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Home My WebLink AboutTR-5846Albert 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 SOUTHOLD March 24, 2004 Mr. Glenn E. Just J.M.O. Environmental Consulting Services P.O. Box 447 Quogue, NY 11959-0447 RE: CHRISTOPHER PlA 5900-6000 VANSTON RD., CUTCHOGUE SCTM#118-1-2 Dear Mr. Just: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, March 24, 2004: RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to Permit #5846 to restore the existing boathouses (30.6' X 16.4') and (20.4' X 12.4'), replacing the existing windows, siding, and to re-shingle the roof, and as depicted on the site plan prepared by Samuels & Steelman dated March 16, 2003. This is not a determination from any other agency. If you have any questions, please call our office at (631 ) 765-1892. Sincerely, Vice-President, Board of Trustees JK:lms Board Of Southold 'Town Trustees SOUTHOLD, NEW YORK CHRISTOPHER PlA ISSUED TO Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1893; end Chapter 404 of the ,L?ws of the State of New York 19521 end the Southold Town Ordinance titled ."REGULATING ,&ND THE PLACINg= OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS end the REMOVAL OF SAND, (~RAVEL OR OTHER IdATERIALS FROtd LANDS UNDER TOWN'WATERS:~. end in accordance with the Resolution of The B6erd adopted et a meeting hem o~ .......D.~.~....~., ~0(~......., and in consideration of the sum of $....~.~.~..~.0 ....... paid by ~h~stop~e~ Pi~ of ....... ~.t.F..~...°..g~.~. ..............................' .................... N. Y. end subject to the Terms and Conditions listed on the reverse slde hereof, of Southold Town Trustees authorizes and rmrmh's the fo~owinc~: all in ac~orclence with the detailed sl?ecif'mations es presented in · the odglnating application. . IN WITNESS WHEREOF, The sald Board of Trustees here. ~ causes ifs Corporate Seal to be affixed, and these p.resenh fo subs~n'bed by a 'mejorfly of the said Board as of this date. Tt~.s?ee~ TER~S ,.nd CONDITIONS l~e p~rm~ Christopher Pia residing ~t 5900-6000 Vanston Rd., Cutchogue 1~. ¥., ~ 2. Tlmt d,~. Pem~ ~s' valid for s .period of 24 mos. ~nld~ b comtde~d ~o ~e f~e for an ezten~.on n~y be n~de to ~ ~ st · I.~*~ d_.~_ 4. 'i'nat d~e work .involved will ~ subject to ~he i~, ~,,p~ion and app~,l of the ~ ~ its agents, and non-mmpllance with. the ptovi~iom of ~e ~ app[~_~on, may be ~ for 5. That there wiH be no unteasomble interfe~'ence wlth mvigalion as a t,e~lt o~ d~e work Albert J. Krupski, President James King, Vice-President Attic Fester 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 December 17, 2003 Mr. Glenn E. Just J.M.O. Environmental Consulting P.O. Box 447 Quogue, NY 11959-0447 CHRISTOPHER PIA 5900-6000 VANSTON RD., CUTCHOGUE SCTM#118-1-2 Dear Mr. Just: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, December 17, 2003 regarding the above matter: WHEREAS, Glenn E. Just on behalf of CHRISTOPHER PIA 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 20, 2003, 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 thc Town Trustees with respect to said application on December 17, 2003, at which time all interested persons were given an opportun/ty 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 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 approve the application of CHRISTOPHER PIA to reconstruct, in-place 824' of timber bulkhead utilizing vinyl sheathing, to reconstruct, in-place, two 50' timber groins utilizing vinyl sheathing, to reconstruct, in-place two timber jetties (60' and 50') utilizing vinyl sheathing, to