HomeMy WebLinkAboutTR-6258
James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
Bob Ghosio, Jr.
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
CERTIFICATE OF COMPLIANCE
Date September 27. 2007
# 0255C
THIS CERTIFIES that the removal of the sun-porch on west side of dwelling and construction
of new addition on same footprint. and new one-story addition on the southeast angle of the
dwelling
At 1230 West Creek Ave.. Cutchogue,
Suffolk County Tax Map # 103-13-10
Conforms to the application for a Trustees Permit heretofore filed in this office
Dated 11/7/05 pursuant to which Trustees Permit #6258Dated 12/21/05
Was issued, and conforms to all of the requirements and conditions of the applicable
provisions of law. The project for which this certificate is being issued
is for the removal of the sun-porch on west side of dwelling and construction of new addition on
same footprint. and new one-story addition on the southeast angle of the dwelling.
The certificate is issued to THOMAS & GEKEE WICKHAM owner of the
aforesaid property.
;-~~
Authorized Signature
Albert J. Krupski, President
James King, Vice-President
Artie Fester
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 ,1631) 765-1366
YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES
72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN
APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO
SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE
PERMIT.
INSPECTION SCHEDULE
Pre-construction, hay bale line
1st day of construction
~7~ 1/~ constructed
Project complete, compliance inspection.
Albert J. I<rupski, 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) 765-6641
TO: ~-o ~f,
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Please be advised that your application dated
reviewed by this Board at the regular meeting of
following action was taken:
(~) Application Approved (see below)
)Application Denied (see below)
has been
and the
( )Application Tabled (see below)
If your application is approved as noted above, a permit fee is now due. Make check or
money order payable to the Southold Town Trustees. The fee is computed below
according to the schedule of rates as set forth in the instruction sheet.
The following fee must be paid within 90 days or re-application fees will be necessary.
COMPUTATION OF PERMIT FEES:
c.\<.~s ~ ,ak ol,_ 0%.o.4..E .
TOTAL FEES DUE:
SIGNED:
PRESIDENT, BOARD OF TRUSTEES
Board Of $outhold 'Town Trustees
SOUTHOLD, NEW YORK
ISSUED TO T~4o~,s ai~D aZ~ZE wzc~
· ": ut' nri atinn .....
Pursuant ~o t~ provisions of Chapter 61~
the. Sta~ of New Yor~ 1893~ ~nd ~pfer ~ of the
' Sf~te of Hew York 19~2~ end Jhe Sou~hold To~n Ordln~nee
'f~led .'~E~U~TIN~ AND-~E. P~GIN~ OF
IN AND ON TOWN WATERS AND PUBLIC ~NDS
RE~OVAL OF SAND, ~VEL.. OR OTHER ~TERIALS~_
~NDS .UNDER TOWN WA~RS:~.' end in ~c¢~den~
Resol~ion of ~he Boerd ~dopfed ~ e meeting held on ...~.~..~... ~ ......
2Q~....., end Jn considerMion of the sum of ~.~.~P.~..Q.~ .......... pe~d by
...... ~ ~....~...~e....~m ..................................................... .....................
of ......... ~?~?~ ......................................... N, Y. ~nd subject So the
Terms end ~nditions listed on Jhe revere ride ~reof,
~ ~of~lhdd Town Tr~ees ~uJhorlzes ~nd perm~H
walls, windows,floor,and r~of and to add a 6 x7 one story add-
ition on the southeast angle of the house with the condition tha
all rupoff be contained on site and haypales be placed o ~he
a~ in ~cco~dance with the detai~d sp~'dmetio.s es pre~nte~
s~ru'~ ~alnat;nq epp~ti~.wacer s~de o~ ~he house during con-
on grid a~ as dep~cLed on ~he p~an s~rvey~ b~ Ac
da~ed 9/~6/~.WiTHESS WHERE', ~e *Md Boerd 01 T~stees
by ~u~; its ~r~r~te Seal 1o be a~xed, ~nd ~ese presen~
~ sub~ed by ~'maj~ of th~d~ o~'
, Peggy. Dickerson
TERMS ~.d CONOmONS
Thomas and Gekee Wickham
.~l~t. . Cutchqgue .. · ' -- ...~ __' ...... N. Y~'aa ·
[or tm ~.t~don Ray !~ nmde to the Dotted at a I,~; ~.~
4. '[~t the woflc lflyotvcd wilt ~ mbjoct to t~ iteration .mci qTrovat ~[ 4he Bo4ttd (z
iu ~ex,t~, and aoix-o~m~l~f~e w/ch the HoN~stom of tim ot~l~ .ppflca~oa, mty I~ cat~ fo~
