HomeMy WebLinkAboutTR-5039Board Of $outhold Town Trustees
SOUTHOLD, NEW YORK
PERMIT NO..5'03q DATE: Aug. :%, 1999
JXuthorizaliou
Pursuant fo the provisions of Chapter 615 of the Laws of
the State of New York, 1893; and Chapter 404 of fha Laws of the
State of New York 1952; and the Soufhold 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;!~, and in accordance with the
Resolution of The Board adopted at a meeting held on ,?:~.~..2~ ......
19 97._, and in consideration of the sum of $....]:.5.q.,.gQ . paid by
. Franc.~s..~' & E]~beth .H' MurPhY ...............................................
of .......... ~t~.C~ N.Y. and sub?ct to the
Terms end Conditions listed on the reverse s~de hereof,
of Southold Town Trustees authorizes and permits the following:
Wetland Permit to construct a single-family residence with septic
system and well with the condition that there be a 40'
non-disturbed buffer and that haybales be placed down during
construction.
all in accordance with the defaiJed specifications as presented in
the originating application.
IN WITNESS WHEREOF, The said Board of Trustees here-
by causes its Corporate Seal to be affixed, and these presents to
b~ subscribed by a majority of the sald Board as of this date.
TERMS end CONDITIONS
The Perm~ctee Francis J. & Elizabeth H. Murphy
1350 Grand AVe., Mattituck
residing at N.Y. ~
part of the consideration for the issuance of the Permit does understand and ptescrlbe to the fol-
lowing:
I. That the said Board of Trustees and the Town of Southold are reletsed from any sad
aU damages, or d:~im,: for d*m~ges, of suits arising ditectl7 or indire~y as a result of any opet.
atlon performed pursuant to this l~'mit, and the s~d Permlttee will, at bis or bet uwu expense,
defend any and all such suks'initiated by thLrd patties, and the ~ald Permitten assumes ~ Ibtbiltty
with respect thereto, on the complete exclusion of the Board of Trustees of the Town of Sombold
2. That this Permit is valid for a Pe_,/od of 24 mo~ which is considated to be the
estimated time re<iulred to complete the work involved, lint should drcumstances warrant, tX~luest
for an ex'tension may be made to the Board at a later da~.
3. ~qmt this Permit should be retained indefinitely, or as long ns the said Petmirtee wishes
to maintain the structure or project involved, to provide evidence to anyone concerned that anth-
orization was originally obtained.
4. That the work involved will be subject to the inspect/on and approval of the Board m
its agents, and non-compliance with the provisions of the otlginaeln§ application, may be cause for
revocation of this Permit by resoindon of the said Bnard.
5. That there will be no unreasonable interference with navigation as a result of the wodc
herein au'thotized.
6. That there shall be an interference with the fight of the public to pass and repass along
the beach between high and low water marks.
7. That if future opecadons of the Town of Southold reClttite the nsnoval and/or alterations
in the location of the ~ork herein authorized, or if, in the opinion of the Board of Tmstet% the
work shall cause unreasonable obstrucoon to free navigation, the said Petmlttee will be m~Leed~
upon due notice, to remove or alter this work or project herein stated without expenses to the Town
of Southold.
8. That the said Board will be notified by the Permittce ot the completion of the work auth-
orized.
9. That the Permittee wiLl obtain aH other pe_rmlts and consents that may be requb-ed sup-
plemental to this permit which may be subject to revoke upon falinte to obtain same.
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) 765-18q2
Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
LETTER OF REQUEST FOR AN AMENDMENT
DATE d7 ~ L
Signed By:
OFFICE OF THE ALIPERTI'S
P.O. Box 149 - Shirley, N.Y. 11967
(516) 821-4162
Fax: ($16) 821-4157
FAX TRANSMITTAL SHEET
NUMBEI~, OF I'AOES (including cover sheet)*: ~
COMPANY: ................
H;,OM: _ _
COMMENTS:
* Contact sender if you do not receive ,all pages or if copy is not legible
~a ~'~.o£,t,£.o~
New York State Department of Environmental Conservation
Notice of Complete Application
Appfication ID
Permit(s) Applied
Project is located
Date FEBRUARY 01, 2000
Applicant FRANK MURPHY
PQ BOX 84
MATTITUCK NY 11952
1-4738-02463/00001
1 · ARTICLE 24: FRESHWATER WETLANDS
1 · ARTICLE 25: TIDAL WETLANDS
in SOUTHOLD in SUFFQLK COUNTY.
