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HomeMy WebLinkAboutTR-6176 Board Of SoutholdTown Trustees SOUTH OLD, NEW YORK PERMIT NO. (01 tJ to DATE: .A.lJgust ISSUED TO ...... GEORGE & ~~RY PAVLICIN ..... ..................... .. ................................ l\ut11oriuttiott Pursuant to the provisions of Chapter 615 of the Laws of the State of New Yor~, 1893; and Chapter 404 of the Laws of the State of New Yor~ 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.f-i-OM LANDS UNDER TOWN WATERS{'. and in accordance with the Resolution of The Board adopted at II meeting held on A:lJg.,..34..,..... 2005 d . ·d t· f th f $ 250 00 'd b ...... .., an '" conSI era Ion 0 e sum 0 . '...'" '... pal y . ... .... ..G"OE¡;" & Ha,r:y'..pa"Ucin .. .......... .....uu........... of .......... ~ree.[l.l'0rt ... N. Y. IInd subject to the Terms and Conditions listed on the reverse side hereof, of Southold Town T rurlees lIuthoriles and permits the following: Wetland Permit for the existing beach stairs, as depicted on the survey prepared by R. VanTuyl P.C. dated July 7, 1978. all in accordance with the detailed specifications as presented in . the originating application. IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Cor¡>orat,: S~al to be a~xed, and these p~esents to be subscn"bed by a majority of the said Board as of this dat.e, ~~~'~~~ (~ PO~iWO~~~ - . m Trwsim TERMS end CONDITIONS ne I'etmitUc George & Mary Pavlicin ~diøg at 2500 Sound Dr., Greenport ". N. Y.. "IS fUt- of the consideration lor the ......~ of th~ ~ does Þødets~ &ad p«$Crlbe to the fol- lowing: 1. That the said -JIoud of Trustees and the Town ú Soutbold ate rdeutd -from any and aU damages, or claims for damages, of suits adsiog_ clltecdy or 1od/rec:d.y as a result of my opec- atioa performed punuaocC&1bIs !>=Út, ~_ ~e ~ ~tteewPI. .c his or bee own ~. defend any and aU such suits"lnltl.vdby t\¡Ird.,atdcs, and the said ~ ....ows f1I11lJab1JJty with respect cbetetO. eo'~exdusloo of . Ikrud of T~ of the Town of ~ 2. That this I'e1IDIt Is - ~d for a period of N/ A II>OS. 'I9bkh- Is citHIs1ðeted to be the estimated time - Kqulred to t'ÔiDplete the 'WOtk Inwtocd, but -should cir<...;¡".ntt$ warrant, nquest - for an exteI1SÌ.on .may be rnade to the JIoud at a ~ iiate. - 3. 'lliat this Per¡nit should be tetaIncd indefioild.y. or as loog as the said Permittee -..ùbès - to - maintain the SU\1Ct11Ce or project Involved, to provide evidence to anyone <DO<:erIled that mth· ~don was originaUy obu.Ined. 4. That the 'WOtk Involv~ will be IUbject to the inspection and appwm øl the Baud or Its agents, and QOQ<OII1 >IIanœ with the provisioøs of the orIginofl,,!: appUcadoa, may be cause for revocation of this Permit by resoludon of the said Board. S. That there wiU be no UI1ttUOOaN~ Interfere<1œ with navigadoø. as a readt of the 'ROCk beRIn oùthorhed. 6. That there JbaI1 be PO Interfuence with the ri&ht of the public to pass and npass alœg the beach between bIgb and low water marks. " 7. That if future OþCWioos ú the Town of Souch9ld ~ the. R:D>Onl ud/or al~ ill the Iocatioa of. work beRlnmthowd. or If, In. 0f:IÛd0G att&e Board at Tmsœes, die. 'ROCk- shaU cause ~able OOsttucbOO to free aa~ the said ~ will be m¡aIrecI. apoo. due ootJœ, to remove or alter this work or proJ«t beteIn ItaIecl ~ ~0(1 to the T_ - of SoIrthold. " - --- --- --- --.- - -- -- -- - - 8. That the Aid Board will be notified by the t'ermittte (It the ~__ of the work mth- orlzed. 