~c~tion of thl; l~m~t by ~oluflon of the ~lki Boa~L
~xmSo~oidue notice, to mm~ve o~ ,tt~ dxls ~oflc or I~oj~c~ ~ m.__..M_ ~ ezt, eos~ to t~e 'l'q:m~'
'od~t
· pmeaut m d~ ~ ~ my'be subJ~ to tz, voh upoa hlim'to ebuh nm~
Albert J. Krupski, President
James King, Vice-President
Artie Foster
Ken Poliwoda
Peggy A. Dickerson
Town Hall
53095Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OFTOWNTRUSTEES
TOWN OFSOUTHOLD
December 21, 2005
Thomas and Gekee Wickham
P.O. Box 928
Cutchogue, NY 11935
Re: 1230 WEST CREEK AVE., CUTCHOGUE
SCTM#103-13-10
Dear Mr. And Mrs. Wickham:
The Board of Town Trustees took the following action during its regular meeting held on
Wednesday, December 21,2005 regarding the above matter:
WHEREAS, THOMAS AND GEKEE WICKHAM 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 November 7, 2005, 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 December 21,2005 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 proposal complies with the standards set forth in Chapter 97 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,
RESOLVED, that the Board of Trustees approve the application of THOMAS AND
GEKEE WlCKHAM to remove a closed-in 12' x 20' sun porch on the west side of the
house and replace it on the same footprint with new walls, windows, floor and roof and
to add a 6' x 7' one story addition on the southeast angle of the house, with the
condition that all runoff be contained on site, and haybales be placed on the water side
of the house during construction, and all as depicted on the plans surveyed by John
Ehlers last dated 9/16/05.
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.)
This is not a determination from any other agency.
Fees: $50.00
Very Truly Yours,
Albert J. Krupski, Jr.
President, Board of Trustees
AJK/hkc
Telephone
(631) 765-1892
Town Hall
53095 Route 25
P.O. Box I 179
Southold, New York 11971-0959
CONSERVATION ADVISORY COUNCIL
TO~VN OF SOUTHOLD
At the meeting of the Southold Town Conservation Advisory Council held Wed.,
December 14, 2005, the following recommendation was made:
Moved by Jack McGreevy, seconded by Don Wilder, it was
RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH
A CONDITION of the Wetland, Permit application of THOMAS & (~EKEE WlCKHAM to
remove a closed-in 12'X 20' sun porch on the west side of the house and replace it on
the same footprint with new walls, windows, floor and roof, and to add a 6'X 7' one-story
addition on the southeast angle of the house.
Located: 1230 West Creek Ave., Cutchogue. SCTM#103-13-10
The CAC recommends Approval of the application with the Condition drywells and
gutters are installed to contain the roof run-off.
Vote of Council: Ayes: All
Motion Carried
PLANNING BOARD MEMBERS
JERIL~N B. WOODHOUSE
Chair
WILLIAM J. CREMERS
KENNETH L. EDWARDS
I~£a-RTIN H. SIDER
GEORGE D. SOLOKION
PLANNING BOARD OFFICE
TOWN OF SOUTHOLD
MAILING ADDRESS:
P.O, Box 1179
Southold, NY 11971
OFFICE LOCATION:
Town Hall Annex
54375 State Route 2§
(cor. Main Rd. & Youngs Ave.)
Southeld, NY
Telephone: 631 766-1938
Fax: 631 765-3136
To: Town of Southold Board of Trustees
From: Mark Terry, Senior Environmental Planner
LWRP Coordinator
Date: December 1, 2005
Re: Request for Wetland Permit for Tom and Gekee Wickham · SCTM# 103-13-10
THOMAS & GEKEE WICKHAM request a Wetland Permit to remove a
closed-in 12'X 20' sun porch on the west side of the house and replace it on
the same footprint with new walls, windows, floor and roof, and to add a 6'X 7'
one-story addition on the southeast angle of the house. Located: 1230 West
Creek Ave., Cutchogue. SCTM#103-13-10
The proposed action has been reviewed to Chapter 95, Waterfront Consistency
Review of the Town of Southold Town Code and the Local Waterfront
Revitalization Program (LWRP) Policy Standards. Based upon the information
provided on the LWRP Consistency Assessment Form submitted to this
department, as well as the records available to me, it is my recommendation that
the proposed action is generally CONSISTENT with the Policy Standards
and therefore is CONSISTENT with the LWRP.
