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Home My WebLink AboutTR-6129A James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen John Holzapfel 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 # Ol56C Date September 21, 2006 THIS CERTIFIES that the deck & screened-in porch At 4855 Stillwater Ave.. Cutchogue Suffolk County Tax Map # 137-3-8.3 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 5/9/05 pursuant to which Trustees Permit # 6129A Dated 5/18/05 'Vas 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 a deck & screened-in porch The (:ertificate is issued to WILLIAM & SUSAN GRAF owner of the afon,said property. r5<~ Authorized Signature . . James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen John Holzapfel 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 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 st day of construction Y, constructed ~project complete, compliance inspection. 4,~/6b 0 rl ~ . . 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) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 6129A Date of Receipt of Application: May 9,2005 Applicant: William & Susan Graf SCTM#: 137-3-8.3 Project Location: 4855 Stillwater Ave., Cutchogue Date of Resolution/Issuance: May 18, 2005 Date of Expiration: May 18, 2007 Reviewed by: Trustee Peggy Dickerson Project Description: To construct a new deck and screened-in porch with partial roof on south side of existing house. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 97 of the Southold Town Code. The issuance of the Administrative Permit allows for the operations as indicated on the site plan prepared by Cara Graf dated June 18,2003. Special Conditions: Permit granted with the condition of a 50' non-turf buffer from the wetlands. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 97 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. ~,,-I 9- 47.~' r;. . Albert J. Krupski, Jr., President Board of Trustees .. .. 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 May 1, 2003 Ms. Caroline Graf 4855 Stillwater Ave. Cutchogue, NY 11935 RE: WILLIAM & SUSAN GRAF 4855 STILL WATER AVE., CUTCHOGUE ., SCTM#137-3-8.3 Dear Ms. Graf: The following action was taken by the Southo1d Town Board of Trustees at their Regular Meeting held on Wednesday, Apri130, 2003: RESOLVED, that the Southo1d Town Board of Trustees APPROVE the Amendment to Permit #5665 to install a patio on the east side of the house. This is not a determination from any other agency. If you have any questions, please call our office at (631) 765-1892. Sincerely, (?~ 9. /~-r"~' 0 Albert J. Krupski, Jr. President, Board of Trustees AJK:1ms . Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda . Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-18<\2 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES , TOWN OF SOUTHOLD LEITER OF REQUEST FOR AN AMENDMENT t0~ O~~ ~',)lf-2J ~ JUt DATE O"2).?4.0'5 6~R~\\.U~l \~~~ U~PHONE (0"51, l..qE> 2l'1IDL- :ADD~SS -1ef:;S '1ttU.AA I~.AZ.. A.t)'Eo 6. \17".k\nq 11"F- AGENT C' AvO' a \t=':. . ct~^~ PHONE (D~1. 791E). 9l"'lw L- ADDRESS -1~ < '711 LvW ~AZ.... ~:I\=_ (A.JT7" Ate 14 Il"""- PROPERTY LOCATION 4fl;~ C:;nu.AA)~.AZ.-~\f' . Gl1rMol:luE TAX MAP NO. ~ Jl~ll\" (JDNe C l':..llO/ J tdr: tt~ request an Amendment to Permit # ..J1;:.~~- ~n /"')1.\ l;:=A"<t" "'5>1l/J;'; Ot==' H~lJ"-,~ M -:::'~"'_Jl..j.. I tJ. 1;;:;lJ,c..u)SF~ 01~ ~. Signed By: Cn,.iQ ~ [5), lE (c lE ~ WI lE rm lnl MAR 2 6 2003 lW Southold Town Buard of Trustees ~ Prutntial . Billy Graf Business Systems Developml~l1t Prudential Securities Incorporated One New York Plaza New York NY 10292-2008 william_graf@prusec,com O~.7~O~ ~ ~~~ k~ Cb ~Wo+~ ~ ~ f'f\M/\ ~ ~vvv\t- ~ t\bS5 S-\\\\~ Ave 1 ~ ~ ~ },.p~\ 1-ro -S ~ '^'& . \ a. 'P etv 8"'-'-- ~ ~ ~\~ ,~~~ l\Ju.. ~'f'*. ~~-\-~), ~ w-o~ "'?P~~ -,\CV./\ W'F~ ~ ~~, \~~) .\~ ~~}~ /.~} l 'euJ I L f I " , /'gfi/ ,," "0.'=' '00-'" III ~'" -=. /10" -1'05.0 .::~~~':'llt. ~~;"t:.: .' FISE;.a ~ ll:'~;:)/ ,-,~,:!,:'.C::;t.,.;t..;_.,--_. '. ..' ,.:::.~ r' -,.I~ ll-:> '-;":"'~/~~<~.>-)':}~ :':~$<-')) . f'''' /" .~~~;.;~.A ,::~-'_:;/:::::"'~~' .../;..' ~- J 'TS'-"J--- .1." "~..7!'.../1 . '--:"'~'" t} J -e_ --' -"..!,j /~:'"...'. ~~J.?'~..V /.... .7 . .. ~.",~ /' I ~ AV"~ 2'9/.'" .::......~ ,":::"'~ ~lt' 5.&'3'5"'=-W. LTo a+';'~" ~':.':., . Sol 0.0 ;:. .' ,', . ..... .' .' 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H.S. NO. 13'SO"/EA , . STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL - SYSTEMS FOR' THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT. OF HEALTH SERVICES. 151 APPLICANT \ SUFFOLK COUNTY SERVICES - FOR CONSTRUCTION ONLY DATE: H. S.IIEF. NO.: It- SO. lEA APPIIOVED: DEPT. OF HEALTH APPROVAL OF " SUFFOLK CO. TAX MAP DESIGNAnD':!: :. DIST. . SECT. BLOCK .PCL. 1000.1:;, 3 :.., Wo 8 OWf'(ERS ADD~ESS: . . . IS- I-;l1eJel1"Lotfe. . . t=a......i,IfJ..'I7I.. N.Y.:'1l?3B.. . ....." ",;,:,.". (Tel. 'S2-~.of1 i)~ DEED: L./S&", EST HOLE '. P.510,6'''' .STAMP r.Ur.1tJ. ~<oll l.NuhIIW~.-=::.~ :I:"-=::'':'''':''':'~; C:-.JCidDnu.. .." ......."""""""..... f." . ..1-..y....J .. L:.;,~;;...;;,.o1C:~oJ:;--.: . ~ o.~ ............Ib: r., .,." 10"""",__", k."\1f itpollPMd...._~........ ..~.,.._.__.:bd....._ ......................... ... IO" ...........IINav.... ...... 0..................... ....................... - . cle-n,8 self!d . .sEAL. / ..1- I , 4' .. . . ~~ Telephone (631) 765-1892 Town Hall. 53095 Main Road P.O. Box 1179 Southold. New. York 11971 _ SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Wednesday, April 16, 2003, the following recommendation was made: WILLIAM & SUSAN GRAF to Amend Permit #5665 to install a patio on the east side of the house. Located: 4855 Stillwater Ave., Cutchogue. SCTM#137-3-8.3 The CAC did not make an inspection, therefore no recommendation was made. "..