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Home My WebLink AboutTR-5629 James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OFSOUTHOLD January 23, 2013 Ms. Marilyn Angelson 876 Park Avenue New York, NY 10075 RE: MARILYN ANGELSON 950 PARK AVENUE, MATTITUCK SCTM# 123-7-13.1 Dear Ms. Angelson: The following action was taken at the Southold Town Board of Trustees regular meeting- held on Wednesday, January 23, 2013: RESOLVED, that the Southold Town Board of Trustees APPROVE the request for a Transfer of Wetland Permit #5629 from Adriana & Dana Courtenay to Marilyn Angelson, as issued on September 25, 2002. If you have any questions, please contact our office at (631) 765-1892. Sincerely, James F. King President, Board of Trustees JFK:amn .lames F. King. President Bob Ghosio, Jr., Vice-President Dave Bergen .Iohn Bredemeyer Michael J Domino PO Box 1179 Southold, NY 11971 Telephone (631 765-1892 Fax (63 I) 765-6641 Date/Time: Southold Town Board of Trustees Field Inspection/Worksession Report MARILYN ANGELSON requests a Transfer of Wetland Permit #5629 from Adriana & Dana Courtenay to Marilyn Angelson, as issued on September 25, 2002. Located: 950 Park Avenue, Mattituck. SCTM# 123-7-13.1 Type of area to be impacted: Saltwater Wetland Freshwater Wetland __Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: __Chapt.275 Chapt. 111 __other Type of Application: Wetland ~Administrative__Emergency Coastal Erosion Amendment Pre-Submission __Violation Info needed: Modifications: Conditions: Present Were: ~;J. King _~B. Ghosio __ ~,~,-d. Bredemeyer ~"'Michael Domino D. Bergen, D. Dzenkowski Form filled out in the field by ,j, Mailed/Faxed to: Date: other Board Of $outhold Town Trustees SOUTHOLD, NEW YORK PERMIT NO ~'~1~ -~ 9 DATE: '~Pt ;'"25';'"'Z002 ISSUED TO .......... ADI~A N .~...& ...D AN.A ..-~ Ob"t~ ~t!iN ~-¥ ............................... IN ~D ~ TOWN w~ ~ .... . .,.~c ~ R~ ~ ~ ~ ad~ed of · meet~ ~ ~ ,.~ep~...~, ~sa.l~nt~...i~c ~ ..on[. Wefl~ P~lit to ~h~lh sclwn~ f~c of approximately 259 I.,i~car f~ ofcxisllltg IJnlb~T ~y 2o a~c ~ of¢l~ ~ fill to ~ I~k~ i~ f~ sn ~l~d ~ James F. King, President Bob Ghosio, Jr., Vice-President ~)ave Bergen John Bredemeyer Michael J. Domino Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DEC 2 1 2012 APPLICATION FOR A TRANSFER OF A WETLAND PERMIT DATE AGENT PHONE ADDRESS Permit # ~'--~ ~ 7 from request a Transfer of /~ ~ ~00~/~ 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 October 8, 2002 Mr. Rob Hvmnann En-Consultants, Inc. 1329 North Sea Road Southampton, NY 11968 RE: SCTM# 123-7-13.1 Adrian & Dana Courtenay 950 Park Avenue, Mattituck, NY Dear Mr. HeH'lllann The following action was taken by the Board of Town Trustees during a Regular Meeting, held on September 25, 2002, regarding the above matter. WHEREAS, En-Consultants, Ina on behalf of Adrian & Dana Courtenay applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated August 29th, 2002 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 September 25, 2002 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, 2 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 of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approved the application of Adrian & Dana Courtenay for a Wetland Permit to resheath seaward face of approximately 259 Linear feet of existing timber bulkhead and +/- 33' return with vinyl sheathing, backfill scour holes landward of bulkhead with approximately 20 cubic yards of clean sand fill to be trucked in from an upland source with the conditions that the non functional groins be removed. 