9. That the "p;.rml_ wiU Ó)taÚ1 aU other permks and .........If"Chat may be required sa¡>; p/ane'I~1 to this permit ~ -rbe subject to moIce apoa &Uaø to obcaIø. same. - "" , " " -'t._ ~ , . ';'~,-..,:." .'....,..'.'.' ,'.1' ..... ,','..'." ,II .,1 ..'.' '..I' . " ,II ~-,",-----------."I .,1 'I , , '.' . '-. .-------.-, , , . . 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 16311765-1892 Fax (631 '¡ 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD August 24, 2005 Mr. & Mrs. George Pavlicin 2500 Sound Dr. Greenport, NY 11944 RE: 2500 SOUND DR., GREENPORT SCTM#33-1-13 Dear Mr. & Mrs. Pavlicin: The Board of Town Trustees took the following action during its regular meeting held on Wed., August 24,2005 regarding the above matter: WHEREAS, GEORGE & MARY PAVLlCIN 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 August 1, 2005 and, WHEREAS, said application was referred to the South old 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 August 24, 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 South old Town Code, 2 . . 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 approve the application of GEORGE & MARY PAVLlCIN for the existing beach stairs, and as depicted on the survey prepared by R. Van Tuyl, P.C. dated July 7, 1978. 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 inspection. (See attached schedule.) Fees: None Very truly yours, &~..f 9- ~.'f}. Albert J. Krupski, Jr., President Board of Trustees AJK/lms .~,' ", '-', "- [....O¡-J6 ~ øÇJi"'" , ¡j ~ III . '" ØQ UI o , ~ - ,... o ...¡ , I~~'! ¡ ... ~ rJO t? \.... Po ~I ÚvlT' - 2.3 I to/,# S .f b J" If LOT 11.';5- - ,/ .. it .. - / , . ,..{ & c~.~· t ~ , "\tGft r C/ ' . .J;.. 't \ .~~~".., ~. " soùrJD ./{.. ((fll' ' I ~·>n· I .>-- He. II f-i-t O~i-'1' iV~Þt~'V~' f-I.s. N,,; 7- 50-/85 ¡'v1ß.p o¡: Pf2.0¡:')~V:-( 'Y' -'::'I...¡";'."~EO r:OCë. ---'J- -'r:.-- .'\ L:/\AAP\/¡:; H~ì.....\,· '.-" l.:..::é..:, K"';;:': ¡'~. ~ YI~¡",,-=-r_=-~-,-_~v.'~,::-:.C~"¡_ t:., .- ~·'--:r':·J~">---).':-· --- ...::; 1£- ~. _ I . --";.' _ . III ~ . ~ ~ ItÌ ,... o "" 1-' - - ~ - ~ :-- ~ Q) TOWN OF ~CXJTHOL.O. N.Y I.INAUIHOIflfD ALTUAt10H OR ....."""" TO THIS SUIvtT 15 A 'IIOIAnaN Of IIØIOM 7209 Of THE NIW 'OIK STAW; IDUCAnoN LAW. COPtI5 OF THIS 5UIvtY MAl HOt ÞM THI LAND SUlmOR'S INKED SIA\ ØI IMI05SID S£AL SHAU t«)T II. 'ONltMllt I TO. A VALID TRUI CO". ¡ GUAIAHIEES INIMCAftD HWO" WU _ ~ OM.' 10 DIE I'Ø5OM FOI WHO" rHlf §IJt.¥~~ IS 1iIINIID. JIM) OM HK IINÞII 'f fMf. ._' muco.NII.QO.4f rq",~' --......-- 1O_~Of..~~¡l_ :5.: ¡~. SO'~," p __.__J,r',_f Q.. ro IIDDRIONIId. ttMIRNIM\)bIS ~ ~ ",.. /..~", p:~' .4r-,t'J ~ ::J. ~4.:: ~.; , ~t ~G [ ~ 1:0:~ ,~ l J Sf,\!!'-'" \ ìl-: pr.-.-- . T, ' - I\) .a.. ...., ~ . t 61/ , $ ," I - "W __ .. ~f:,'30·Z.O . , ::.>.::1 IV tJ()~:~+"',)""'i:»,'1J ~.I .~+o MtI¡' <>f ea,,+.,r-,., Sko"'5 -. ~ct."1;' ~ /led ;..., ~1P :Ä.J.1",'i; :;ovl'ffL.( C.r'",t" ',"-~" ..." '-1aþ No. "'i'!:81ò. - . Soff. Co. ï4K IWtlþ D.øiq"'rff'iCtl'f, O¡,;.. /OOt.;;, SItler. '3, eloc.Ít:.I,l..t:It~. ïl+l. No. /29'- 7-n / / --.--- .-¡';;;;;;;-J' -- No-f~: p,.£ ;"'~.:JIrJf 41"~ ,.,,,f~b/ '1\ "0 "'''I ~,'7ð.une"f.s ",. ,,,,¡lrts 0, ~f of/ul' Pf"ðP.rl¡ C'~"'_r.1 Ú, OiZ¡ V6. :I?e ''£¿ldr-tf'1'n ~"'¡''''4''- "nrd. . __ _-...J-----rd/c ""'''$ ¡-" "...:1'''''''''-( /I,,,1f <Udr-e,. r./,~,../<' ¡n L.., I. L"I",,-·,d'. 100.0 SOUND ,--~-~ ~ r- tti \ .- '" V· Ži ÍÌ\% r- :¿ / G.J"'),·c·,+t#'lE-d ~ 71-r~ n"+.C' ,J".:_I,,~ ~,.J'~".