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Home My WebLink AboutTR-5989AAlbert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route25 P.O. Box 1179 Southold, NewYork 11971-0959 Telephone(631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OFSOUTHOLD Permit No.: 5989A Date of Receipt of Application: August 16, 2004 Applicant: Alan & Teresa Sucher SCTM#: 111-1-6 Project Location: 60 Haywaters Rd., Cutchogue Date of Resolution/Issuance: September 22, 2004 Date of Expiration: September 22, 2006 Reviewed by: Trustee Peggy Dickerson Project Description: To replace the windows and doors of the existing dwelling and remove and replace the existing cedar siding and asphalt roof shingles. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 97 of the Southold Town Code. The issuance of the Administrative Permit allows for the operations as indicated on the survey prepared by Martin D. Hands dated May 24, 2004. Special Conditions: None If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 97 of the $outhold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. Albert J. Krupski, Jr., President Board of Trustees AUG ' 0 ~.:,04 Southold Town Beard of Trustees ,O0'gcJ /H.OO~oL8 N 9~'DV ZW:*O = 'J.=l'O$ OgZ'O~ :(2V'*-JI.P,~E 01 ~107 f, O0~ '~ AVW :9.J. VO ,0~ = .~ Albert J. Krupski, President James FAng, Vice-President Artie Foster Ken Pnliwoda 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 Office Use Only ~'Wetland Permit Application __ W aiver/Amendmcnt/Cbange s _~Received Fce:$~ .~f~ompleted AppYtc a~on Incomplete __SEQRA Classification: Type I Type II Unlisted Coordination:(date sen~) . --~'CAC Referral Scnt:~ _~Date of __Receipt of CAC Report __Lead Agency Determination: Technical Review: __Resolution: . . Coastal Erosion Permit Application Minor ~f~7.~. --% (provide LILCO Pole #, distance to cross streets, and location) Board of Trustees Application GENERAL DATA Land Area (in square feet): Area Zoning: Previous use of property: Intended use ofpropert3,: Prior permits/approvals for site improvements: Agency Date .zk~ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspen.ded by a governmental agency? .~'~ No Yes If yes, provide explanation: Project Description (use attachments if necessary): Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ,~t..T~_ ~'~ .7?gt,~t~ ~,4 cc. t' Area of wetlands on lot: 0 square feet Percent coverage of lot: Closest distance between nearest existing structure and upland edge of wetlands: I ~- ~ feet Closest distance between nearest proposed structure and upland edge of wetlands: /~tA feet Doe~th~oroject involve excavation or filling? j/r N No Yes If yes, how much material will be excavated? cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: feet Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): Board of Trustees Application County of Suffolk State of New York ~ BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HiS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE "~i~na-tur% SWORN TO BEFORE ME THIS I O DAY OF~.~~ ,20 Oq ~ NoOuy ~ublic ' of Trustees Application Au-~uOR/ZATIC~ (where the applicant is not the owner) I , ~resid~ng at~ . . W [_ _ ~WM~ to apply for ~it(s) fr. the ees on my behalf. ~ f (O~ner's signature) APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM Town of Southold's Code of Ethics nrohibits conflicts of interest on the nm't of town Officers and cmnlovecs. The oomose of form is to movide infprmation which can alert the town of nussible conflicts of interest and allow it to mice whatever action is pecassarv to avoid same. (Last name, first name, ~iddle h{itial, unless you a~ applying in the name of someone else or other catity, such as a company. If so, indicat~ the other person*s or company's namc.) NAIVlE OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Tmstec Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (I f"Other', name thc activity.) Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of Soothold? "Relationship" includes by blood, marriage, or business interest "Business interest" means a businoss, including a parmership, in which the town officer or employee has even a partial ownership of(or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. YES NO ~ If you answered "YES", complete thc balance of this form and date and sign where indicated. Name of person employed by thc Town of Southold Title or position of that poi'son Describe the ~elatioaship I~tween yourself (the applicant/agcnt/reprasentativc) and thc town officer or employee. Either check the appropriate line A) through D) and]or dcscrihe in the space provided. The town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply): __.A) the owner of gn:ater than 5% of the shascs of the corporate stock of the applicant (when the applicant is a corporation); B) the legal or beneficial ownO' of any inter~st in a non-corporate entity (when thc applicant is not a corporation); C) an officer, director, partner, or employee of the applicant; or __.D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS I' Submitted this ~_~___day, of ~/~'ff"~" 200 .~ Signature ' . __ Pdnt Name ' . ~