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Home My WebLink AboutTR-5298SURVEY OF PROPERTY A T MA TTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK ',' lO00-1;gg-03-31 SCALE: 1"=30' z CER T/FIED TO~ NORMAN WENK Z FR. ~B 6/ 77.~.00. W Z~CZON AREA=23,334 S.F. TO TIE LINES 00-335 EN-CONSULTANTS, INC. 1329 North Sea Road Southampton. New York 11968 631-283-636¢ Fax: 631-283-6136 E mail: encon(~'peconic.nel www.enconsulta~ts c,%m ENVIRONMENTAL SERVICES March 26. 2001 Lauren Standish Board of Trustees Town of SouthoM P.O. Box 1179 Southold, NY 11971 Re: Norman Wenk~ 675 East Legion Avenue~ Mattituck Dear Ms. Standish: As discussed during the 21 March 2001 public hearing on the captioned application, please find enclosed (3) copies of a project plan revised to depict a reduced dredge area; reduced spoil calculations; and a I0' non-turf buffer landward of the new bulkhead. Although I expect this information will alloxv you to issue Mr. Wenk's permit, please contact me at your earliest convenience if you have any questions. Robert E. Herrmann Coastal Management Specialist EN-CONSULTANTSINC. 1329 NORTH SEA RD. SOUTHAMPTON, N.~ 11968 631-283-6360 EN-CONSULTANTS INC. 1329 NORTH SEA RD. SOUTHAMPTON, NZ 11968 631-263-6360 LN-CONSULTANTS INC. :329 NORTH SEA RD. 5r')UTHAMPTON, NZ 11968 ~31-283-6360 Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hail 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax t631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD March 22, 2001 Mr. Robert Herrmann En-Consultants, Inc. 1329 North Sea Road Southampton, NY 11968 Norman Wenk 675 East Legion Avenue Mattituck, NY SCTM#122-3-31 Dear Mr. Herrmalm:: The following action xvas taken by the Board of Town Trustees during a Regular Meeting, held on March 2 l, 2001, regarding the above matter WHEREAS, Eh-Consultants, Inc. on behalf of NORbIAN WENK applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated March 1, 2001 and WHEREAS, said application was referred to the Southold Toxvn 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 March 21,2001 at xvhich time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viexved 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 97-18 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare o f the people of the town, NOW THEREFORE BE IT. RESOLVED, that the Board of Trustees approved the application of NORM~N WENK for a Wetland Permit to remove & replace (in-place) approximately 136 linear feet of existing timber bulkhead with vinyl bul ~khead, including a 10' westerly and 16' easterly tatum 50 foot dredge in the middle to 4 foot - 10 foot non-turf buffer. BE IT FURTHER RESOLVED that this determination should not be considered a deternfination made for any other Department or Agency which may also have an application pending for the same or similar project. Permit to construct project xvill expire two years from the date it is signed. Fees must be paid, if applicable, and pemfit issued within six months of the date of this notification. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Txvo inspections are required and the Trustees are to be notified when project is started and on completion of said project. FEES: NONE Very truly yours, Albert J. Krupski, Jr. President, Board of Trustees AJK/cjc cc: DEC Army Corp. Dept. of State Of Southold To n Trustees SOUTHOLD, NEW YORK NORMAN WENK ISSUED TO ................................................................................................ Pursuant to the provisions of Chapter 6IS of the Laws of the State of New Yorl~, 1893: and Chapter 404 of the Laws of the State of New Yorlc 19~i2: and the Southold Town Ordinance en- tiffed ."REGULATING AND THE PLAC~ING 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 afa meeting held on .M~u~.ch £00.1..... and in consideration of the sum of $ 200...0.0 .... paid by E~.