Project Description
APPLICANT PROPOSES TO CONSTRUCT A SINGLE FAMILY DWELLING, SEPTIC
SYSTEM, TO BE LOCATED 40 FEET FROM A REGULATED FRESHWATER WETLAND AND
260 FEET FROM THE TIDAL WETLAND BOUNDARY. PROPERTY IS LOCATED ON
OLEJULE LANE, MATTITUCK, SOUTHOLD. SCTM# 1000-114-12-13.1.
State~nviron~entalQualityReview($EQR)Determlnation ~L
SEQR ~ 1 Project is not subject to SEQR because it is a Type II action.
SEQR Lead Agency None Designated TOVtfN OF SOL/T~
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 regulations.
Availability For Public Comment Contact Person
Comments on this project must be MARILYN E PETERSON, NYSDEC
submitted in writing to the Contact SUNY @ STONY BROOK BUILDING 40
Person no later than 02/25/00. STONY BROOK NY 11790-2356
~- (631) 444-0365
¢~-0~-~ ~:~? FROM:PECONIC SURUE¥ORS PC 631-?B$-1?g? TO:?BSiBBB
John T~ M¢~:z~cr~ L$,
PECONIC ~ ~ · ''
~ [,RVE~ ()RS,
P.O. Box 909
1230 T~^v~:~ STREET
SOUTHOLD, N,Y. 11971
631-765-5020 · F~x 631-765-1797
To: Whom it may concern
From: John T. Metzger, L.S.
Date: August 2, 2001
Re: Aliperti
01e .lule Lane, Mattituck
1000-114-12-13.~
This is to state that Hr. Aliperti has reLained this
firm to set foundation stakes for the Southold Town Trustees
Inspection, and that he made thie request some several
weeks ago.
These stakes will be set by Tuesday of next week (08/07)
and we apologize for the delay that our scheduling has caused
any party interested ~n this matter.
With questions, please contact our office at the above
telephone number.
Thank you.
CC: A.lJperti
Trustees
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) 765-18,~2
Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF $OUTHOLD
Office Use Only_
Coastal Erosion Permit Application
~--Wetland Permit Application
Grandfather Permit Application
Waiver/Amendment/Changes
~,meceived Application: ~*~0 ' ~
.fReceived Fee:$ /~)
JUN 3 0 1999
,]'OWN OF SOUTHOLD
Completed Appli~at%og,
~ Incomplete/~lm~F~~F~
SEQRA ClaSsificatiOn: '- ~
Type I__.Type II ~ Unlisted
Coordination:(date sent)
~Z-cAC Referral Sent: ~ -~(~-~--
~Date of Inspection: 7-/~'~ Receipt of CAS Report:
Lead Agency Determination:__
Technical Review:
~Public Hearing Held: ~-~[- ~
Resolution:
Name of Applicant Francis J. & Elizabeth H. MurDh¥
Address 1~%~ Grnnd Ave., P.O. Box 84 Matti~uok. N.Y. 11952
Phone Number:(516) 298-~975
Suffolk County Tax Map Number: 1000 - 114-12-13.1
Property Location:~Od 0Ie Jule Lane Mattltu~k, N.Y.
Pole $ NYT 4-5 Ole Jule Lane - New Suffolk Avenue
distance to cross streets,
Phone:
FAX#:
(provide LILCO Pole #,
AGENT: Self
(If applicable)
Address:
11952
and location)
of Trustees Application
GENERAL DATA
Land Area (in square feet):
Area Zoning: R 80
Previous use of property:
Intended use of property:
1.793 acres 79,788.5 sa. feet
None Not Developed
Build Stnqle Family Home
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?
X No Yes
If yes, provide explanation:
Project Description (use attachments if necessary):
Bo~of Trustees Application
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: ~/~wm .~ ~/~3~
Area of wetlands on lot'~//~ ~/~ sq/u~re~feet
Percent coverage of lot: ~/~ %
Closest distance between nearest existing structure and upland
edge of wetlands: feet
Closest distance between nearest pro~sed structure and upland
edge of wetlands:~~/ feet
Does the project involve excavation or filling?
No ~ Yes
If yes, how much material will be excavated?
How much material will be filled?