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. Fee must be paid, if applicable and permit issued within six months of the date of this notification. If inspections are required, at a fee of $5.00 per inspection (See attached schedule). FEES: $5.00 Very truly yours, Albert J. Krupski, Jr. President, Board of Trustees cc DEC Board Of $outhold 'Town Trustees SOUTHOLD, NEW YORK ISSUED TO .......... AD.R.~A N A....& ...D AN.A.-.. -G O-u'-~ T ~ N AY ................................ Authorization Pursuant to the provisions of Chapter 61!i of the Laws of the State of New York, 1893: and ~._.hepter 404 of the Laws of the State of New York 19521 and the Southo~ Town Ordinance rifled ."REGULATIN~ AND THE PLAC:ING OF OBSTRUOTIO~S IN AND ON TOWN WATERS AND PUBLIC: LANDS and the REIdOVAL OF SAND, GRAVEL'OR OTHER IdATERIALS FROId LANDS UNDER TOWN'WATERS;?. and in aeeoedanee with the Resolution of The B6ard adopted at a meeting held on ..$.~p.L..zSt~, .2QQ2..., and in consideration of the sum of $'"'-'Z00;'00 '" paid by .... ,~z~=C~oz~$u.]~nt.~..-i~¢.~'on7 be~zai~'-o~" · hereof, of ............... $ou.~l~em~?~ ................................... Terms and Conclif,ons listed on the reverse Of .~:~fh~ Tn'wn Tr,~~'~'~ ~,,dh~'~';?,~¢ ~qnd r~rm~ Wetl:md Pe~,lfit to resheath seaward face or~pproxlmatcly 259 l.i~car feet of cxisli,g limber bulkhead and +/- 33' return with vinyl sheathing, backfill scour ho[es landward of bulkhead with approximately 20 ¢ldsic yards of clean sand fill to be trucked in from an upland source with the c~ndRl~na tl, aI the non fttnc~ional grolns be rernm, ed. all in ac. ordam:e with the defai~ed Specifications as presented in the originating appr~cafion. IN WITNESS WHEREOF, The said Board of Trustees Irate- by causes ifs Coroorate Seal to be afl?ed, and ~ese presents fo be subsc~'bed by a' 'majorfly of the satd Board as of ~is darn. Trustee~ TERMS end CONDmONS ~ fo~ d~e Is?'''v~ o~ ~e ~ ....... -- plemental to this permit which .~y be subject to t~oke upon hilum to o~ _ - 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) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Eh-Consultants,_,,Inc'. on behalf of Adrian & Dana Gourtenay Please be advised that your application, dated August ?2~h 2002 has been reviewed by this Board, at the regular meeting of e ..... ~ ........ and the following action was taken: ( X ) Application Approved (see below) ( ) Application Denied (see below) (__) Application Tabled (see below) If your application is approved as noted above, a permit fee ts 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: ~ Inspection @$5.00 each TOTAL FEES DUE: $ 5.00 BY: PRESIDENT, BOARD OF TRUSTEES 4/98 - Albert J. Krupski, President James King, Vies-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 'r~UST~:ES TOWN OF SOUTHOLD 72 HOURS PRIOR TO COMMENCEMENT OF THE WOKr~, _ APPOIHTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. COURTENAY INSPECTION SCHEDULE X Pre-construction, hay bale line 1st day of construction % constructed Project complete, compliance inspection. One Inspection, @$5. O0 Telephone (631) 765-1892 Town Hall. 5a095 Main R~mi P.O. Box 1179 8outhold. Ne~v York 1197]. $OUTI~IOLD TOWN CONSERYA.TIOI~' _4J)VISORY COUNCIL At the meeting of the Southold Town ConserVation Advisory Council held Monday, September 23, 2002, the following recommendation was made: Moved by Melvyn Morris, seconded by Bill'McDermott, it was RESOLVED to recommend to the Southold Town Board of Tru Wetland Permit Applicatio (below lower wale) seaward face aPl sting timber bulkhead and +/-33' return with vinyl sheathing. Backfill scour holes landward of bulkhead with approx. 