-Con~.!t.~n~ .....[B.~., .o.n....b.e.h~f..of...NOR~AN..~EN~ .................. of ll ~ Ol~ ~ ~ m ~ 0 ~l~ t~e' reverse slde hereof. Terms and Conditions ............ 'iisfed'""~ Y. and subject to the of Southold Town Trustees authorizes and permlts the following: Wetland Permit to remove & replace (in-place) a~o,prox~ra~e~y 136 linear feet of existing timber bulkhead with vinyl bulkhead including a l0t westerly and 16' easterly return, 50 foot dredge in the. middle to 4 foot - 10 foot non-.gBr¢ buffer. all ~n accordance with the detailed speclf,c~'fions as presentea in · the originating application. IN WITNESS WHEREOF, The said Board of Trustees here- ' by causes its Corporate Seal to be at, xed, and the~e p.resents to be subscribed by a majority of the said Board as of th,s date. TERMS and CONDITIONS Ti~ Pctmkt~ NORMAN WENK' 675 East Legion Avenue, Mattituck, s~-~ll,~ st ....... N.Y., as 1~: 1. That the said Boaid o/ Tm._~__~__ s~d the Town ol 5oudmld ~ xd~as~l 'fi,~ any sad atlo~ pedo,',,~4 puxsuau¢ to this p-,~,', and the *aid Peanieeee wi~ ~tl~ ~ he~ om~ expense, for an ~on may be made to the Board at a latex d-to. ~. That this Permit should be tetalned indet"mite~y, or as loo~ ~ d~e s~d ~ wish~ to mahzain the structure ot project involved, to provide evidence m anyone corn:creed that ac/zatio~ was originally obtained. 4. That ~he work involved will be subject to the inspection s~! approval of the Board it~ agents, and non-comp~;-~'~ with. the provisions of the orl~a,,g appllcadoo, may be cause tevocallo~ of rhL~ Peimlt bI' zesoludon of the ~id ~ 5. That ~here will be no unzeasoaable intesfe~ence with n~vlgatioa as · t~mlt of the work hetdn a&hot~zed. 6. That there shall be no intedetence with the tight of d~e ~ to pass and vt~tss alm~ the beach between high and low water marks. 7. Th~ if fum~e operations of the Town of 5outhold require ~he removal and/or alterations in the location of the work herein au ~d~°a~, or if, in the opinkm of the Board ot Tmstee~, ~. work r.l~dl ~use unreasonable obstx~:tm~ to free navig~ the ssld P~mkte~ will be ~lutrgd, upoa ~ue notice, to remove or alter Oais work or projec~ herein ststed witho~ ezpem~ to the Town 8. That the said Board will be no~qed by the Petmluee ot the compledon'0f the work amtx. odzed. 9. That d~e Petmittee will obtain aH other ~cs and consents that may be t~lulted sup- plementai to this permit which may be subject to revoke ul~m fai~ to o~ same. FROM : ENCONSULTANTS, INC. PHONE NO. : 6312856136 Mar. 21 2001 02:30PM Pi 1329 North Sea Road Southampton, NY ~1968 Phone: (516) 2836360 Fax: (516) 283-6138 Email: encon~peconic,net En-Consultants, Inc. · Comments: Al: As per our conversation yesterday, I spoke with Norman Wenk regarding the location of his bulkhead and obtained a copy of his deed from Suffolk County Clerk's Off-ice, a copy of which follows. The deed, most recently dalai 1995, still contains the original metes and bounds deschption from the filed map of Har~y DePetris, and reflects lot depths of 263' on the east and 250' on the west, as compared to the respective lot depths of 207' and 179' depicted on the survey dated 8 January 2001, submitted wi~ our application. Mr. Wenk in fact recalls being the first person to bulkhead along James Creek in the mid-1960's, after the creek was dredged by the U.S. Army Corps of Engineers. Therefore, it makes sense that Mr. Wenk's bulkhead would extend further into the creek than the adjacent bulkheads if these were subsequently constructed farther landward due to the natural landward translation of the exposed shoreline. I was also able t~ leam from Lauren that the Board issued a grandfather permit for the bulkhead in 1984, which of course legalized the structure