~. ::~, ~~ "'"'''.-yoM JuJ'I 7,1978. "oc..--r:p:¡·':. 'r: V;·1.\f T:_ ,.- _ , .~ . ./ V -,- f 1'-.., ~. ~. L¡...,n:Þrc ~~~II' ~1--·#·."f!'llD.."ð '::¡'r'''.~''f3ol.'''' New "r':J~þ:. . . Telephone (631) 765·1892 Town Hall 53095 Route 25 P.O. Box 1179 Southûld, New York 11971-0959 CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD At the meeting of the Southold Town Conservation Advisory Council held Wed., August 17, 2005, the following recommendation was made: Moved by Doris McGreevy, seconded by Jacob Smith, it was RESOVLED to recommend to the Southold Town Board of Trustees APPROVAL of the Wetland Permit application of GEORGE & MARY PAVLICIN for the existing beach stairs built in 1978. ' Located: 2500 Sound Dr., Greenport. SCTM#33-1-13 Vote of Council: Ayes: All Motion Carried ill, . ~- ~ ~_""N'~ ~~~i.,~~~i:"~~~'~;~/~0·,' "~. .'::~/. :,~ ~Ii:r /. ''',j/./ r¡( -&, ~ ,':>' 0:' I: .. "';::.;:-;\;". ..... ' !"" ,¡!' "YA"":^?'4""Y('\"'~~y<',>~' /,,!: . ...0....-- . %.\<.._.~<. " ~5I; it '" I'!/\~¡\ ~\,/',.,«>; \.\ t.< .>.....,~ ':" ,,' r.~.~~~ " :. .('~" './ "'~~>>,,¡':.-\~,(,s-\ "".:;.'" "/t ,'" < .~,. \~~', \, /.('\, 7' . l' ,,'.,; ".¡o' A .. . ~ .' ...... '_.<1,'::- ') , "-' \ " .' ",'y..,....,?'.' \'V. .. 7---^\" y ". 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" ~ Ie' '¡~j~ -0, 8~.. _"' I d.~; :;~f ! ~~j! >- i !~. ê¡i o _!h, "d <~ , f ~ ; 1 "C ~ ~ : i ¡ - . uH; H11il,1 ;¡,i!¡¡ :;lj,111 ÜhiH III; Ilil, 1 I ; ~ ~ j ~ : p ,:11'; Iii I 11,11 II il'l ¡!U¡ L!H ¡el!! I Iii !. ;" j j ¡i' 'j5.!! . ~ :; ¡iJI, ! 1 j ~ J 'I " 'f,: ~ I:! ,J1 ~ I ; ¡ i J!! i " IL ~\\\ ~f SOUl'1t ~.e:' "" ..¿) + + en 1!oc: ~ ~ ~ ~ ~. r.rCOu~~r-v . . . 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 16311 765-1892 Fax (6311 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only __Coastal Erosion Pennit Application ~etland Pem,;t Application __ Administrative Pennit _ Amendmt"ntTrans~èr/Extension /Received Application: ~ I ( /()~ -Aeceived Fee:$ ~~~ ~ompleted ApplicatIOn ;5 / ( tŒS:' _lncomplete______ __SEQRA Classification: Type I_Type H__Unlisted_ Coordination:(date sent) ~ Consistency .-\ssessm~nt Fonn 2)flos.. - <..-Ð\C Referral Sem:._"Kl!L0'), . -- -- __...Bate of Inspection: )¡ 1(1/7:> j __Receipt ofCAC Report: _ __Lead Agency Detennination:_____ Technical Review: ...-public Hearing Held: kid tf/O'!. Resolution: ~ ~ :G ~ I~ ,~,f",~ Southold TOWQ Board of Trustees , Name of Applicant GèDR~€" A. PAlil-IC ìw t MARc( e. PAV.LIG;N Address 2.500 ~()UV 0(Z.IVb' , P. o.~)C. 4D2- G~p"eír Ñ.'{. 11'144 PhoneNumber:(&Ia~ +11-0'312.- Suffolk COllnty Tax Map Number: 1000 -+7 3"889 33. -1- IS' Property Location: 3--tJ.~ 'ec-òo..¡! tAlßTW DoD ~e { ~""ÞlI> Þ~."f: 9~~""P..,¡z:'Í (provide LILCO Pole #. distance to cross streets, and location) AGENT: (If applicable) /" Phone: ~ (()JJ q~ \'01. 1\1( ,-- Address: - 4IÞBoard of Trustees APPlic~n .4 GENERAL DATA Land Area (in square feet):__~ Area Zoning: Previous use of property: Intended use of property: Prior pennits/approvals for site improvements: Agency Date _ No prior pernÜts/approvals for site improvements. Has any pennitlapproval ever been revoked or suspended by a governmental agency? ~_Yes If yes, provide explanation: -- --- ,--- /' Project Description (use attachments if necessary): E'XI s n;';új S7ZT-PS Of<.¿ ß ¡'JPF- = 'f¡61'1C If IN", ï'rJl.I-t¡'> iU If¡;^, ik¡)~ C< ¡µ¡t¡-5 ßv i.... T - --- ?vRý'""7 :J'õt.