20 cy. of clean sand fill to be trucked in from an upland soume. Located: 950 Park Ave., Mattituck. SCTM#123-7-13.1 Vote of Council: Ayes: Ail Motion Carried Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town H~l 53095Route 25 P.O. Box 1179 Southold, NewYork 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN T~US'r~:ES TOWN OF SOUTHOLD 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 1= day of construction ½ constructed tx// Project complete, compliance inspection. 950 PARK AVENUE Figure L Looking east along face of ex. bulkhead to be resheathed below lower wale with vinyl. Figure 2. Looking west along face of ex. bullhead to be resheathed below lower wale with vDtyl. DANA COURTENAY, 950 PARK AVENUE~ MATTITUCK Figure 3. LooMng northwest at bnlhhead return to be resheathed below lower wale w~h vinyl. Figure 4. Lool~ing west along top of bulhhead and at scour holes to be backfilled with clean sand. EN-CONSULTANTS, INC. 1329 North Sea Road Southampton, New York 11968 631-283-6360 Fax: 631-283-6136 E-mail: encon @peconic.net www. enconsultants.com ENVIRONMENTAL SERVICES August 26, 2002 Town of Southold Board of Trustees Post Office Box 1179 Southold, New York 11971 Attn.: Lauren Standish Re: Adrian & Dana Courtenay 950 Park Avenue, Mattituck SCTM #1000-123-7-13.1 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 $200.00. I trust this information shall allow you to process our permit request. Should any additional information be required, please do not hesitate to contact our office. Robert E. Rbrrmann Coastal Manngemoot Sl~ialist /khs Enc. Albert J. Krupski, President James King. ¥ic~President Henry Smith Artie Foster Ken Pol/wo~a Town Hall · 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF sOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application STATE OF NEW YORK) AFFIDAVIT OF POSTING EN-CONSULTANT$ INC. SOUTHAMPTON, N.Y. 11968 being duly sworn, depose and say: That on the ~ day of,~.~ , 20~, I personallyp9sted the property known as ~& rt ~ ~ /~'~<~ ~a~ by placing the Board of Trustees official pos%er 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 o~~ hearing. Date of hearing noted thereon to be held (signa~r~ ~n to be_fore me this day or-~~ 200 ~--~o~ Public _ ' ~Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken P01iw0da Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fex (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application Wetland Permit Application /,/Major Waiver/AmendmentAChan~es Re~eivedApplinatio~l: ~'~l~l ~ ReeeivedFee:$ ~.~¥~'~ ~ ~ ~ Completed Application ~ ]0 ~ Incomplete -- SEQRA Classification: Type I Type H Unlisted Coordination:(date sent)~ CAC Referral Sent: 'Date of lnspoction:~ Receipt of CAC Report: Lead Agency Determination: Technical Review: Public Hearing Held:~/ ~ Resolution: Minor Name of Applicant ADRIAN & DANA COURI'ENAY Address C/O COURTENAY COMMUNICATIONS CORP.; 100 AVENUE OF THE AMERICAS, NEW YORK, NY 10013 Phone Number.