Depth of which material will be removed or deposited:
feet
Proposed slope throughout the area o~ 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):
617.2.1
Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART I--PROJECT INFORMATION (To be comD/eted by Applicant or Proiect sDonsor)
1. APPLICANT/SPONSOR I 2. PROJECT NAME
Fr~t ~ .T. M]~rphy I Private HOme
3. RROJECT LOCATION:
MunicIDaiity (~1 F, ,T~11 ~ T,R~ HR~ ~)1~ Counly Suffolk
OLe Jule Lane, Approximately 300' South of New Suffolk AVenue_
and Ole Jule Lane Tax Map ~ 1000 114 12 13.5
5. IS PROPOSED ACTION:
5. OESCRIBE PROJECT BRIEFLY:
Build home
within Approximately
60' from Fresh Water wet Land Pond.
SEC
7. AMOUNT OF LANO AFFECTED:
Initially 1 /2 acres urtimately 1/2 acres
8. WiLL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING L~,NO USE r'~ESTRICTIONS?
'~ Yes ~ NO If No, descriPe 0rlefly
~ Remdenlial L~J~,!ncusmal ~ Commercial
L~ Agriculture
lO. DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDING, NOW OR ULTIMATELY PROM ANY OTHER GOVERNMBNTAL AGENCY (FEDERAL,
STATE OR LOCAL)?
~ No If yes, Jlst agency(s) and oermit/approvaJs
11.
Southold Town Building Department
DOES ANY ASPECT OF THE ACTIO/4 HAVE A CURRENTLY' VALID PERMIT OR APPROVAL?
[] Yes [] NO if yes, list agency name and permit/approval
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MOOIFiCAT;ON?
~ Yes ~ NO
I CERTIFY THAT THE INFORMATION RROVIIDED ABOVE IS TRUE TO THE BEET OF MY KNCWLSDGE
J. Murphy o~e 7/1/99
If the action is in the Co,stat Area. and you are a state agency, complete lbo
Coasta{ Assessment Form before proceeding with this as~.,$essment
OVER
!
PART III--OETERMINAi"ION OF $1GNIFtCANC~' i~ro be com¢letecl by Agency)
iNSTRUCTIONS; For each adverse effect idendiied acove, delermine wneti~er it is substantial, large, [mco~n[ or ot~e~ise signift
ChecX ;~is box if you have idem:ified one or more cotendady large or significant acverse imoac:s wnica h{.:
occur. ';'hen 2roce¢,'d direc.'ly to ;ne FULL =-AF ~ndlor preoare a gosltive' declaration.
Checx th,s box ~ you ,~ave determined, based on the information aRC ar~alysis adore ar, d an,/ sucsortir
Albert J. Krupsld, 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) 765-1~J2
Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
BOARD OF TRUSTEES: TOWN OF SOUTHOLD
In the Matter of the Application
of
COUNTY OF SUFFOLK)
STATE OF NEW YORK)
AFFIDAVIT OF POSTING
I, F~anc~s J. MuroS¥ , residing at 1350 Grand Avenue
Ma~tituck, N.Y. 1195~
being duly sworn, depose and say:
That on the 17~ day of July , 199 9, I personally posted the
property known as ~h~d~l Pr~p~r~y
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 the
public hearing. (dat~ of hearing noted thereon to be held
Dated: ~//
Sworn to before me this
~ ~'day. ofJ'~ y 199~
/~tary Public
~/ JANET V. STEWART
NOTARY PUBLIC, State of New York
No. 52-46633485
Oua~ified in Suffolk ~ounty ~,
Commission Expires NOV. 30, 20 ~
Albert J. Krupski, President
James King, Vice-President
Henry Smith
Artie Foster
Ken PoIiwoda
Town Hall
53095 Main Road
P.O. Box 1179
Southold, New York 11971
Telephone (516) 765-18~2
Fax (516) 765-i823
BOARD OF TOV~NTRUSTEES
TOV~NOFSOUTHOLD
BOARD OF TRUSTEES: TOWN OF SOUTHOLD
In the Matter of the Application
of
~__ .....
COUNTY OF SUFFOLK)
STATE OF NEW YORK)
AFFIDAVIT OF POSTING
I, Francis J. MurDhy , residing at 1~50 Grand Avenue
Mattituck, N.Y. 11952
being duly sworn, depose and say:
That on thel2th day of July , 199 9, I personally posted the
property known as
by placing the Board of Trustees off£cial 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 the
public hearing. (date of hearing noted thereon to be held ~ ~
ore.. -/-
Dated: ~/~/~
Sworn to before me this
~ ~day off-f4// 199~
FRANCIS J. VAN MANEN ASSOCIATES
REAL ESTATE CONSULTANTS AND APPRAISERS
66.17 MYRTLE AVENUE
SUITI~ 200
GLENDALE, N.Y. I1385
718-386-7138
NEW YORK FAX # 718-497-1327
A~bert J. Krupski~ President
James King, Vice-Preeident
Artie FosS;er
Ken Poliwada
Peggy A. Dicke~'son
June 28, 2002
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hal!