-'t' ? I rç¡ 78 W#-bIV C!oMh-eTPÞ, - . ~oard of Trustees APPlic~n . WETLAND/TRUSTEE LANDS APPLICATION DATA ml14rr eX/~r74JG-' Purpose of the proposed operations: f5T""E'PS'tUlh<:'u 8¿J;J.-Þc"72 II/GV~ &z:¿ue>reD /11./ 1717/9"B -r Area of wetlands on lot: . square feet 7 Percent coverage of lot: . ~'Ó Closest distance between nearest existing structure and upland edge of wetlands: ? feet Closest distance between nearest proposed stmcture and upland ~ edge ofwetlands:.-=---__ Jeet Does the project involve excavation or filling? <:@ Yes If yes, how much material will be excavated') --- cubic yards How much material will be filled? ç.--- _cubic yards Depth of which material will be removed or deposited: -- feet Proposed slope throughout the area of operations:~_____ Manner in which material will be removed or deposited: N ðN' e 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 attaclU11ents if appropriate): NOMtF PROJECT ID NUMBER PART 1 - PROJECT INFORMATION REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) STATE 617.20 APPENDIX C ENVIRONMENTAL QUALITY SEQR 1 APPLICANT { SPONSOR 2. PROJECT NAME ~.e Ø'fF !;. t"Abi:¡,¡tf: P.4VL Ic/"; Sr-ee s ø-.( SL.UrP TlJ B~CJl-, 3.PROJECT LOCATION: MunicIpality t:f~ØlPJJ/C.1'; çOtJT1/O~ -,3u.h}l County £ Uf=roLK -4 PRECISE LOCA nON: Street Addes5 and Road Intersections. Prominent landmarks etc· or provide map .:2'5'<30 ~ë<.J"'D ÞJetV€ /~.seirrt!JN ~O.b £4u': 5 IS PROPOSED ACTION· 0 New o Expansion o Modification / alteration ~ "5nAJ Go- 6 DESCRiBE PROJECT BRIEFLY: ß-1<MIr' )?€tJJ..~R&D ';::0 I( ~77:3Ps '7ZJ J3i91-c II úJJ.lrðl-i tve¡¿é- :V¡5721¿~é:P /¡oJ /97:i aJ-Ut:;Ì\/ ,t../pd~~ W/)5 Sd( tJr iJN' V"'C-4Io/' Lot' 7 AMOUNT OF LAND AFFECTED Initially acres Ultimately acres 8. ~ROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? Yes 0 No If no, describe briefly 9 WHAT IS PRESENT LANO USE IN VICINITY OF PROJECT? (Choose as many as apply) ~ ReSidential D Industrial D Commercial OAgriculture 0 Park / Forest I Open Space DOther (describe) 10_ DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) DYes ~NO If yes, list agency name and permit I approval" 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? DYes Œ)NO If yes, list agency name and permit I approval: 1è1; A D~LT OF PROPOSED ACTION WILL EXISTING PERMIT I APPROVAL REQUIRE MODIFICATION? es No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant {In,o, Name <5Gðlè;fý/Š 4. AJýt..,è I~ /(v¡IJ-~'I E. 4vl-~;v Date: Signature a· Pcw&'c.4.- Y)\n~ €'.?~ J Ifthe action is a Costal Area. and you are a state agency. complete the Coastal Assessment Form before proceeding with this assessment L . . 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-~"'1 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TO\VN OF SOUTHOLD ----~-.-------------------------------------------------------- In the 1\Iatter of the Application of _~~_~~~___I!.ª-rllL'(t"t1_ COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDA VIT OF POSTING I, ~ A. ~C\\j \ i <.'( ~1 , residing at z..Soo St>Lmd ÌJ(;ve---j_6r~ being duly sworn. depose and say: That on the \~luay of i\u~ ~~ , 20c£, I personally posted the property known as _____l(OD <;\)Ui-"\d n\J~, (1YQHI~t"1~. NL by placing the Board of Trustees off¡cial pos er where It can easily be seen, and that I have checked to be sure the poster has remained in place ;en: eight days prior to the date of the public hearing. Date of hearing noted thereon to be held WOttI, t:Luél. ()OS- . '~ , Dated: ~1A~(,t- 1(, l00~ 1b.A-.