro;ect_ The resulting condition will be more beneficial than the existing condition. 3 . . Board of Trustees Application COASTAL EROSION APPLICATION DATA Purpose of Proposed Activity: D~lC[E~~( A licant ro oses to re-ve etate 4 900 s uare feet of distu tbe seaward ed e of limit of clearin and disturbance and tb of top of bluff. witb Rosa TUllosa (2 eallon pots). OCT 2 area witbin n Board of lrllsteë=: Are wetlands present within 75 feet of the proposed activity? No X Yes If Yes, how much material will be excavated? ~(cubic yards) How much material will be filled? 0.0 (cubic yards) Manner in which material will be removed or deposited: N/A Describe the nature and extent of the environmental impacts reasonably anticipated resulting from the implementation of the project as proposed. (Use attachments if necessary) No adverse impacts to the area are anticipated by the re-veqetation of native pJ.ant species within this area. AJ.J. efforts wiJ.J. be maximized in order to mitiqate this project. The resuJ.tinq environmentaJ. conditions wiJ.J. be more beneficiaJ. than the existinq environmentaJ. conditions. 4 l¡: nì·n L-J r "--1' :1 I , ;¡ ..::; . . NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: Amelia Mendoza SCTM# 1000-015-02-015.1 YOU ARE HEREBY GIVEN NOTICE: 1. That is the intention of the undersigned to request a Permit from the Board of Trustees to: Applicant proposes to re-vee:etate 4. 900 square feet of disturbed area within the seaward ede:e of limit of clearina and disturbance and the landward ede:e oftoD of bluff. with Rosa rU1!osa (2 e:allon pots), 2. That the property which Review is located adjacent follows: is the subject of Environmental to your property and is described as 38015 Main Road, Orient, NY 11957 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: Amelia Mendoza 99 Jane St., Apt 7F, New York, NY 10014 PHONE # : (212 ) 784-9608 Ene.: Copy of sketch or plan showing proposal for your convenience. 5 . . PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: ~ æ O~T ~ 91 : æ ~ PLEASE REFER TO THE ATTACHED ADD UM Soull1old Town Board of Trustees STATE OF NEW YORK COUNTY OF NEW YORK I, Diane Wassick, residing at Suffolk Environmental Consultinq, Inc.; Newman Villaqe; Main Street; Bridqehampton, NY, being duly sworn deposes and says that on the 8th day of October ,2002, 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 their 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 Bridgehampton, that said Notices were mailed to each of said persons by (certified) (registered) mail. ,^(;~. ~ I( -~~.£. ..!.1Tt( Sworn to before me this day of Qq. , 2003 ../ 1_ / mtf?J' . ///,/ ~---- /. Notary Public ( Mattl1ew D. Ivans Notary PubliC of New York No. 011V6053859 Qualified in Suffolk County Commission Expires January 22, 200 7 6 11 '19-'03 "ED 15,24 FAX 6317651366 f Southold Town Accountlns_ ~001 -- Albert J. Krup,ki, PreBident James King, VLce·President Artie F[)3ter Ken Poliwoda Peggy A. Dickerson . Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765.1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES, TOWN OF SOUTHOLD __________9____________________________________________________ In the/latter of the Application ~~~~~~~--..~~~~.... STATE OF NEW YORK) AFFIDA VIr OF POSTIN9 1,2:,<"£ j ¡/~~-' . residing at AkWM/J,J V:<-<.Aa:.- ßf1Œt1L1..-<'\m'-.J ;(1 ~ b g duly sworn, depose and say' That 0 the/ð'"day of ~t"42003, I pcrsonallyposted the property known as - OZA ___ by placing the Board of Trustees official poster where it can easily be seen., and thai I bave checked to be Sure tbe poster has remained in place for Igbt days prior 10 the date of the public hearing. Date of hearing noted thereon to be held VIÕ ((¡Jo3 . Dated:;ti. If ZOJ;, ( Sworn to be~re me this /f"'dayof Nav. 200> NO'Þ ~ y Matthew D. mnl Notary Public of New VolII No. 011V6053859 Ou~lified in Suffolk County Commission Expires January 22. 2rtJ7 . . to the MENDOZA Board of Town Trustees Application NAME ADDENDUM ADJACENT PROPERTY OWNERS MAILING ADDRESS Timothy G. Hallock P.O. Box 521; Peconic, NY 11958 William S. Faltin, Jr. 307 Lynn Ave.; E. Northport, NY 11731 James S. Duffe & Patricia Dolan 851 Annette Dr.; Wantagh, NY 11793 Pelly's Bight Association, Inc. P.O. Box 339; Orient, NY 11957 Barbara Kern Francis A. & Dorothy A. Carr Daisy E. Gill Bruce Dinuzzo Richard J. Tamaro, Jr. Vera BanDon Walter P. & Rose T. Camier Dennis & Susan Long Elinor Spohn John & Constance Albano Dorothy K. Austin Diane Johnson Carlton Latham Martin J. Bancroft, Jr. Aryeh Spero o..nald L. Wojnar Stephen A. Kelemao Daniel L. Fischer ~ott L. Harris Peter B. Nathanson Daniel & Linda Mannix Henry W. Burden Roger M. Tabor William R. Fagan Jenny Georgiou Ralph & Julia Vanacore Joseph G. Farrell, Jr. Gwyneth M. Ketterer Mary Ellen Long James K. Whittaker 86 Ripplewater Ave.; Massapequa, NY 11758 53 Boulevard Ave.; Greenlawn, NY 