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-~892
Fax (631) 765-1366
Mrs. Josephine Aliperti
81 Halleck Road
Rocky Point, NY 11778
RE: 400 aLE JULE LANE, MATTITUCK
SCTM#114-12-13,1
Dear Mrs. Aliperti:
The following action was taken by the Southold Town Board of Trustees at their Regular
Meeting held on Wednesday, June 26, 2002:
RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to Permit
#5039 to add a 14'X 12' deck onto the rear of the house and to tempora~qly move the hay bales
back 10' away from the northwest comer of the house with the condition that drywells are
installed immediately and once all of the construction is ,~omplete, the hay bales must be moved
back to the 50' non-disturbance buffer line and the I 0' area restored.
This is not a determination from any other agency.
If you have any questions, please call our office at (631) 765-1892.
Sincerely,
Albert J. Krupski, Jr.
President, Board of Trustees
AJK:lms
Telephone
(631) 765-1892
Tow~ l*I~ll, $3095 Main Road
P-O. Box 1179
8onr. boM, Ne~v Y~x~ 1197!
SOUTHOLD TOWN
CONSERVATION ADVISORY COUNCIL
At the meeting of the Southold Town Conservation Advisory Council held Monday, June
24, 2002, the following recommendation was made:
JOSEPHINE ALIPERTI to Amend Permit #5039 to add a 14'X 12' deck onto the rear bf
the house and to maintain a 40' buffer area to the rear of the house.
Located: 400 Ole Jule Lane, Mattituck. SCTM#114-12-13.'I
The CAC recommends that a violation be issued for the as-built structure.
New York State Department of Environmental Conservation
Division of Environmental Permits, Region One
Building 40 - SUNY, Stony Brook, New York 11790-2356
Phone: (631) 444-0365 · FAX: (631) 444-0360
Wehsite: www.dec.state.ny.us
NOTICE OF INTENT TO REVOKE PERMIT
Erin M. Crotty
Acting
Commissio~er
Mr. Anthony Aliperti
81 Hallock Lane
Rocky Point, NY 11778
December 10, 2001
Re:
NYSDEC # 1-4738-02463/00001
ole Jule Lane, Mattituck, Suffolk County
SCTM # 1000-I t4-12-13.1
BEC;3
Dear Mr, Aliperti: [
A review of this recently transferred permit application indicates that the transtar turin received
November 16, 2001 was not signed by the holder of the permit, Mr. Frank Murphy. The Transtar of
Permit should not have been processed without Mr. Murphy's signature, Further review of the facts
shows that Mr. Murphy was not the owner of the property as indicated on the original permit application
form submitted in November I, 1999. Therefore, the original permit should not have been processed
either. There is no indication in the original file of who the actual owner of the property is or if there
was any authorization from the owner to apply for permits, hence, the original application and the
subsequent transfer constitute "material(y false or inaccurate statements in the permit application or
supporting papers; " Therefore, in accordance with Uniform Procedures, 6NYCRR Subdivision
621.14(a)(1) the Department intends to revoke both this permit and the transfer of permit.
This letter shall serve as notice to revoke. You may within 15 calendar days of the mailing of this notice
submit a written statement to the department, giving reasons why the permit should not be revoked,
requesting a hearing or both. Failure to timely submit a statement shall result in department's
action becoming effective on December 26, 2001, If you have any questions [ can be reached at the
above address or (63 I) 444-0361.
Very truly yours,
Deity Regional Permit administrator
Southold Town
Frank Murphy
ACMT Equities, Inc.
Land Use Ecological Services, Inc.
C. Arfsten, NYSDEC
J. Pavacic, NYSDEC
M. Peterson, NYSDEC
Albert J. Krupski, President
James King, Vice-President
Artie Foster
Ken Poliwoda
Peggy A. Dickerson
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-1366
September 21,2001
Mr. Anthony Aliperti
81 Hallock Lane
Rocky Point, NY 11778
RE: 700 Ole Jule Lane, Mattituck
SCTM#114-12-13.1
Dear Mr. Aliperti:
The following action was taken by the Southold Town Board of Trustees at their Regular
Meeting held on Wednesday, September 19, 2001:
RESOLVED that the Southold Town Board of Trustees grants a One-Year Extension to Permit
#5039 to construct a single-family residence with septic system and well, with the condition of a
50' non-disturbance buffer and hay bales placed down during construction at the 50' buffer, as
depicted on survey dated June 4, 1999 and last revised September 25, 2001.