~212 )925-7300 ext. 279 Suffolk County Tax Map Number: 1000 - 123-7-13.1 Property Location: 950 PARK AVENUE, MATFITUCK (provide I.ri.co Pole #, distance to cross streets, and location) AGENT: EN-CONSULTANTS, INC. (If applicable) Address: 1329 NORTH SEA ROAD, SOUTHAMPTON, NY 11968 Phone: 631-283-6360 of Trustees Applicat Land Area (in square feet):. Area Zoning:. R-40 GENERAL DATA ACRES Provious use of property: RESIDENTIAL Intended use of property: NO 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 (u~e attachments if necessary): RESHEATHE (BELOW LOWER WALER) SEAWARD FACE OF APPROXIMATELY 259 LINEAR FEET OF EXISTINO TIMBER BULKHEAD AND +/-33' RETURN WITH VINYL SHEATHING. BACKFILL SCOUR HOLES LANDWARD OF BULKHEAD WITH APPROXIMATELY 20 CUBIC YARDS OF c~I .I~AN SAND FILL TO BE TRUCKED IN FROM AN UPLAND SOURCE. of Trustees Applicat~ WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose oftbe proposed operations: MAINTAIN INTEGRITY OF EXISTING EROSION CONTROL STRUCTURE. Area of wetlands on lot: 0 .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 s~ucture 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? N/A cubic yards How much material will be filled? 20 cubic yards Depth of which material will be removed or deposited: +/-5 feet Proposed slope throughout the area of operations: N/A Manner in which material will be removed or deposited: APPROXIMATELY 20 CUBIC YARDS CLEAN SAND TO BE TRUCKED IN FROM AN UPLAND SOURCE AND USED TO BACKFILL EXISTING SCOUR HOLES BEHIND BULKHEAD. 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 ENTAILS THE ROUTINE MAINTI~NANCE OF AN EXISTING BULKHEAD AND WILL HAVE NO SIGNIFICANT ADVERSE IMPACT ON THE ADJACENT TOWN WA'IT~,S. ALL HEW SHEATHING WILL BE CONTRUCTED OF VINYL. IPROJECT I.D. NUMBER Ai~mdix ¢ State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I--PROJECT INFORMATION (To be comptete~ by Applicant or Project ~on~or) SEQR If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment I OVER I APPLICANT/81~ONSOR:ADRIA~ & DANA COURTENAY { 2. ~O~CT NAME {Y EN-CONSULTANTS, ]NC. Mun~aty SOUTHOLD co,mW SUFFOLK }50 PARK AVl~IUE, MA'I'II'I ~,, TOWN OF SOUTHOLD, SCTM #1000-123-7-13.1; MAP PROVIDED iD',- D BULKHEAD AND +/-33' RETURN WITH VINYL SHEATHING. BACKFILL SCOUR HOLES LANDWARD OF BULKHEAD WITH APPROXIMATELY 20 CUBIC YARDS OF CLEAN SAND FILL TO BE TRUCKED IN FROM AN UPLAND SOURCE. mma.y 4.2 ~ ~ 4.2 De~rll~: STATE OR LOCAl.)? DEC, COB OyiI ~No If yll, ~lt agency name &nd plmtlt/llp~rovll A~k~nV.~=,~ n,,m. RO~E~r ] '. ~. COASTAJ~ MG]vlT. SPECIALIST DATE AUGUST 26, 2002 NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEESt TOWN OF SOUTHOLD In the matter of applicant:AD~Lm-N&DANACOURTENA¥ SCTM#1000- 1~-~13.1 YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: RESHEATHE (BELOW LOWER WALER) SEAWARD FACE OF APPROXIMATELY 259 LINEAR FEET OF EX~STING TIMBER BULKHEAD AND +/-33' RETURN WITH VINYL SHEATHINg. BACKFILL SCOUR HOLES LANDWARD OF BULKHEAD WITH APPROXIMATELY 20 CUBIC YARDS OF CLEAN SAND FILL TO BE TRUC~I~ IN FROM AN UPLAND SOURCE. 