-,- . . TERMS and CONDITIONS a.. . ,.~~) ~ic The Permittee lJilliaffi &. gasa:B Cr af 4855 Stillwater Avenue, Cutchogue. ~" ~~u put' of the coosideradoa for the isSuaoce of the PUmlt does \JIlderstaod and ptescribe to the fol- lowiog: 1. That the said Board of Trustees and the Town 01 Souchold ale released from IJ1'f ..,d all damages, or tWms fot damages, 01 sula uisiag directly or iadirecdy .. . ~ of IJ1'f op<<- atioo p<<focmed pUauaot to cbls petmlt. and the said 1'0-. JI~... wl1I, at his or - own est' CDS'". defead IJ1'f and all sUch suits'ln;./.-I by tblrd panles, and the said 1'0-. "104' -- fall u.hlllq with reSpect thereto, to the CO"'f"-' a;clusioo of the Board 01 'i'rasttes 01 die TowD 01 ~ 24 2. That cbls PeaDlt is wild foe . period of mos. -..bich is OOJISI"-..--' to be the estimated time' required to cocnpIete the .-k invol..ed, but ihoa1d clraailstaDceS wuraat, request for an eDeDSiOD may be made to the Board at . later dalle. 3. That cbls Permit should be retalaecIladeflaitely. or u loag u the said Pemdttee wishes to ""';....in the sttueture or project involved, to provide evldeace to IJ1'fODC roocemed chit auth- .orizatioo was originally obtained. 4. That the wolk im'olved will be subject to the ~ ..,d approval 01 the Board or its qcats, and ooo-oompliaace with. the pr.msions 01 the orlgl....fL,g applicatioa, may be cause for revocadoo of cbls Permit by moludoo of the said Board. 5. That there will be DO unreasoaable interfereoce with aa~ as . ~ of the wed< . bereIa ...morized. 6. That there shall be 00 laterfereoce with the right of the pabIlc to pass and repass .wag' the beach betweea high and low ....ter marks. . 7. That if future operadoas of the Town of South91d require the remonl and/or a1tendoos in the Iocadoo of the .-k berela ..lborP-.l, or if, in the oplab1 of the Board of Trustea, the, wotk shall cause wueasooable ~ttualoo to free oavigadoo. the said Pe1miuee will be requlred. upoo due DOtice, to remove or alter cbls Walk or project herela stated witbout ~ to the Town . of Souehold. 8. That the said Board will be aotlfied by the Permittee ot tbe comp1edoo of the wotk auth- orized. 9. That the Permittee will obtain all ocher permits and coaseolI that may be required sap- pi_tal to this permit which _y be subject to revoke upoo fdlare to obcala -. Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson r . 