~ S;.,¡om to before me this 1~l1Iay ofl1u~lA(t20O< ~\1lt^, \J ~IUh\h____ Notary Public MELANIE OOROSKI NOTARY PUBLIC, State of New vm No. 01004634870 Qualified in Suffolk County) ,,7\} Commission Expires Septamber 3O~"(J . . PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: STATE OF NEW YORK COUNTY OF SUFFOLK ß\J \ 1(.1" _, residing at tr;bO ç~\ÀII\J «OCAC\ , . VI 0' -r , being duly sworn, deposes and says that on the 1,\+1,- ay of ~~'> 1-- ,200 S' , deponent mailed a true copy of the Notice set forth in the Board oflrustees 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 (\ Y lO\ fiJl t- , that said Notices were mailed to each of said persons by (certified) (registered) mail. ~ tJ. Pø-<--~ Sworn to before me this IS-\{ Dayof 'AA~~<:J , 20~ ublic MELANIE DOROSKI NOTARY PUBLIC, State of New'tblk No. 01004634B70 Qualified in Suffolk County !JC\r\.l Commission Expires September 30~ . . APPLlCANTI AGENTIREPRESENT A TIVE TRANSACTIONAL DISCLOSURE FORM The Town of South old's Code of Ethics nrohibits conflicts ofìntcrest on the Dart arrow" officers and emDlovees. The numose of this form is to nrovide information which can alert the to\\-TI ofoossible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOVRNAME 6éoa...67:Ç 4. P/fvttt!../...J (Last name, first name, .q1iddle initial, unless )'ou are applying in the name of someone else or other entity, such as a company. If so. indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply_) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other /) A' , ([F"Other', name the activit) _) ,~1I/I1 T H¡lJ(Jl.-/ C,q-n D '" --- Do )'ou personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employe~ of the Town of South old':"' "R~lationship" includes by blood, marriage, or business interest. "Business interest" means a business, including a partnership, in ,\hich the town officer or employee has even a partial ownership of (or employment by) a corporation in which the' town ofiìcer or employee owns more than 5~'ó of the shares. YES --- e- If you ans\,crcd "YES". complete the balance of this form and date and sign where indicated. Name of person emplo)cd by the Town of South old Title or position of that person --- Describe the relationship between yourself(the applicant/agent/representative) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space pco\:ided. The town oftìcer or employee or his or her spouse, sibling, parent, or child is (check all that apply): ~_A) the o\\'ner of greater than 5% ofthe shares of the corporate stock of the applicant (when the applicant is a corporation); ~B) th~ legal or beneficial own~r of any interest in a non-corporate entity (when the applicant is not a corporation); ~ C) an officer, director, partner, or employee of the applicant; or ~D) the actual applicant. DESCRIPTION OF RELA TIONSHIP /NoNe Form TS I Submitted t~ d62.of 200 _ Signature ~ ~-'-~' Print Name 6Pez:>R<t" A. ;4(/';" '-c.i-J . . Town of South old L\VRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for pennits* including Town of Southold agencies, shall complete this CCAF tor proposed actions that are subject to the Town of South old Waterftont Consistency Re\'iew La\\'. This assessment is intended to supplement other information used by a TO\\11 of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits alld otht'r ministerial pern/its not located within the Coastal Erosion Hazard Area. 2. Be[¡)re answering the questions in Section C, the preparer of this fonn should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterftont Revitalization Program. A proposed action will be evaluated as to its signiticant beneficial and adverse effects upon the coastal area (which includes all of South old Town). 