2. That the property which is the subject of Environmental Review-is located adjacent to your property and is described as follows: 9~0 PARK AVENUE, MA'rrrrt~CK 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: ~ER25,2~2 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. ADRIAN &: DANA COURTENAY OWNERS NAME: c/o COUR'IIc;NAY COMMUNICATIONS CORP. MAILING ADDRESS: 100 AVENUE OF THE AMERICAS NEW YORK, NY 10013 PHONE #: 212-925-7300 Enc.: Copy of sketch or plan showing proposal for your convenience. O~N'F~CONIC ~AY 5~t'f'dk C~r~q Ha~ ~ 2~ VIA ~ATOOKA T Name: ELIZABETH SHEEHA~ PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Address: 63 W~ST $gTH ST~T NEW YORF~ NY 10U24 STATE OF NEW YORK COUNTY OF SUFFOLK ROBERTH~%t4~N 1329NO~THSEAROAD SOUTHAMPTON~NYlI968 doing business st. EN~ONSULTANTS,~C. , being duly sworn, deposes and says that on the 26TH day of AUGUST ,20 02 , deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at ~OUT~L~%~ON , that said Notices were mailed to each of said pers~ by (certified) ~~(~) mail. %./ Sworn to before me this 26~H day of AUGUST ,2o02 Notary Pubt~-c F~C~ L FROM : ~NCONS~LTANTS PHON~ NO. ' 631 28J 61~3~ Jun. 05 2002 10:2SAM P5 Board of Tr~stee~ A~pli~ation coun~ of Suffolk State of New York _~UBE~O DULY 5~ORN CANT FOR TH~ ABOVE DESCRIBED P]~RMIT(S) AND THAT ALL STATF-.,ML=NTS CONTAINED I-.m_..R~IN AR~ TRUE TO ~ BI/ST OF HIS/HER KNOWLEI~E AND Bt~.I.II~.~, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES, THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTF~S HARMI.~:.SS AND ~,EE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER:OR BY VIRTUE OF SAID PERMIT(S), IF GRAN'I'~D. IN COMPLETING THIS APPLICATION, ! HE~-RY AUTHOI~I~. THE TRUSTEES, THEIR AG~2,~r(s) OR KEPRESI/NTATIVF. S(S), TO I/NT/~ ONTO MY PROPEKTY TO INSPECT THE. PRI/MISES IN CONFo'NCrION WITH KEVIEW OF THIS APPLICATION. SWORN TO BP, FOP. I! MI~ THIS /~_~ DAY OF~20~ Nota~ Public ' FROH :' 'ENCONSULTRNTS PHONE NO. : 6~1 21~ ~1;~1S Jun. ~ ~ 10:26~ PS Tho ?own oE Sou~old'a ~odo o£..~thica D~oltSb~n ~0n£1~$ 0~ pur~ouo o£ ~h~a ~o~.~ ~o o~ovtdo"l~£o~ma~n which qan ~b ~o ta~e whatqve~ ~c~on ia t~ecO~a~y'~o evoid'~e. ~mme, ~t~M(; name, m~dd&e ~ibl~i,"unl~ea ~ATURB OF APPLZCATZON* (Chock ali ~ba~ apply.) Ch&~go o~ ARP~OVat o£ pl~ ~xo~p~ion ~rom p&a~/or o~olal map OtZar amp/cyme o~ ~be Torn o~ ~uUhold? 'Relub/~ahip- ~ne~udes' vhi~h bhe ~ovfl oE~e~ o~ ~O~le hal ~n I ~lr~al X~ you an~e~ed 'YKS,". oompleeo hho balan*a o£ ~hLe term and Name o~ person employed bF the Town of Soubho~d T~bI~ or pent,ion oE bheb person . Deeuribo ~ho caLe~ionehip bo~vo'en youreol~ (the applicant) and tho ~own o~lcec or employee. {ibho~ aback tho p~ovidod. The ~OWn o£~l~or o~ o~ployoe or h~e or ho~ epo~oo, a/bltng, parent, o~ child LB (clte~ all ~ila~ apply)t corporate eboak o~ bite appl/o~nb ('when ~he appil~aat . ia a oorpora~/on)~ B) ~ho legal-o~ beneficial owner oE any /nboroeb in a noncorpora~e'onbl~y (when tho applioan~ tm no~ a corpo~ab/on)~ C] an oC~tooc; d~eo~o~, Pn~ner; o~ employee o~ ~he appl~oon~; ac .. D) ~ho actual eppiiCan~. D~RIPTTON 0~' R~LATION$IIZP · FROM :''~NCON~U~TANT$ PHONE NO, : 6~1 2B~ 61B6 Board of Trustees Application Jun. 05 2002 10:2,~M P4 AUTHORIZATION (where ~he applicant is not ~he owner) (print owner of 9top.my) (mazling ~ ~ ' ~ d0 her~ au~ori~- ( Agene . ~ to apply ~or pe~t(s) fr~ ~e $outhold Board of Town Trustees on my behalf. 8 5i1'~ ( ~£~55 VIA M~P-A1'OOKA ROAP, 13~N A:~O55 ~LANi20~ 5tl3J~Cf P,~C~L ) T EN-CONSUtTANTS INC. 329 NORTH SEA RD. SOUTHAMPTON, N.Y. 11968 631-283-6360 ~I~AI'I~CONIC ~,AY ~Y RAMPARt 5L~N~, P,¢. I?EOPOSr~I2 bOWiE BIJUI~AD 1~Skll~AlldlN~i FOE AI21~IAN ~ DANA COIJiel~NAY ON ?~CONIC BAY, MAl'll11.E:K, 51~FO!..K COIJNIY~ NY ~1' I OF I ~? :20/O~ ,.RUFFOLK CO. TAX MA;P DATA:- · co. CLK. NO.t~ · SUFFOLK COUNTY N.Y. RAMPART ~4JRVEYING P.C. P/O BOX 340 EAST MORICHES, L.I., N.Y. 11940 SUFFOLK CO. TAX MAP DATA:- ~,_K. ~ LOT- ~B. , co. CLK~./E 454) · sum~