dredge an existing 55'X 115' boat basin to -4' ALW, the resultant spoil 300 cy. of sand shall be utilized as backfill for the reconstructed bulkhead as needed, to remove 162' of timber bulkhead and install 162' of 100-200 lb. stone along the bank, to remove 30' of timber bulkhead and install a 20' return utilizing vinyl sheathing, to remove 10' of timber bulkhead and to install 50' of 100-200 lb. stone along bank, to reconstruct in-kind/in- place 4,000 sr. of timber walks, to remove an existing 200 sf. deck, to construct a new 200 sf. deck and to install a temporary 10'X 15' duck blind, and as depicted on the site plan prepared by J.M.O. Environmental Consulting Services last dated February 11, 2004. Permit to construct and complete project will expire two years fi-om 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 $5.00 per inspection. (See attached schedule.) Fees: None James King Vice-President, Board of Trustees JK/lms BOARD OF TOWN TRUSTEF. S TOWN OF SOUT~OLD 5309S Hain Road Sout~oM, N.Y. ].1.971 ( ) OFFE/'/ORE HOO.qOVG' - Mushroom only - Weight; B0~rd of Trustees ( ) Off'SHOREST, e,X~ C ) O~RE ST,4X~ ~ ,':~LLEr TO ON,.~OREST,4XE C ) r~'~e~rw~v e~G~CNumber of p~les) OWN~ ~-' ~ ~ ~- ~, ~ ~ ~t ~m ~n ~ ~ w~i ~ ~. ~ ~ ~ ~ ~. On ~ ~e ~ ~p. ~ a ~ ~ Appr~c distance to channel: ~- Number boats moored within 100' Tn making this application, t declare'rtl at bSe placemmlt of ttlZs flx~odng will not be an Impediment to the normal needs of ot~e~_ 'Permit, when issued, ts valid for one year, at wMch time runewal Is nb ~. Permit ~ am based upQn length ol' boat. No mooring permit will be i~ued I~r boats over 8860~9TS Wd~I:~ $00~'0~'~0N T'd ~TP'ON 12/'10/03 Field Inspection i2/10/03 Field Inspection 12/10/03 Field Inspection 12/'10/03 Field Inspection 12/10/03 Field Inspection 12/10/03 Field Inspection 12/10/03 Field Inspection Telephone (631) 765-1892 CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 At the meeting of the Southold Town Conservation Advisory Council held Monday, December 8, 2003, the following recommendation was made: Moved by Don Wilder, seconded by Tom Schlichter, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH A STIPULATION of the Wetland Permit application of CHRISTOPHER PlA to reconstruct in-place, 937' of timber bulkhead utilizing vinyl sheathing, to reconstruct in- place, two 50' timber groins utilizing vinyl sheathing, to reconstruct in-place, two timber jetties (60' and 50') utilizing vinyl sheathing, and to dredge an existing 55'X 115' boat basin to -4 ALW. The resultant spoil, 300 cy. of sand, shall be utilized as backfill for the reconstructed bulkheading as needed, and to reconstruct in-kind/in-place, 4,000 sq.ft. existing timber walks. Located: 5900-6000 Vanston Rd., Cutchogue. SCTM#118-1-2 The CAC recommends Approval of the application with the Stipulation no treated wood is used and a non-turf buffer is established below the bluff level. Vote of Council: Ayes: All Motion Carried Pia Property 5900-6000 Vanston Road Cutc~hogue 8SEP'03 1030HRS Pia Property 5900~000 Vanston Road Cutchogue 8SEP'03 1030HRS Pia Property 5900-6000 Vmlston Road Cutchogue 8SEP'03 1030HRS Pia Property 5900-60~K~ Vanston Road Cutchogue 8SEP'03 1030HRS Pia Property 5900.6000 Vanston RoM Culehogue 8SEP'03 ! 030HRS \0 Pia.Property 5900-6000 Vanston Road Cutchogue 8SEP'03 1030HJtS Pia Prop~y 5900-6000 Vm~ston Road Cutc~hogu¢ 8SEP'03 1030HRS Pia Pro~'~erty 5900-60~) Vanston Rood Culcho[,u¢ 8,~1.':I"03 10301 IRS Y FOR ADJOINING AREA SEE MAP NO30 I C B A Y 42 MAR-2~-2004 14:54 FROM:JMO CONSULTING 65~3~8 TO:?65182~ P.