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 11, 2002 Caroline Graf 4855 Stillwater Avenue Cutchogue, NY 11935 RE: SCTM# 137-3-8.3 William & Susan Graf 4855 Stillwater Avenue Cutchogue, NY Dear Ms. Graf: The Board of Town Trustees took the following action during a Regular Meeting, held on November 20th, 2002 regarding the above matter. WHEREAS, Caroline Graf on behalf of William & Susan Graf applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of South old, application dated October 25th 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 November 20th 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, WHEREAS, the structure complies with the standard set forth in Chapter 97-18 of the Southold Town Code. . 2 . WHEREAS, the Board has determined that the project as proposed will not affect the health, Safety and general welfare of the people ofthe town. NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approved the application of William & Susan Gral for a Wetland Permit for new deck and screened in porch with partial roof on south side of existing house - unheated. 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. Ifinspections are required, at a fee of$5.00 per inspection (See attached schedule). FEES: None Very truly yours, ~}/~~. Albert J. Krupski, Jr. President, Board of Trustees AJKlcjc cc DEe Building Department Telephone (631) 765-1892 . Town H&1.I.. 53095 Main Road P.O. Box 1179 Southold. New York 11971 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Monday, November 18, 2002, the following recommendation was made: WILLIAM & SUSAN GRAF to construct a new deck and screened-in porch with partial roof on south side of existing house. Located: 4855 Stillwater Ave., Cutchogue. SCTM#137-3-8.3 The CAC did not make an inspection, therefore no recommendation was made. . . . '" ~ r m ~ ~ . . . '" ~ r m ~ G RAF 4855 Stillwater Avenue, Cutchogue, NY 11935 (page 1) . . . '" \l ~ m co !l . . . '" \l In co !l G RAF 4855 Stillwater Avenue, Cutchogue, NY 11935 (page 2) . . . (f> Sl r m " ~ . . . (f> Sl r m ~ G RAF 4855 Stillwater Avenue, Cutchogue, NY 11935 (page 3) SITE PLAN · 1 ~~~ ~A~. ( . SCALE 1:500 o ~. , 3: b o Co LO o OJ co en o :g . "It , w b o Co LO .0 OJ co Z ,.~ I ......... f ~, f f f f f f f f -....1...- -....--.., f f f I f f f c...._ l " f __... I . ~ PRQPOSEDCECK -.......--_j l . S1. J OoO~ HIG EUGENE'S E - 11~A;ER CREEk. IA.Rk r-...- / " , -"'-... I " / " " / . / I I / / / " EXlSTlNG CARPORT / / / I / / I / / I ...--.1.... " " " " " ---...., / I / / I / / I / / I / / / /. / / I / / I / / / / / / I / / I / / / . . . ~l ~ ~ ..: -JZ::"3 t~ <" EXISTING OOUSE ---- o ~ , s: '" " '" " -- """ --- ~"'" ----...-... .' . PROPOSED DECK CONSTRUCTION: UNCOVERED . o o' <0 lC) o Ol CO en . PROPOSED DECK CONSTRUCTION: PROPOSED R()()F J' L ---- S 1 0~07' '20. E . -112J2- EUGENE'S SITE PLAN CREEK . . . - o ~ ~ .W b _ 0 <0 lC) o Ol co 'Z HIGH WA . '. -r~ti.MA~ SCALE 1 :200 -- -~ /37- 3-;:: 3 TOWN 'OF SOUTHOLD PROPERU ..JlECORD CARD STREET 55 VILLAGE DIST. SUB. : If. ';)liJ/wt>/e>" lv, (}'(/Ic/';;'i/C- - 7lJ -Lj LOT ..J. rER OWNER N Jt((",pi E - .'