3. If any question in Section Con tlús fomI is answered "yes", then the proposed action may affect the aclúevement of the L WRP policy standards and conditions contained in the consistency review law. Thus, the action should be analyzed in more detail and. if necessary. moditìed prior to making a detennination that it is consistent to the maximum extent praeticahle with the L \VRP policy standards and conditions. If an action carmot be celti tied as consistent with the L \VRP policy standards and conditions, it shall not be undertaken. A copy of the L WRP is available in the following places: (southoldtown.northfork.net), the Board of Trustees Oftìc libraries and the Town Clerk's office. 15) 1~I~n c) lrù AUG - 1 2005 \\'ebsite cal B. DESCRIPnON OF SITE AND PROPOSED AcnON 4139 ~'=t ~3,-I-¡3 SCT[\[# - t,;~ I~ SGutllGld ¡cwn Board of Trustees The Application has been submitted to (check appropriate response); Town Board D Planning Dept. 0 Building Dept. D Board of Trustees ~ I. Category of Town of South old agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital construction, planning activity, agency re¡''l.llation, land transaction) o o (b) Financial assistance (e.g. grant, loan, subsidy) (c) Pem1Ít. approval, license, certification: ~ Nature and extent gf action: r e/Z./U rF 8Øfd1.# h:>k eXt'ST/Nq- Srt=t>s cW 8W¡;F 1l> .-/ 11I/~7lIUl?b aJ#G>I/ 1f-o¡)$E" Wt4S 8w¿.r ¡fo/i<f7ð . Attach additional sheets if necessary . Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See L WRP Section III - Policies Pages 6 through 7 for evaluation criteria DYes D No IKI Not Applicable ~~~ -~~ Attach adthtional sheets ¡fnecessary NA TUR-U- COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resoU/'ces from flooding and erosion. See L\"RP Section HI - Policies Pages 8 through 16 for evaluation criteria DYes D No æ Not Applicable --~~- ------ ---- ----- ---- ------ -------- Attach additional shc:ets ifueces::ìary Policy 5, Protect and improve water quality and supply in the Town of South old. See L\"RP Section III - Policies Pages 16 through 21 for evaluation criteria DYes D No ~ Not Applicable ---------- -- ----- ~~ ~~~ Attach Jdditional sheets if necessary Policy 6. Pmtect aud restol'e the quality and function of the Town of South old ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See L WRP Section III - Policies; Pages 22 through 32 for evaluation criteria. DYes D No ~ Not Applicable --~---- . . ----- Attach additional sheets if necessary Policy 1 I. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See L WRP Section III - Policies; Pages 57 through 62 for evaluatiou criteria. DYes 0 No IE1 Not Applicable ----- ------ ---- Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of South old. See L WRP Scctiou III - Policies; Pages 62 through 65 for evaluation criteria. DYes D No iXl Not Applicable --------- --- ._----~-- --- ---- ---~- ------- ------ ------------------------ Attach additional sheets ¡fnecessary Policy 13, Promote appropriate use and development of energy and mincral resources, See L\VRP Section HI - Policies; Pages 65 through 68 for evaluation criteria, DYes D No ~ Not Applicable -- ------------ --- ------- Created 0/1 5'25/05 11.-20..11"[