~ Environmental Consulting Services March 23, 2004 Mr. Albert Krupski, President Board of Town Trustees Town of Southold P.O. Box 1179 Southold, NY 11971-1179 Southold Town RE: Application for Christopher Pia Board 0! T~usteas 5900-6000 Vanston Road, Cutchogue S.C.T.M, No. 1000-118-1-2 Dear Mr, Kmpski: At the present time we are seeking to modi~ this permit which was issued on 12/17/03. Thc r~uestcd modification is to allow for thc restoration of existing boathouses (30.6' x 16.4 ') and (20.4' x 12.4'). The proposed restoration would b~ to replac~ ~,isting windows, siding and to re-shingle roofs. Please feel free to contact me at any time with any comments or questions pertaining to this matter. Sincerely, of E, Just GE J/ed Via facsimile Phone (631) 653-0607 * Fax (631) 653-3348 121 Jessup Ave * 2nd Floor * P.O. Box 447 Quogue, New York 11959-0447 J.l l.0. Environmental Consulting Services Februar~ 20, 2004 Mr. Albert Krupski, President Board of Town Trustees Town of Southold P.O. Box 1179 Southold, NY 11971-1179 $0uth01tl TOwn RE: Application for Christopher Pia B0~d 0f ~ru~tees 5900-6000 Vanston Road, Cutchogue S.C.T.M. No. 1000-118-1-2 Dear Mr. Krupski: In response to my recent discussion with Lauren regarding this project I have enclosed copies of the revised plans. The plans which were last submitted on 1/13/04 have been modified to depict the proposed temporary duck blind. Upon your review of these material please feel free to contact me at any time with any comments or questions pertaining to this matter. Enclosure Phone (631) 653-0607 · Fax (631) 653-3348 121 Jessup Ave · 2nd Floor · P.O. Box 447 Quogue, New York 11959-0447 JETTY SECTION SCAL~ I%Z' --AHWZ¢' ALWO EK)TTOM ...... / ~ ,~ ~ J.M.O. Environmental Consulting Ser¢ces Quogue, New York SD. CTIO, N I~ULKHDAD REIqOvAD f STOND INSTALLATION SCALE- Applicant: Christopher Pla Purpose: Bulkhead reconstruction Location: 5900/6000 Vanston Road Datum: Apparent Low Water S.C.T.M.No. 1000-118-1-2- Locus: 72027'41~00L SHrifT 6C~ 6 /"~BLKD- TO 13E RF_~,OVED DJ LTEE FABRIC~i~--¥ 3-' 7AHW 6' ,),^ LW Applicant proposes to reconaia act, in place 824' of timber bulkhead utilizing vinyl sheathing, to reconstruct, in place, two 50' timber groins utilizing vinyl sheathing, to reconstruct, in place two timber jetties (60' and 50') utilizing vinyl sheathing, to dredge an existing 55'x 115' boat basin to -4' ALW, the resultant spoil 300 c.y. of sand shall be used as backfill for the reconstructed bulkhead as needed, to remove 162' of timber bulkhead and install 162' of 100-200 lb. stone along bank, to remove 30' of timber bulkhead and install a 20' return utilizing vinyl sheathing, to remove 10' of timber bulkhead and to install 50' of 100-200 lb. stone along bank to reconstruct in kind in place 4,000 s.f. of timber walks, to remove an existing 200 s.f. deck and to construct a new 200 s.f. deck. At Great Peconic Bay, Cutchogue, Town of Southold, Suffolk County, New York. Quogue, New York YtoA ~aN 'anBonO se:~t~, e~§U!~lnsuoo le~ua~uuo, q,~ug '0'1t11'£ U c,q ................ 120 SECTION t5 SCALE 2'~X I ;~' CAP FOLLOWERS EX.~PROR. GRADE'¢ MANTCY'__, ~5¢B~ wALE ~CH~ '~IT ~ DIS~ ~PI~ ALWO ' BOTTOM~ 5H6ET JMo ~NVmO~NT^L QUOGUE, N.Y. 20F ~ Z J.M.O. Environmental Consulting Services Quogue, New York "'~CTION 15 SCALE CAP FOLLOW:RR EX.~ PRO~. GRAD6~' ~ , ~ANTARAY*~ ~ ~ ~XS~WALE AHW*~ ALWO ' SHEET JlVIO ENVIRONM£NTAL CONSULTING QUOGUE, N.Y. ZOF G ¥~ox ~eN 'en/JonO seo!A~eS [JUfllnsuoo le~ueu~uo~!Auj~ 'O'I/V'P J.M.O. Environmental Consulting~Services Quogue, New Yo~k JETTY SECTION SCALe I%,Z'" AHWZ¢' ^LWO .SECTION L3ULKHF_AD REI,.IOVA b ~( STONE' INSTALLATION SCAL[- 14 z/ Applicant: Christopher Pla Purpose: Bulkhead reconstruction Location: 5900/6000 Vanston Road Datum: Apparent Low Water S.C.T.M.No. 1000-118-1-2- Locus: 72°27' 41~00L ~BLKD- TO Lg~ RF_.