in its present location. Based on this information, I assume that you will consider the question answered and can issue a permit for the project, Should you have any questions, however, please let me knew, Thanks foryourcooperefion, Rob Herrrnann DEPARTMENT OF THE ARMY ' NEW YORK DISTRICT, CORPS OF ENGINEERS JACOB K. JAVITS FEDERAL BUILDING NEW YORK, N.Y. 10278-0090 REPLY TO AI~E NTION OF Eastern Permits Section March 14, 2001 SUBJECT: Application Number 2001-00326-L2 by Norman Wenk To Whom It May Concern: The New York District, U.S. Army Corps of Engineers, has received a request for Department o~ t~'~rmy authorization for the following~g~.~%~t~,: _. ./~ ~ APPLICANT: Norman Wenk 675 East Legion Avenue Mattituck, NY 11952 ACTIVITY: Replace approximately 136 linear feet of existing timber bulkhead and 10 foot and 16 foot existing bulkhead returns with vinyl bulkhead, and backfill with 25 cubic yards of clean upland material. Dredge approximately 40 cubic yards of material up to 10 feet waterward of the replacement bulkhead. All dredged material would be disposed of at a state-approved upland site where it would be suitably retained so as to prevent its re-entry into any waterbody. The purpose of this work is to maintain an existing erosion control structure. WATERWAY: James Creek, Great Peconic Bay LOCATION: Mattituck, Town of Southold, Suffolk County, NY As this is minor in nature, authorization may be by Letter of Permission. This is in accordance with current Federal Regulations governing work in navigable waters of the United States. To accomplish the coordination required, prior to the issuance of a Letter of Permission, your review of the enclosed drawing is requested. Pursuant to Section 307 (c) of the Coastal Zone Management Act of 1972 as amended (16 U.S.C. 1465 (c) (3) (A)), the applicant has certified that the activity complies with and will be conducted in a manner that is consistent with the approved state coastal zone management program. To allow for the timely processing of the subject application, your comments are requested within 15 days of date of this letter. the Sincerely, ~. Hagger~~ ~ief, Eastern Permits Enclosure Section EN-CONSULTANTSINC. ~329 ';ORTH SEA RD. SOUTHAMPTON, N.~ 11968 631-283-6360 Telephone (631) 765-1892 Town H~ll. 53095 Main Road P.O. Box 1179 Southold, Ne~v York 11971 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Monday, March 19, 2001, the following recommendation was made: Moved by Bill McDermott, seconded by Bret Hedges, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL of the Wetland Permit Application of NORMAN WENK 122-3-31 to remove and replace approx. 136 linear ft. of existing timber bulkhead with vinyl bulkhead, including a 10' westerly and 16' easterly return. RESOLVED to recommend DISAPPROVAL to dredge to -4' ALW up to 10' off bulkhead to recover lost fill and truck approx. 40 cy. spoil off- site to an approved upland source. Approx. 25 cy. of clean sand will be trucked in from an upland source as used as backfill. 675 Legion Ave., Mattituck The CAC recommends Approval to repair the bulkhead but recommends Disapproval for the dredging because there is no need shown. Vote of Council: Ayes: All Motion Carried EN-CONSULTANTS, INC. 1329 North Sea Road Southampton, New York 11968 631-283-6360 Fax. 631-283-6136 E-marl: encon @ peconic, net www.enconsultants.oom ENVIRONMENTAL SERVICES February 28, 2001 Town of Southold Board of Trustees Post Office Box 1179 Southold, New York 11971 Attn.: Lauren Standish Re; Norman Wenk 675 East Legion Avenue, Mattituck SCTM #1000-122-3-31 Dear Ms. Standish: In regard to the above referenced property, enclosed are the following for the Board of Trustees review: 3. 4. 5. 6. 