This is not an approval from any other agency.
If you have any questions, please do not hesitate to contact this office.
Sincerely,
Albert J. Krup~ki, Jr.
President, Board of Trustees
AJK:lms
Albert J. Krupski, President
James King, Vice-President
Henry Smith
Ax-tie Foster
Ken Poliwoda
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-1366
September 21, 2001
Anthony Aliperti
81 Hallock Lane
Rocky Point, NY 11778
Francis & Elizabeth Murphy -to- Anthony Aliperti
700 Ole Jule Lane, Mattituck NY
SCTM#114-12-13.1
Dear Mr.. Aliperti:
The following action was taken at the Southold Town Board of Trustees Regular Meeting on
September 19, 2001
RESOLVED, that the Southold Town Board of Trustees approve the request for a Transfer of
Permit #5039 from Francis & Elizabeth Murphy -to- Anthony Aliperti to construct a single
family residence with septic system and well with the condition that there be a 50 foot non-
disturbed buffer and that haybales be placed down during construction also noted on survey. /
S inclfy°Uerelhavey, any questions, please contact our office at 765-1892. /~ q-tl .~f./~'
President, Board of Trustees I r~'
AJK:cjc
Building Depa~ment
Albert J. Krupski, President
James King, Vice-President
Henry Smith
Artie Fester
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
August 26, 1999
Mr. & Mrs. Francis J.
1350 Grand Ave.
P.O. Box 84
Mattituck, NY 11952
Murphy
Re: SCTM#114-12-13.1
Dear Mr. & Mrs. Murphy:
The following action was taken by the Board of Town Trustees
during its regular meeting held on August 25, 1999 regarding the
above matter:
WHEREAS, FRANCIS J. & ELIZABETH H. MURPHY applied to the
Southold Town Trustees for a permit under the provisions of the
Wetland Ordinance of the Town of Southold, application dated
June 30, 1999 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 August 25, 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 submitted concerning this application, and,
WHEREAS, the structure complies with the standard set forth in
Chapter 97 of the Southold Town Code,
WHEREAS, the Board has determined that the project as p~oposed
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
FRANCIS J. & ELIZABETH H. MURPHY to construct a single-family
residence with septic system and well with the condition that
there be a 40' non-disturbed buffer and that haybales be placed
down during construction.
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 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,
Albert J. Krupski, Jr.
President, Board of Trustees
AJK/lms
cc: DEC
Health Dept.
Bldg. Dept.
Telephone
(516) 765-1801
Town Hall, 53095 Main Road
P.O. Box 1179
Southold. New York 11971
SOUTHOLD TOWN
CONSERVATION ADVISORY COUNCIL
At the meeting of the Southold Town Conservation Advisory Council held Monday, July 19,
1999, the following recommendation was made:
Moved by Scott Hilary, seconded by Ken Meskill, it was
RESOLVED to Table the Wetland Permit Application of FRANCIS & ELIZABETlt
MURPItY 114-12-13.1 to construct a single-family home with septic system and well.
400 Ole Jule Lane, Mattituck
The CAC Tabled the application because the property was not staked and no survey was
available. The CAC requests to re-inspect the property when the survey becomes available.
Vote of Council: Ayes: All
Motion Carried
SUPPLEMENTARY
INCIDENT REPORT
/ of / ~
Southold Town Police Department
Route 25
Peconic, New York 11958
631-765-260O
Incident Report No.'s
Narrative: (Pdnt or Type Only)~. ~:~..,
R
E
P
O
R
T
$
T
A
T
U
PDTS-2A
S~nature o~ Investigating ~
INCIDENT
STATUS
CODE
Status Code
2 First
Rank: ~ P~' I 4 Date:
FOR OFFICE USE ONLY
A - Under Inv: F - Ref. to Chiefs Office=
B - Cleared by Inv: G - Ref. to Chief of OperaUons
C - Cleared by Arrest H - Ref. to Traffic DIV.
D-File I - Ref. to Der. DIV
E - Incident Unfounded J - Ref. to Youth Div.
Date: / /~
3
Rank Time Hrs.
L - Other
Forward Copy to:
4
£ou~L~ -ro~o,. / ~O~mm~?~ClDEN'FREPORT:I NY 0515-~ 0~-
I
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