~,OVED S~ 60~ 6 LW Applio~t pro~s to ~~ ~ plno~ ~24' of timer bu~ead util~inB v~yi shm~B, to ~ons~ct, in pl~oo, ~o 50' timbor ~ins utili~8 v~yl shea~, to mcons~, in pl~eo ~o timber jemies (60' ~d S0') util~ vinyl shea~in~, to ~od~o ~ o~istin~ 55'x 115' boat b~in to 4' ~W, ~e ~ul~t s~il 300 c.y. ofs~d shall be ~ed as b~ll for ~e recons~ct~ bu~ead ~ needed, m remove 162' offer bu~ead ~d hsmll 162' of 100-200 lb. stone along b~ to remove 30' of timber bul~d ~d ins~ll a 20' re~ ufili~ng v~yl shea~ing, m ~move 10' oft~r bul~ead ~d ~ install 50' of 100-200 lb. stone ~ong b~ to mcons~ct in ~nd in place 4,000 s.E oft~ber walks, m ~move ~ existing 200 s.f. deck ~d to ~nsmct a new 200 s.f. deck. At ~em Peconic Bay, Cutchogue, To~ of Sou~old, Suffo~ Co~, N~ York. Ouogu , N,w ,qm;fb~,hT. t',.'v Yol], ! 1971-¢)f)Sg IlOAI~'I) OF TOWN TOWN OF ~OU'I'HOLD '- ...... Office Use Only _. C_~.o sial Erosio. l'e~ mi! Applicmion ~_~tla.ld Permit Al,plicatio. _..~".Major ....... Min(.r WaiveffA m enchnent/(:t~8..~es --~eeived Fee:$ ~ ..~lncomplete ~SEQRA Classification: Type I ..... Type 11 U ~listed Coordinafion:(date sent ~eeeipt orCAC Report: Le~d Agency Determination: Technicnl Review: NOV 2 0 003 Southold N~me of Applicant ,,Christop_b_hgr Pia Address ................. _-4__A_g~_~_iel_ __~__Lane, Green_w__i_c_h_~ CT 06831 .......................... Pho,e Number:( )._~c/_9 SulTolk Cuunty 'Fax Mnp Numl~er: 1000 - __.J__l_8__-~ Property Local ion :_j~_0_.0_7 6.q ~ (~ (provide Lll,CO Pole #, distance to cross streets, and location) AGENT: Glenn E. Just/ AH0 E,~vironmental Consult~i~q/t___ (If applicable) Address: ........... P_; _0_,_ B o x ./* (~ 2... Q.9 ~_u e_.~._ !_19~_9_ :-0_4.4_7 ........................................ Phone: ...... ~i~_3_~.ObO_!_ GENERAL I)ATA Land Area (in square feet)' + 497 166 Area Zoning: Previotm use ofproperty: .... single family dwelling Intended nse of property: ........... same Prior permits/approvals fi~r site improvements: Agency Date Southold Town !rust_es 12/19/02 N.Y.S.D.E.C. 3/26/03 .... N. prior permits/approvals for sile improvements. Ila~ any pcrmil/approval ever been revoked or s.spended I,y a govt,.mental agency? __~No_ _ _Yes lfyes, provide explanation: Project Description (use at/achn,ests if necessary):. _ P!~_~_e see attached. Project Description for Christopher Pia 5900/6000 Vanston Road Cuthchogue Applicant proposes to reconstruct, in place, 937' of timber bulkhead utilizing vinyl sheathing, to reconstruct, in place, two 50' timber groins utilizing vinyl sheathing, to reconstruct, in place two timber jetties (60' and 50') utilizing vinyl sheathing, to dredge an existing 55' x 115' boat basin to -4 ALW, the resultant spoil, 300 c.y. of sand shall be utilized as backfill for the reconstructed bulkheading as needed and to reconstruct in kind in place 4,000 square feet existing timber walks. Board of Trus~:ees Application WE'II'!,A, NII/TRUSTEE II,ANI)S APPI,ICA'I ION DATA Purpose of the proposed opcralions: ._ __B~_u_~!c_hggd~_e_e_c_9.? s_ _t_~ u_ c_ ~ t_on_ Area or wetlands on lot: I gO ,.~07 ....... square feet Percent coverage of lot; ..... n/. e. .... % Closest distance between .emesl c×i~ling struclure a.d upla.d edge of wetlands: .~ 0 ...... feel Llosest d s a ~ce between nea~c, proposed sbuctore and upland edge of wellands: ......... 