7. Three (3) Wetland Permit Applications. ( including Notice and Proof of Mailing to adjacent owners). Three (3) Short Environmental Assessment Forms. Three (3) copies of authorization & disclosure forms. Three (3) work plans. Three (3) copies of survey. One (1) set of site photographs. Application fee of $200.00. I trust this information shall allow you to process our permit request. Should any additional information be required, please do not hesitate to contact our office. Robert E.il~maxn Coastal Management Specialist /khs Enc. Albert J. Krupski, President Jan/es King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone(631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OFSOUTHOLD Office Use Only Coastal Erosion Permit Applicatio/{ Wetland Permit Applicationt." Major Waiver/Amendment/tChan]ges Received Application: --% 1o t [o / Received Fee:$ .D.- (r-o Completed Application Incomplete __SEQRA Classification: Type I Type II Unlisted Coordination:(date sent)~ CAC Referral Sent: ~[ 6 I Date of Inspection: 2~ I Receipt of CAC Report: ' Lead Agency Determination: Technical Review: Public Hearing Held: ~llgt Resolution: ~ Minor Name of Applicant Norman Wenk 675 East Legion Avenue Address blattituck, NY ij_952 Phone Number:( ) b3~-298-42~3 Suffolk County Tax Map Number: 1000 - ~ 2 2- 3- 3 1 Propeny Location: 675 East Legion Avenue, Mattituck (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: En-ConsulEants, Inc. 1329 North Sea Road Southampton, NY 1196U Phone: 63t-283-6360 Board of Trustees Application GENERAL DATA 23,334 Land Area (in square feet): Area Zoning: R- 40 Previous use of property: a e s _, d e n t i a 1 Intended use of property: ilo Change Prior permits/approvals for site improvements: Agency Date x 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 ifnecessary): Remove & replace (in-place) approximately ~36 linear feet of existing timber bulkhead with vinyl bulkhead, including a 10' westerly and i6' easterly return. Dredge to -4' ALW up to I0' off bulkhead to recover lost fill and truck approximately 40 cubic yards spoil off-sLte to an approved upland source. Approximately 25 cubic yards of clean sand will De trucked in fz'om an upland source and useo as Dackfil±. Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Maintain existing erosion control structure and ,~estore navigaole depths ad]acent bulkhead by dredging to recover lost fill. Area of wetlands on lot: u square feet Percent coverage of lot: n/a % Closest distance between nearest existing structure and upland edge of wetlands: n/a feet Closest distance between nearest proposed structure and upland edge of wetlands: n/a feet Does the project involve excavation or filling? No x Yes If yes, how much material will be excavated? 4 u cubic yards How much material will be filled? 2 b cubic yards Depth of which material will be removed oxxa~pn~ited: -4 feet i~LW (maximum) Proposed slope throughout the area of operations: n/a Manner in which material will be removed or deposited: ,,pproxima t_ely 40 cubic yards spoil to be Oredged via clamshell Ducker crane and trucked off-site. Approximately 25 cubic yards clean sand to De trucked in from upland source and used as backfill. 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): The project will involve maintenance of existing conditions and result in no adverse impacts to adjacent wetlands of Town waters. 