Pursuant to Chapter 95, the Board of Trustees shall consider this
recommendation in preparing its written determination regarding the consistency
of the proposed action.
Please contact me at (631) 765-1938 if you have any questions regarding the
above.
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 (63D 765-1892
Fax ~631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only
~eastal Erosion Permit Application
tland Pem~it Application ___ Adnfinistrative Permit
Amcndment/Trans fer/E xte~sion
~.~---Rece~ved Application: ~
--'"'Received Fee:$ ~'~X9 ~
.-..-'Co,npleted Application~/1/q [~
Inco~lete
_~SEQ~ Classification:
T~e I Type II Unlisted~
Coordination:(date sent)
-~'~ Co~istency Ass~s~ro~ I t/Olo~
~ACRefe~alSent: I I [lb lO~ ~
~ate of Impection: I & ] t q l O ~
__Receipt of CAC Report:
Lead Agency Detemfination:
Technical Review:
_--Public Hearing Held: I~/Dllt3~
Resolution:
Name of Applicant T/'~ $ ~T ~%--' F',._k--~
Phone Number:(
Suffolk County Tax Map Number:
Property Location: /~ ~
(provide LILCO Pole #, distance to cross streets, and location)
AGENT:
(If applicable)
Address:
Phone:
ard of Trustees Ap~
Land Area (in square feet):
Area Zoning:
Previous use of property:
Intended use of property:
GENERAL DATA
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?
v" No Yes
If yes, provide explanation:
Project Description (use attachments if necessary):
of Trustees Applicat~
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpos~.,pfthe proposed operations: ~ ]'~ ~-~ [,/~ ~ ~}
Area of wetlands on lot: ? .square feet · · [/'~
Percent coverage oflot: (*,~- % -- ({~ ~ J~e
Closest distance between nearest existing structure and upland
edge of wetlands: ~70 feet
Closest distance between nearest proposed structure and upland
edge of wetlands: ~ 0 feet
Does the project involve excavation or filling?
~ 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:
feet
Proposed slope throughout the area of operations:
Manner 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
PROJECT ID NUMBER
PART 1 - PROJECT INFORMATION
617.20
APPENDIX C
STATE ENVIRONMENTAL QUALITY REVIEW
SHORT ENVIRONMENTAL ASSESSMENT FORM
for UNLISTED ACTIONS Only
( To be completed by Applicant or Project Sponsor)
SEQR
4. PRECISE LOCATION: S~eet Addess and F~a~ Inte~ec~ons~Prominent landmarks etc -or ~rovide ma~
5.1S PROPOSED ACTION' ~ New
6. DESCRIBE PROJECT BRIEFLY:
7. AMOUNT OF ~ AFFECTED: ~
8. ~LL ~ROPO~D ACTION COMPLY WITH ~ISTI~ ZONIN~OR OTHER RESTRICTIONS?
9. WH T IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.)
~'~.~'&Re~idential [~lndustrial r'~Commercial {---]Agriculture ['~ParklForest/OpenSpace ~-~Other (describe)
10. DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDING, NOW OR ULTI~I,~.TEL~( FR(~M ANY OTHER GOVERNMENTAL
AGENCY (Federal. State or Local) ! ~',~,,~ ~,~_j/~ ~-~..~.. ~ )
~ ~No If yes list agency name and pe~it / approval' ~~ ~,7 }~
sASA RESULT PROPOSED AOT,ON W,L'_ EX,S > ;:OVAL REO ,RE
I CER THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
If the action Is a Costal Area. and you are a state agency,
complete the Coastal Assessment Form before proceeding with this assessment
PROOF OF MAILING OF NOTICE
ATTACH CERTIFIED MAIL RECEIPTS
Name: Address:
STATE OF NEW YORK
COUNTY OF SUFFOLK
( {{'~5. ~ ?~2~ C- ir,._ t4"~C'L , residing at 2 ~-zro tt-~t,., ~7~,
(__~'~. l,,,,~ ~,~_~ -),97' t t"t ~ being duly sworn, deposes and says that on the
30 ~. ,~ayof /L~t~, ,20~,,deponentmailedatmecopyoftheNotice ·
set foFah in the Board of Trustees Application, directed to each of the above named
persons at the addresses set opposite there respective names;.that the addresses set
the names of said persons are the address of said p,~sons ns shown on the current
opposite
assessment roll of t~e ~rown of Southold; that said Notice~were mailed at~e United States Post
Office at C t,~.~ ~,~ c..,..__ , that said Notices )//ere mailed,Co eag'~ of.~aid persons by
(certified) (registered) ~x~il' ff///~. /~///
Sworn to before me this
Day of N ~,~e~ 6... ,20
Q..) Notary PubliUs--) O
John M. Judge
NOTARY PUBLIC, State of New York
No. 01JU6059400
Qualified In Suffolk County