0 ....... feet Does thc prqject involve excavafi(m or filJi,g? No ..... JL _ Yes lfyes, how re.ch material will be excavaled?__ _.~0 cubic yards tlow much material will be filled ? ........ ~__~.9~ _cubic yards Depth of which material will be removed or deposited: - &et Proposed slope throughout lhe area of operations: ~: ~ Manner in which material will be removed or deposited: payloader Stotemcnt ofthe e~ect, ifa.y.o, the wetla.ds ant{ tidal water~ o£tbe town that may resnl{ by reason of such proposed operations (use attachments if appropriate); _~0 ~r~osed, the pro3ect should have no negative ±~paets _~pon the waters or wetlands of the Town of Southold Appendix C State Environmental Quality Revi.w' SHORT ENVIRONMENTAL ASSESSMENT 'FORM For UNLISTED ACTIONS Only PART I o PROJECT INFORMATION (To be completed by A[~plicant or Project Sponsor) 1. APPLICANT/SPONSOR J2. PROJECT NAME Christopher Pla J Bulkhead reconstruc'tio. 3. PROJECT LOCATION: Municipality Cutchogue County Suffolk 4. PRECISE LOCATION (Street address end road intersections, prominent landmarks, etc., or provide map) 5900-6000 Vanston Road S.C.T.M. No. 1000-118-1-2 5. PROPO~SED ACTION tS: [] Expansion 6. DESCRIBE PROJECT BRIEFLY: D Modificationleitersfion })lease see attached 7. AMOUNT OF LAND AFFECTED: Initially ,~ acres Uitimstely ..~ acres 8 WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? '~ Yes [] No If No, describe briefly 9 WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ~.Restdential [] Induslrial [] Commercial Describe; single family dwelling [] Agricuituro [] Park/ForesVOpen Space [] Other 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNME~FAL AGENCY (FEDERAL, STATE OR LOCAL)? ~ Yes [] No If Yes, list agency(s) name and permit/approvals: Southold Town Trustees, NYSDEC, NYSDOS & USDOA 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMiT OR APPROVAL? ~Yes [] No If Yes, list agency(s) .ame and permit/approvals: Southold Town Trustees NYSDEC 1-4738-03155/00001 12, AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? DYes J~No I CERTIFY That TF~NFORMATIOI*~PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEI~i~E.I I If the action iS in th~ ~.a{ial Arg;, and you are. st;ie a,;"cy, complet~ I Coas~l Assessfiient Form before proceeding with ~s assessment OVER · Complete Items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. · Print your name and address on the reverse so that we can return the card to you. · Attach this card to the back of the mailpiece, or on the front if space permits. 1, Article Addressed to: 2. Article Number PS Form 3811, August 2001 Demerit Return Recaipt G. Det~, of ,Deli~A~d~vvo~ [ O. Is delivery address dEfsm~t fmm ifom l ? ?~ If YES, enter delive~ address below: Lq NO 3. Service Type ~rtEied Mail r'l Express Mall ri Registered ~'3 Return Rec, elpt for Merchandise D Insured Mall [~ C.O.D. 4. Restricted Delivery? (Extra Fee) r'3 Yes U.S. Postal Service CERTIFIED MAIL RECEIPT (Domestic Mail Only; No Insurance Coverage Provided) m mi HATTITUCK ~ , NY 119~2 ~,, ~! 0.83 UNIT II): ogb'g · Complete items 1, 2, and 3. Also complete item 4 if Restitct~d Delivery is desired. so that we can tatum the card to you. · Attach this card to the back of the mailpiece, or on the front if space permits. 