14-16-4 (2187)--Text 12 PROJECT I.D. NUMSER 61 7.21 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I--PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1 . APPLICANT/SPONSORNOR~I~N V~NK BY I 2. PROJECT NAME EN-CONSULTANTS, INC. I 3. PROJECT LOCATION' Municipaldy MATTITUCK County SUFFOLK SEQR 4. PRECISE LOCATION (Strut address and road intersections, prominent landmarks, etc.. or provide map) 275 EAST LEGION AVENUE, MA"UF[TUCK, TOWN OF SOUTHOLD; SCTM #1000-122-3-31; MAP PROVIDED I s. PROPOSED ACTION' [] New [] Expa,sio, [] Modification/alteration 8. DESCRIBE PROJECT BRIEFLY' REMOVE & REPLACE (IN-PLACE) APPROXIMATELY 136 LINEAR FEET OF EXISTING TIMBER BULKHEAD WITH VINYL BULKHEAD, INCLUDING A 10' WESTERLY AND 16' EASTERLY RETURN. DREDGE TO -4' ALW UP TO 10' OFF 3ULKHEAD TO RECOVER LOST FILL AND TRUCK APPROXIMATELY 40 CUBIC YARDS SPOIL OFF-SITE TO AN ~PPROVED UPLAND SOURCE. APPROXIMATELY 25 CUBIC YARDS OF CLEAN SAND WILL BE TRUCKED IN FROM ~N UPLAND SOURCE AND USED AS BACKFILL. 7. AMOUNT OF LAND AFFECTED' Initially 23,334 S.F. acres Ultimately 23334 S.F. acres 8. W~LL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? [] No If No. describe briefly W,AT PRESE.T LA.D USE WC.. TY OF P.OJECT? [] Residential [] Industrial [] Commercial [] Agriculture [] Park/Forest/Open spa~e [] Other Describe: 10 DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? [] Yes [] NO If yes. list agency(s) and p~mlit/approvals 3EC, COE 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAL D PERMIT OR APPROVAL? ~J Yes ~ No I1 yes, list agency name and permit/approval 12 AS A RESU~-T OF PROPOSED ACTION WILL EXISTING PERMIT~APPROVAL REGUmRE MODIFICATION? I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE APP~iCa nU~p°n~o~ na m~'/,~//~B[~HERRMANN' COASTAL MGMT' SPEC IALIST Date: FEB, 26, 2001 Signature: ~ ~'/~ ~ ~ If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES~ TOWN OF SOUTHOLD In the matter of applicant: Nur~an Wen]< SCTM#1000- ±22-5-31 YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: Remove & replace %in-place) approximately 136 linear feet of existing timber bul~head with vinyl bulkhead, ±ncluding a 1u' off bulkhead to recover lost fill and truck approximately 40 cubic yards spoil off-site to an approved upland source. Approximately 25 cubic yards of clean sand will be trucked in from an upland source and used as backfill. 2. That the property which is the subject of Environmental Review~s located adjacent to your property and is described as follows: 675 East Legion Avenue, ~at~i~uc~ 3. That the project which is subject to Environmental Review under Chapters 32, 37, or 97 of the Town Code is open to public comment on: 3/21/01 You may contact the Trustees Office at 765-1892 or in writing. The above referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal. OWNERS NAME: Norman Wenk MAILING ADDRESS: 675 East Legidn Avenue ~4attituck, NY 11952 PHONE #: 631-298-42~3 Enc.: Copy of sketch or plan showing proposal for your convenience. Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda 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) AFFIDAVIT OF POSTING being duly sworn, depose ~d~ay: That on the I~__day of ~ , 200~ I persogally posted the property known ~_ ~$~ ~ L~ /~.~ ~c~ by placing the Board of Trust~s offi6ial poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date ~he ~blic ' Date of hearing noted thereon to be held~. Dated: ( · Sworn to before me this ~r~ day of 7~?c~_ 200/ FRor,~ : EN~-dHSULTANTS INC. PHONE NO. : 63128::361:]6 Mar'. 2.1 2001 02:]lPM P.- '~000 122,00 O31 .009 B£~.~F_NI NOR.M~ B. ~'[,N}(, ,1l(.. ro~(dln~, ~f. 875 E~t York I [ '. A v.. MURIZL E. WF. NK 675 F.~sc Le',{ior, ^venue, ~L~ul {tuck, Ne~ York 11952 H~c:~tuck, ~e~ Yor~ It952, will ~nd Ic~lcmcr.;, .Ind in co=s/dcrldun of T~ AND ~O/~00 ($ [O.00) .............. ........................................ doi{~r~, and York. bounded ~.nd described as foll~w~: on the East c~a hundred ~nd s~xty thr~e (263) fear by l~nd o[ Ou$cav Berg; on the South o~e hllndr~d at~d t~enty (120) ~ et by Legion Avenue: on the West cwo hundred anf :iffy (250) foot by l~d o~ John New Y~rk. bet 22, !993, ~n Liber 1J6~2, at page 902, ?i7P95. 