~ i. f." ;-" '''", W . +~, fI \N;.-J~ A COMM. CB. MICS. 9;/2- ACR. O.~l TYPE OF BUILDING -;;.5 h . /o.Yj S RES. .:J./O ND {J. a.f(ACC, Q ., VL ~. , .'i''^''< SEAS. FARM Mkt. Value IMP. ,;2 0 ("-,1\ TOTAL DATE ,),Ovo c::l /'?vu .A .00 Z"i'o 0 Z"loc> ;:;::000- Lj.5oo / '2 '100 5'"~0 . Tillable FRONTAGE ON WATER /1-0 ~ ,2 G - ;; '). Y b-O Woodland FRONTAGE ON ROAD Meadowland DEPTH " () .I House Plat BULKHEAD Total 137.3-&',]02/02 -Cl-,- - - A. Bldg. -.---------------- J ,2.~ 327 / Foundation . S--O IO'(J / Basement F.xt. Walls Kc - :xtension :xtension xtension Fire Place ~t\\., l.~Cld \~ ~~ ~L\ 't-~t:. ';. 12~b orch Pool Jeck Patio .reezeway i-;r~~ Driveway 2 ~.x :a. '" = AC"o ,so 2.3 0 I '. B. ./ ).":)~( _~eIO (J I I I I i u-""/~~' !i '/<, V :' s .:. "- If. , rL c; 1':'< ., i::-'Io . . . p,Co Bath I +>-ll.-l-- Floors --n:. )( Interior Finish Heat , , Attic Rooms 1st Floor Rooms 2nd Floor s ~i " ,. D%...a....... !!Iff fif: ifi .!'~I+ JII IP'lJ I II fl. f , , . ' ~lI.lth .~ -. 'ilf I I f i 'i III I 11181 '"" I II 11'1 fiiiii 111111 '" "1 ii!in filii iii i IIII1 :r'.' , Iii i i " I' I 'ff~~ 1llliltl~ II II nUL 'liM il h!lj ~ !'I'! ,~ ~. ,-1"1' fI' litO .~ I " /7 ~ I 'j? '(/ fv" ) / / Iii' . (.-' - . NO. 424 P.3 To_Hall S309l5 BDtltc 2S P.O. Box 1179 So1>tl.old, Ne",York 11971.o1159 TlJepha"" (GS1) 765-1891 B'axCSS1)7Se......III BOARD OF TOWN TRUSTEES 'I'OWN OF SOUTHOLD om..VnOllIy _ COllSlil Sl'OIioa Permit Applicp- _ Wet!alld PcnIIit AfpliClltion _ AclmilliSlnlive Permit A.mendmllTltlT 1.~OD . '6ceived Applic~' '. ) ~eceiwd l'ed ~ re (f'l re -cO\1ljlle1:d Application 0 IS liB IS II _tno\11nll1e1:a SEQRA. C1as!i1il:lition: Tw.l~TypeU_UIlIiJled_ MA~-" 9 2 _Coordinllion:(dete stlll)~7 - ..t::.C'Ac. R.eferT&1 Sent.~.L!L .-:- ~ofllllPlCtionl_...s:ztL iiI SOllthold Town _Rccclpl of CAe Report: Board of Trustee _t.eldApnll)'IlcttrmW.IiOll:_ _1Jchnical Review: Zl'ublieHCuiPSHeid: c"tj 1C1;E _1l,e.oIution,_ "';i~ 1'-...1 Name of Applicant \JII 11...~ ~ ~11t..I..\ ~...&" Address -\e~ ~LL'\JA.~" 6.'-1_. r..J.J~"""Vtllt~ PhoneNumbtll':l1d!I) !C/A.A"'{,1 .eN".51LI.2A41d.54\ Suffolk County Tax Mil' Number: 1000. \ :=r.1-~ - A. '!, Property Location: "'Ae~ ~1u..WA."'1Z. 6,,.Jl!!o ~1'lI"_\l,tl(..JlI! L\M6."-- '~""A .gr.Y~r 'P"'A"IIL16:!-" ~"\J~. (provide ULCO Pole *. distance to cross streel$. and location) AGENT: (If applica.ble) Adchess: Phone: my. 5.2005 3:51PM .OPACCC ARCHITECTSUl!lt.8. Aprlli~On ~~O. 424 GENERAL DAIA Land Area (in square feet); .t\. ~ ",,(:> Area ZoniDi: - Previous we ofpropelty: \;>~I'i'~'W~ '''I"IAL. ("~""_'" >-I_I ..!.~ Intended use of property: ~-"'nwW:n,^l ""'.1l1li" .",,1'. Prior permits/approvals for site improvements: Aiency Date ~~.gt: t:lto... ~.llt 04. u..Cl.~ ~"'" ~~,~ ~ ~nEP.!I. ~~ O\,~ """ \~lb .... l\lbI..1.4. t:w.