11740 1830 Greenway E.; Orient, NY 11957 2000 Greeoway K; Orient, NY 11957 101 Hollyhock Rd.; Levittowo, NY 11756 2230 Greenway E.; Orient, NY 11957 P.O. Box 91; Orient, NY 11957 P.O. Box 924; Millerton, NY 12546 420 Greenway E.; Orient, NY 11957 448 Broadway; Massapequa Park, NY 11762 P.O. Box 423; Orient, NY 11957 P.O. Box 103; Orient, NY 11957 P.O. Box 608; Orient, NY 11957 38099 Main Rd.; Orient, NY 11957 1 CorDelia Ave.; Great Neck, NY 11024 15 Amber Ct.; East lslip, NY 11730 P.O. Box 575; Orient, NY 11957 38785 Main Rd.; Orieot, NY 11957 37800 Main Rd.; Orient, NY 11957 P.O. Box 190; Orient, NY 11957 38100 Main Rd.; Orient, NY 11957 212 Cascade Ln.; Palm Beach Shores, FL 33404 P.O. Box 44; Orieot, NY 11957 77 Dover Pkwy.; Garden City, NY 11530 22 Pen Mell Dr.; Bethe~ CT 06801 1885 Plum Island Ln.; Orient, NY 11957 P.O. Box 14; Bridgehampton, NY 11932 652 Hudson St.; New York, NY 10014 265 Ryder Farm Lo.; Orient, NY 11957 169 Beckwith Hill Dr.; Salem, CT 06420 SCTM # 1000-015-02-021 1000-015-02-0 I 0 1000-015-02-009 1000-015-02-008 & 1000-015-01-006 1000-015-02-007 & 1000-015-02-014 1000-015-02-006 1000-015-02-005 1000-015-02-004 1000-015-02-003 1000-015-02-002 1000-015-02-00 I 1000-015-02-020 1000-015-02-019 1000-015-02-013 1000-015-02-012 1000-015-02-011 1000-015-02-015.6 & 1000-020-03-007.1 1000-015-02-016 1000-015-02-018 1000-015-08-031.4 1000-015-02-017.4 1000-015-08-001.1 1000-020-03-009.1 1000-020-03-009.2 1000-020-03-009.3 1000-020-03-014 1000-015-05-006 1000-015-05-005 1000-015-05-004 1000-015-05-003 1000-015-03-034 1000-015-03-002 & 1000-015-03-001.1 1000-015-08-002 1000-015-08-003 . Board of Trustees Application County of Suffolk State of New York . Bruce A. Anderson BEING DULY SWORN DEPOSES AND RMS 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 REPRESENTATIVE(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF TH S APPLICATION. SWORN BEFORE ME THIS 217""f //~ 1f1/Jt6Z----------- &tary Public DAY OF OCT. Matthew D. Ivans Notary Public of New Vor1c No. 011V6053859 Qualified in Suffolk County Commission Expires January 22, 2(1:>7 7 2003 . . , , ' OWNER'S ENDORSEMENT (TO BE SIGNED IF APPLICANT IS NOT OWNER) STATE OF NEW YORK) COUNTY OF SUFFOLK) SS: AMELIA MENDOZA, being duly sworn, deposes and says; I reside at 48 Palace Gardens Terrace: London. Ene:land In the County of , and the state of , and I am the (owner in fee) (officer of the Corporation which is owner in fee) of the premises described in the foregoing application and that J have authorized Suffolk Environmental Consultinl!. lue. to make the foregoing application as described herein. ~ . 0b f ./-b?J / _/ .I'ï_ ·--Signature f Signature If Corporation, name of corporation and Officers Title Officer's Title Before me, this ~ day of L1 ----Apri J , 2002 GttiA-------.~~ Notary Public PATRICIA RICHARDS Notary Public, State of New York No. 01 RI6042467 Qualified in Suffolk County Commis810n Expires May 30, 2002 . . 14-16-4 (9/95)-Text 12 L:ROJECT I.D. NUMBER 617.20 I Appendix C _~ S1ate Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only SEQR PART 1- PROJECT INFORMATION (To be comoleted bv Appliænt or Proiect sponsor) I. APPLICANT/SPONSOR 2. PROJECT NAME Suffolk Environmental Consultin2, Inc. Mendoza 3. PROJECT LOCATION: Municipality Southold County Suffolk 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc. or provide map) 38015 Main Road, Orient. NY 5. IS PROPOSED ACTION: 1:81 New D Expansion D Modificationla~eration 6. DESCRIBE PROJECT BRIEFLY: Applicant proposes to «-vegetate 4, 900 square feet of disturbed area witbin Ibe seaward edge of limit of clearing and disturbance and tbe landward edge oftop of bluff, witb Rosa rugosa (2 gallon pots). 7. AMOUNT OF LAND EFFECTED: In~ially < O.5acres U~imately < O.5acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? 1:81 Yes D No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? I:8IResidential D Industrial DCommercial DAgricu~ure D ParklFcrest/Open space DOther Describe: Private sinele fumily dwelling with related aODurtenances, 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENT AGENCY (FEDERAL, STATE OR LOCAL)? Dyes I:8INo If yes, list agency(s) and pennit/approvals tl. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? DYes 1:81 No If yes, list agency(s) and permit/approvals t2. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? Dyes 1:81 No I CERTIFY THAT THE INFORMATION PROVIDED IS TRUE TO THE BEST OF MY KNOWLEDGE ApplicanVsponsor name: Matt Mvans - Suffolk Environmental Consultin~. Inc. Date: 10/23/03 Lb/Ý/" Signature: ,., ---- II ~þ" ------- If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Fonn before proceeding with this assessment OVER 1 . . MENDOZA Property Situate: 38015 Main Road; Orient, NY SCTM #: 1000-015-02-015,1 SITE ,.'·0/· \ ," '\ \ t;~",s" ~~\ 1Ì1I~ . 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