41~, I" = ~xO' // / / PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: Robert & Anna Finora 795 East Legion Avenue Mattituck, NY 1±952 Robert Patchell 1~5 Raff Avenue Floral Park, NY 11001 STATE OF NEW YORK COUNTY OF SUFFOLK doing business En-Consultants, inc. Robert E. Herrmann , r~l~l~ at i329 North Sea Road ~outnampton, NY 1196~ Robert E. Herrmann , being duly sworn, deposes and says that on the 28 day of ~ ,~9 200% deponent mailed a true copy of the Notice set forth 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 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 Southampton _, that said Notices were mailed to each of said persons by (certified (~ mail. Sworn to before me this day of ~~ ,/~9~ Notar~ Public Coastal Management Spec~aiist ?o e (Please Print Clearly) (To be complet~ by mailer) [~}---'~.';/~£','v': ~;"~s~'b;;~-'"~. .................... C ae, ZI +4~/0 ~oard of Trustees Appl£c~n CounTy of Suffolk State of New York TRUE TO TPIE BEST OF HIS/HER KlqOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AiTD AS M3%Y BE APPROVED BY T~ SOLV~HOLD TOWN BOARD OF TRUST~EES. THE APPLICANT AGREES TO HOLD ~ TOWN OF SOUTHOLD A/qD T~LE TOWN TRUSTEES HAP/~LESS AND FREE FROM ANY AND ALL DAF~AGES AND CLAIMS ARISING U1FDER OR BY VIRTUE OF SAID PF~RMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTt{ORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN coNJUNCTION WITH REVIEW OF THIS APPLICATION. ~ SignaUure O/ SWOR/{ TO BEFORE ME THIS I~ DAY OF Notary Public MELAI~E V. ~qo~ HQb. y pIjIdi~ ~ d I~v Yc~ Board of Trustees ApDliclon AUTHORIZATION (prhnu owner of property) (mailing address) /~"1-/'~., ~ I/.~2-~ do hereby authorize {Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. · / ~ · /[Owner' s signauur~ APPLICANT TRANSACTIONAL DISCLOSUBE FORM Tile Town of Southold's Code of Ethics prohibits conflicts of interest on the parL of town officers and employees. The purpose of this form is to provide information which can alert tile town of possible conflicts of interest and allow it to ta~e whatever action is necessary, to avoid same. YOUR (Last name, first'name, middle int~[al, unless you are applying in the name of someone else or other entity, such as a company. If co, indicate the other person's or company's name.) NATURE OF APPLICATION: (Check all that apply.) Tax grievance Variance Change of zone Approval of plat . , Exemption from plat or official map other ./ [ (If "Other," name the activity.) /0~-C'~' ~/~ DO you personally (or through Four company, epoaee, 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 interest' means a bueiness, including a partnership, in which the town officer or employee hat even a partial own~rship of {or employment by} a corporation in which the town officer ur emplyyee owns more than shares. NO If you answered "YES,#. complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself (the applicant) arid the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space provided. The parent, A) town officer or employee or his or her spouse, sibling, or child is (check all that apply), the owner of greater than 5% of the shares of the corporate stock of the applicant (when the applicant is a corporation); B) the legal or beneficial owner of any interest in a noncorporate'entity (when the applicant is not a corporation); applicant; or D) tile actual applicant. DESCRIPTION OF RELATIONSHIP ¢:dTolk Fl~r~r~ ~, 2~ EN-CONSULTANTSINC, 1329 NORTH SEA RD. SOUTHAMPTON, N.~ 11968 631-283-6360 FROPO~I2 BULKI~AI? I~PL. ACg/VeNT ( PLACt~) POR NORMAN WP-NK ON JA/V~5 C~I~K,/V~fl'I11JCK, 5LIPPOtK CO,, NY F:Yr~.T I OF I 2/2~/OI i SURVEY OF PROPERTY A T MA TTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK 1000-12~-03_31 SCALE; 1"=30' /AN 8. Z N 85°~6'30' E 110,93' FR. $~D ~'~Y. FR. GAR. CEN I/FIED [0, NOfeMAN IfENK N 7>.~3.oo' W Rd, p~ ~eo. oo. AREA=23,334 S.F. TO TIE LINEs 0-33,