~ ~. _ No prior permits/approvals fOr site lmprovemenu. lW any penult/approval ever been revoked or suspeDded by I. goveromental agency? ...x...... No_ Yes IfYe5. provide ellpla~tJon; - Project Description (use attacnments if necessl.l)'): l\_'-' ,.....,...~w.. ~ 4.""- ,,\,,1) 'l.\ ~"'u \-JI-n.\ ~""'IItt.L ~J:: t!JLl ~U"ft1 -....-- ~s::" "'i\'b"'1'\~ WI"- IlLlu.a._.l'\. -- P.4 my. 5.2005 3:51PM .PACIC ARCHITECTS118tM. ~11C1tOn WETLANDITRUSTEE LANDS APPLICA noN D" fA NO. 424 P.5 , Purpose of the j)TOposecl operations: I"lI ~ 'b-.. \l_ f \l\Jt,Jr... ~_ - Area orwetlandi on lot: Ulc..~ Percent coverage of'1ot:_~ % square feet Closest diatanc;e between nearest existing structure and upland c4gc: ofwctlands: "1~I_OI' feet Closest dlltam:e b~en nQl'Cst proposed JUUcture and upland edge of wetlands: ~ ~ I -~.. feet Does thl! project involve ~cavati()n or filling? )( No Yes If yes, haw much matcrilli will be cxeavaled?__CI.lbic yards How much ma.terl1Ii will be fl1\ed? cubic yards Depth ofwhic/l material wjll be removed or deposited: Proposed slope throughout the uta of operations: Mannar in which material will be removed or deposited: feet Statement of the effect, if any. on the wetlands and tidal waters of the tow! that may result by reason of s~h pwpoaed operations (use atta.chmems it'appropriate): MAY. 5.2005 3:51PM OPRCIC RRCHITECTS . . NO. 424 P.6 '..1....~Tu1'a I ",CWICT 1.0. H~"'IR 617.2Q Appendix C $Iele I!nv1ronmanlel Qualily Rnlew SHORT ENVIRONMENTAL ASSESSMENT FORM !'at UNLI$T211 ACTIONS IInlV PART I-PROJECT INFORMATION (To be campleled bV Applicant at ProjaOl 5Ilonlor) SEQR " tl'l'l.ICIINT IIl'IlH8OIl /,,, I 2. ~AOlICT H."'I :;'""",.. -, ~c~.I._...... I, ~AO.IIIeT L~TIQII: ~ CautyL M..,.,1IIllY '1J W' ''''' .. ~~_& I.CIQA~ l81MM 1lCIlI_ ........ ,__ _..., 1oIMI_. _ .t ....""...ll ~~5 STI"'-W"'t.... ~ c.u.'tI:.o~OQUI!. 10.1'( \\<\55 UtAI.lIitT ~ '5of' \ ~Qll.1IlliM Orue. I. 'I '1Ill_ ACIItlN: 0.. CJ MoalllOiltlOnllll.ra'lan e. DI!ICIlI. 'AO.IICT IIII1'lV: Ulo\~o l:>8CM- 'C . t!!W ~14 I!l.C:UIloQ....11 ~ ~M(~ 10 .,.1&>tloJ4 ~1l6e.. ~ ~~ f&.4lol". 7. _NT 0' l.MlIl_m 'n"'lII' - UII_ - a. WIJ, ,Il\IOOUD _ CDMJl.Y """' elI~NQ ZONING OR 0TIl.~ lIICIIT1Na LAND US! ~1ITIIlc:nollS1 0.,.. 0... II....n_~ e. _T """~UNO IIRIN w:INITY 0' ~1CTl ~III 0_ 0__., O~ O""lIrIF___ 00tll0r .- 11, DODACftONIIMlLYI A ....NIT _AI. oa ....OING, NOw OR UL'lI".T1!I.Y _.NY OTHIII_aIMINT.L "'_ ~l, STAT! oa LOOMlI CJy.. )it.. "_'" ",~......",.II".._1o n. DOU AHr _ OPTHaAD'I'IOH HAVIlA CUIIIIINTLY YAUO '''''''IT OR._V....1 RYoo ON. ~_..._._.II4l_V_ ~L1 d"_O~. ~\Io.OIo,'lt< ~1' b...,. ~~i'. ... ...... ~auLT OP _ED AllTION WILL fXISTING ~SUoIIT/.,PRQV.L II!OUIM MOO'I'1CATlO~ OYM . I ceRII" tHAT I'M!! 