2. Article Number (Transfer from selvlce labeO Ps Form 3811, August 2001 yReceive~l by ( Prinfed Name) C. Date of Delivery NOV 2 8 D, Isd~iveryaddre~sdJfferentf1,~grnJfem t? [] Yes If YES, enter delivery address below; [] No 3. Se~,Ice Type ~ied Mail I-I Express Mall [] Registered J~ Return Receipt for Merchandise r-I Insured Mail n C.O.D. 4. Restricted Delivery? (Extra Fee) C1 Yes U.S. Postal Service CERTIFIED MAIL RECEIPT (Domestic Mail Only; No Insurance Coverage provided) 0.83 · Complete ~tema 1, 2, and 3./Uso complete item 4 if Restricted Delivery is desired. · Pdnt your name and address on the reverse so that we can return the card to you. · Attach this card to the back of the mailpiece, A. Si nature X I-I Addressee B-,~Received by( Pdnted Name) . C, Date of Delivery 3. Se~ice Type ~r~lfled Mall E~ Express Marl ri Registered ~1 Return Receipt for Merchandise r-J Insured Mail /-1 C.O.D. 4, Restricted Delivery? (FA-tm Fee) [~] yes 2. ,~ticle Number (Ttansferfromservlcelabel) ~ ~'~ ~("~ ~,~L~__~~, PS Form 3811, August 2001 Domestic Return Receipt U.S. Postal Service CERTIFIED MAIL RECEIPT (Domestic Mail Only; No Insurance Coverage Provided) 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 SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of COUNTY OF SUFFOLK) STATE OF NEW YORK) $outboldTowg ~oard of Trustees AFFIDAVIT OF POSTING I, (~',,,~q,~,"~ '~L,L,~I~ , residing at being duly swom,-dOSpose a~d say: T,,at on theC/-tt orX , ,200'~ I persOnally posted the property known as by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eighl days prigr to the date of the public hearing. Date of hearing noted thereon to be held L~ .~ [,)i~_~[~f" I¢) ,~C~2' . Dated: 1/ // ........ (signature) ~ j Sworn to before me this ['3 dayof~c 2003 t'WA DO8 P-2YNSKA Notary Public. State of New York No 01D06073464 Ouahfled m Suffolk C0unly Comm*ssion Expiras April 22, 2~06 ,I. Pl. O. A PPI JC ANT/A GENT/REPRESENT A TI VE TRANSACTIONAl. DISCLOSURE FORM 3'he TowrLo_f Southold's Code of.F;JLfic_'~2~phi_bbi~g~_o_nflicts of interest on the parl of town officers and empJ~.veem The purpose of ~t!~is fom_Ds_m provide information~ ._w.h_ich c~_n_ale,!$be town o~fpossible conflicts of interest and allow it to take whatever action is ne~c_es_s~ary to avoid same. (Last name, irst name, mit[die initial, unless you are applying in the nalne of someone else or cqfier entity, such as a company. If so, indicate the olher person's or COll}pally's name.) NAME OP APPLICATION: (Check all that apply.) Tax grievance Variance Change of Zone Approval of plat Exemption fi'om plat or official map ........ Other the Do you persooaHy (or through your company, s )ollse, sibling, m~enh o[ child) ha~.e a relationship wilh any nfficer or employee of Ibc Tox n of Sonthold'~ "Relafio. ~ship" includes by. blood, marriage, or btlslnc~s intc~e~l 1~ s ne~s n ~ e.s ' n cans a bus ness, b~cluding a palmetship, in ~hich tim town officcr m employee has even a paai:d m~mrship of(or employment by) a corporation in which the to~xn officer or employee ex, ns mole than 5% of the shares. YES ......... lfyoua swred YES c)mplee lc[ I ceof hsfomaml I eandsgnv.}ccl Icacl Name of pe~son employed by Ihe 'Fmvn of Southold Title or position or that person Describe thc iclalionship between )rourself (lhe applicant/agcnl/repmsentative) and the town officer or c~ · ~ ,.: e. Either check Ihe appm,miate line A) through D) m~d/or describe Jn the space provided. 'Ihe town officer or employee or his or her spouse, uilding, parent, or child is (check all flint apply): ._.A) the owner of greater than 5?,;, of die shares of the corporate stock of thc applicnnt (when the applicanl is a corp~walion); .... B) Ihe legal or beneficial owner of any interest in a non-corporate entity (when lhe applicant is not a corporation); .... C) an officer, director, partner, or employee nfthe applicanl; or .... D) the actual applicant. DESCRIP I'ION OF RELATIONSItlP