Commission Expires May 29, 20 ~
Albert J, Krupski, President
James King, Vice-President
.~tie Foster
Ken Poliwoda
Peggy A. Dickerson
Town Hall
53095Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone(631) 765-1892
Fax(631)
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
BOARD OF TRUSTEES: TOVeN OF SOUTHOLD
In the Matter of the Application of
COUNTY OF SUFFOLK)
STATE OF NEW YORK)
AFFIDAVIT OF POSTiNG
I, ~ t~ $. ("P-? c- ff-((~ ~t~, residing at
being dui3 sworn, depose a~d say:
That ou the 'l: da',, of ~)~'e._- ,200 , I personally posted thc property known as -- /
by placing the Board of Trustees official poster ~ here it can easily be seen, and th'bt I have
checked to be sure the poster has remained in place for eight days prior to the date of the public
hearing. Date of hearing noted thereon to be held _~/-)a~., 6.Q~(', ~t~
~tq co ~b~ 9:6B
Dated:
(si~ature)
Sxvom to before me this
2.-0 day
Pu'b
lic cO O
John M. Judge
NOTARY PUBLIC, ~tate of New York
No. 01JU6059400
Oualified In Suffolk County
Commission Expires May 29, 200_.~
Board of Trustees Application
County of Suffolk
State of New York
'~t),.~ ~ ~tk[-~:~ 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
SWORN TO BEFORE ME THIS 44a' DAYOF Nt~/~-,6,,- _,20_oj
Notary (-~ 0
HOTARY PUBL C, State of New York
No. 01 JU6059400
Ou~ ¢ieO In Suffolk Countv
Commission Exp res May 29, 20 ~
Board of Trustees Application
County of Suffolk
State of New York
~-~V¥~ ~Jt C~o,-,,~ 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. TIlE APPLICANT
AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES
HARMLESS AND FREE FROM ANY .MN-D ALL DAMAGES AND CLAIMS ARISING
UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS
APPLICATION, I HEREBY AUTHORIZE THE TR~5,~TEES, THEIR AGENT(S) OR
REPRESENTATIVES(S), TO ENTER ONTO MY/P/ROPERTY~ TO )NSPECT TIlE
Signature
SWORN TO BEFORE ME THIS
DAYOF P4. ~¢~ 6¢x ,20~,~"
(,._~otary Public K...9 L/--
John M, Judge
NOTARY PUBLIC State of New York
No. 01JU605940~
Qualified In Suffolk County
Commission Expires May 29, 20
APPLICANT/AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
Thc Town of Southold's Code of Ethics orohibits conflicts of interest on the oart of town officers and emnlo¥ces. The nuroose of
this form is to nmvidc information which can alert the town of oossible conflicts of interest and allow it to take whatever action is
nec, gssarv to avoid same.
(Lust name, first name, middle initial, unless you arc applying in the name of
someone else or other entity, such us a company. If so, indicate thc 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
([£"Other". name the 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 Southold? "Relationship" includes by blood, marriage, or business interest. "Business intcresf' means a business,
including a partnership, in which thc town officer or employee hus even a partial ownership of (or employment by) a corporation
in which thc town officer or employee owns more than 5% of the shares.
YES ~ NO
lf)ou answered "YES". complete the balance of this form and date and sign where indicated.
Describe thc relationship between yourself(the applicant/agent/representative) and the town officer or employee. Either check
the appropriate linc A) 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):
A) the owner of greater than 5% of the shams of the corporate stock of the applic0nt
(when the applicant is a corporation);
_B) the legal or beneficial owner of any interest in a non-corporate entity (when the
applicant is not a corporation);
D )
an officer, director, partner, or employee of the applicant; or
) the actual applicant.
DESCRIPTION OF RELATIONSHIP
Form TS 1
'Town of Southold
LWRP CONSISTENCY ASSESSMENT FORM
A. INSTRUCTIONS
All applicants for pemaits* including Toxvn of Southold agencies, shall complete this CCAF for
proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This
assessment is intended to supplement other information used by a Town of Southold agency in
making a determination of consistency. *Except mhlor exempt actions including Building Permits
and other m#tisterial permits not located within the Coastal Erosion Hazard Area.