'NPO~~'lI0N _W AIOTI. ~UITO I'M!! am o. !lY KNOlIl1J!llQI f\DO..CIln.U.,...... n... ,- SlOnlW~ " thl Icllon Is In the COIIIlII Area, Ind you a,. a l'ltl Illlncy. ooml,ll" Ihe Coaetal AM,,,,ment Forni bite,. plllClldl11\l with !hI. ......mlnt OVER 1 Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Albert J. Krupski, President , . James King, Vice-President Henry Smith Artie Foster Ken Poliwoda .f . Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit ApplicatiQII _Wetland Permit Application ~ Major Waiver/AmendmentlC an s _Received APPlica~ 10 I~ { ()-./ Received Fee:$ ___ I _Completed Application .-Incomplete _SEQRA Classification: Type I_Type 11_ Unlisted_ _Coordination:(date sent)?:,! : CAC Referral Sent: /0/ 0 ~ Date of Inspection: /I{I ~ () _Receipt ofCAC Report: _Lead Agency Determination: Technical Review: I {/ _Public Hearing Held: II {d-iJ fO" Resolution: Minor Name of Applicant L,\ ~L\~ ~ f All'" ~ '\\ \\M t!...\v\. ~ S. ~ . \ 4655 71'\LU\fJA'"T~~ ~~. /' -D'TT' ~lAL)'6 ~~ \\'135 Address Phone Number( ) <..D ~\. 7~ CV'J. 59 '" 1 Suffolk County Tax Map Number: 1000 - \ ~ 1- ~- ~."'::> Property Location: li~^'i' =r" r~ <;1". ~Il~ ~'l~ Jf: 1't:- (provide LILCO Pole #, distance to cross streets, and location) AGENT: C.~'r7t\1 .-\ ~~ Ctv..A'F- (If applicable) Address: ~<; 7T\\A.IW~/?- ~ [. )1(AoC~ l,)~ \..\~ \\q.:; I:) Phone: ~~ -4 ~\ . . Board of Trustees Application GENERAL DATA Land Area (in squarefeet): 4\ I ~ 4. I Area Zoning: Previous use of property: ~ \ t>t"o~ T\ ~ \- \'::xu t=;1.-\.;\ ... \ 11 Intended use of property: ?lp.c.\~"'I\\\~L \::>\li1l!!!.\ \ \~~. Prior permits/approvals for site improvements: 4- Date .~S 'f>?*= '2 \3(05 _ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? -X-No_ Yes If yes, provide explanation: Project Description (use attachments if necessary): \..l'eNJ ~ v.. ~ ~.cz"\:::\..i~t) ,\0..1. "(;::r:)~ ~ W \'n\- "P ~17n ..... \ ~ 0 tJ <", '"f\\. c;.u"::.e. nr: ->e't.\c,'t) 10..\( i WI~~ \J ~ U:c::;~-n:p. . . Board of Trustees Application WETLANDffRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: t:1lt"t:)(X)'!Z- -- "-I L\ \Jllol.'t Sl='t-c.e. Area of wetlands on 10t:.\lO~.... 2!JrtJsquare feet po Percent coverage of lot: 'A- % Closest distance between nearest existing structure and upland edge of wetlands: 151- 0" feet Closest distance betwMearest proposed structure and upland edge of wetlands: 1-0" feet Does the project involve excavation or filling? )( No Yes If yes, how much material will be excavated? cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): . . 14-16-4 (218n- Text 12 .:' 'I PROJECT 1.0. NUMBER 617.21 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I-PROJECT INFORMATION (To be completed by Applicant or Project sponsor) I" APP}-fANT {SPONSOR I' 2. ?AOJEC7 NAME . L<^1:701'~ CAr~:r 3. PROJECT LOCATION: SEa Municipality County 4. PAEC:SE LOCATION (Street address and road intersections. prominent landmarks, etc., or previae map) 16SSc;-n\...V~~\~ ~~~ C.U'CJ'c::lto\1J'!!. ~'-I \ \'\ ~5 ~~t-V~ '\. \) 5. IS PROPOSED ACTION: o New !S.ExpanSion 0 Modificationialteration 6. DESCRIBE PROJECT BRIEFLY: \.)