Before answering the questions in Section C, the preparer of this form should review the exempt
minor action list, policies and explanations of each policy contained in the Tovm of Southold Local
Waterfront Revitalization Program. A proposed action will be evaluated as to its significant
beneficial and adverse effects upon the coastal area (which includes all of Southold Town).
If an), question in Section C on this form is answered "yes" or "no", then the proposed action will
affect the achievement of the LWRP policy standards and conditions contained in the consistency
review law. Thus~ each answer must be explained in detaii~ listing both supporting and non-
suooortim, facts. If an action cannot be certified as consistent with the LWRP policy standards and
conditions, it shall not be undertaken.
A copy of the LWRP is available in the following places: online at the Town of Southold's
website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all
local libraries and the Town Clerk's office.
scm# I o$
PROJECT NAME
DESCRIPTION OF SITE AND PROPOSED ACrHON
The Application has been submitted to (check appropriate response):
TownBoard ~ Planning Board ~ Building Dept. [] Board of Trustees ~
Category of Town of Southold agency action (check appropriate response):
(a) Action undertaken directly by Town agency (e.g. capital [-~
construction, planning activity, agency regulation, land transaction) [~
(b) Financial assistance (e.g. grant, loan, subsidy)
(c) Permit, approval, license, certification: [~//
Nature andextentofac~ ~g~..~e.~ o~/~ S t th ~o~to[ q/'LtX'2~ot),~t7 ~,.a~
Site acreage:
Present land use: 12e__) ,~ ~2~ ~_'--~/
Present zoning cl~sification:
If an application for the proposed action has been filed with the Town of Southold agency, the following
information shall be provided:
(a) Name of applicant:
(b) Mailing address:
(c) Telephone ntunber: Area Code
(d.) Application number, if any:
Will the action be directly undertaken, require fimding, or approval by a state or federal agency?
Yes [] No [~Ifyes, which state or federal agency?
C. Evaluate the project to the following policies by analyzing how the project will further support or
not support the policies. Provide all proposed Best Management Practices that will further each policy.
Incomplete answers will require that the form be returned for completion.
DEVELOPED COAST POLICY
Policy 1. Foster a pattern of development in the Town of Southold that enhances community character,
preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and
minimizes adverse effects of development. See LWRP Section III - Policies; Page 2 for evaluation
criteria.
Attach additional sheets if necessary
Policy 2. Protect and preserve historic and archaeological resources of thc Town of Southold. See
LWRP Section III - Policies Pages 3 through 6 for evaluation criteria
[] Yes [] No ~Not Applicable
Attach additional sheets if necessat3'
Policy 3.
LWRP Section III - Policies Pages 6 through 7 for evaluation criteria
~Yes [] No ~ Not Applicable
Enhance visual quality and protect scenic resources throughout the Town of Southold. See
NATURAL COAST POLICIES
Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP
Section III - Policies Pages 8 through 16 for evaluation criteria
~ Yes [] No ~Not Applicable
Attach additional sheets if necessary
Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section II1
- Policies Pages 16 through 21 for evaluation criteria
~ Yes [] No [~Not App. licable
Attach additional sheets if necessary
Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including
Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section Ill - Policies; Pages 22
through 32 for evaluation criteria.
Yes
No Not ~pplicable
Attach additional sheets if necessary
Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section II1 - Policies
Pages 32 through 34 for evaluation criteria.
~ Yes ~ No ~plieable
Attach additional sheets if necessary
Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous
substances and wastes. Se~e_LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria.
[] Yes ~ No[~t--I Not Applicable
PUBLIC COAST POLICIES
Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public
resources of the Town of Southold. See LWRP Section III - Policies; Pages 38 through 46 for evaluation
criteria.[] f~ ~
Ye~ · No cable
Attach additional sheets if necessaD'
' ' POLICES
· WORKING COAST
Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in
suitable locations. See LWRP Section III - Policies; Pages 47 through 56 for evaluation criteria.
[~Yes ~] No ~able
Attach additional sheets if necessary
Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic
Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria.
[] Yes ~-] No N[~ot Applicable
Attach additional sheets if necessary
Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III - Policies; Pages
62 through 65 for~riteria.
[] Yes ~ No~L-L/Not Applicable
Attach additional sheets if necessary
Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP
S~[~- Policl,es; Pages 65 through 68 for evaluation criteria.
No [] Not Applicable
PREPARED BY T{~ra ~/~/,~ -~- C ~(~ ] ~n'/ TITLE