\o.lWE:-~ T::*Ie..~ "f:) ~ 'e:AJ\\;f" Jl.ct>J~-r ~ ~ 'to '1!l/..~."U" ~e; \J.l\\A..- ~~ ~\\)o..\'" ~ F€. ,,- 7. AMOUNT OF LAND AF~ECTEO: InWallY acres Ultimately acres a. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND US~ RE5Tr:l[CTIONS? eYes 0 No If No, describe briefly 9. VJHAT IS PRESENT LAND IJse: iN VIClNITY OF PROJECT? ~RaSldential O.!ndUSHial C Commercial Descnbe: LJ Agricuiture : I Park/ForestlOoen soace LOlher 10. DOES ACTION INVOLVE A PERMIT APPROVAL OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE On LOCAL)? DYes gNo If yes. list agency(s) and permit/approvals .::t- 11. DOES ANY ASPECT OF THE ACT'or~ HAVE A CURRENTLY VAllO PERMIT OR APPROVAL? DYes. JlJ No If yes, list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL FlEQUIRE .\o1QOIFICATION? o Yes ~" I CEiiTIFY THAT THE INFORMATION PROVIDED AeOvE IS TRUE :0 THE 3EST OF MY KNOWLEDGE Applicantlsponsor name: _~ o.~J~ c... ~..~ c... ~v.o\""\ ~'e= C. tA 2..~'S= Dale ill'.J. \1\11 M'L- SIgnature: If the action is in the Constal Area, and you are a state agency. complete the Coastal Assessment Form beiore proceeding with this a:j..~essment OVER PART 11_~NVIRO:"JMENIA' . SaMENT ,7;) :,e c:Jr7i:::ieteo:::y Age:tc' -- ;/ yes. ::ocrClnats :ne revlt~.,., :roces~ ana 'Jsa :r:e .=:JL:.. ;:')\,= ...... :JOES AC;";C,'1 :::\C2:.=.:: ":','.ly ~Y~s 1- ,'10 ,':s, 7i-1:=:.E3~OLJ!N 5 ,\l'fer.R. :J';;:.l ji/_::? 3. 'NIU.. ..:..C71CN ::l.E':;::iVS:::CROINA, cD ,=!EV1l2N ':'S ;:=P.C'J10EJ ,=':R UNLS,E:J .:..G7;CNS iN :3 ,'1'fC2R. :::J'1.R, 5.7.37 may Oe sucerseCaC ~y a.ncmer ;nvolved a.;enc'f. it ,'~o. 3 :'\e1;~t:'1e :.::ec:.u:; L Yes \-:' :-10 C. C;:ULD AC7JON .:::J.ESUL7:N ,.l..NY ADVE?SE :::=:=='-:.5 ASSCC:..;,:;:D WIlH -;-,E :='JLLC"'V[."lG; ~p.nS'Ners ;'nay ':.e "'lancwrlt:en. d ;eglcl~) C1. ::;dsting air Quality, 3utfaC2 ,Jr 'Jtaunowster ;:uslity ':Jt :::uanllty, ."'LOISe ;e'fels. ~xts.lng :raitic ;:alterns. selic .vaSia :JrCOL:c:::::n :Jr:J!s,::: pctenllal fer ~rosjon. :'::ralna~e or !looaing ;lroOlems? S,-:.olaln ~rieity: C2. Aesthetic, agric:.zltural. :HC:1aeological. :1is.orlc. or other ."'Lat:,Jtal or cultural ~esource5: ,or community or i1elgnccrncad c~arac:er? ~ctaln .' 03. lJeqe!allon or :auna. :Isn. 5r:elHisn or wildlife scecies. ~lgnliicant :"laoitals. or :I'lreatened or ~nc:ant;ered :;cec:es? S::clam :Jrtally: C.J. A ccmmunity's existing ;Jlans or '10a15 as offlc:aUy adocted. or a cnange in usa or intensity ot use 01 land or other natural resourcas? ::lpI3In ::; CS. Growth. subseauent=eveloomenl. or related ac:ivilies likelY to be indue eo 'JY !t'le :::rooosea ac:ion? =xolaln ,melly. CS. I..cng :erm, snort :erm.:::.zmuialive. or omer ~Itec:s no! iC:entilied in 0--;-<:5? =:<:0Ia1l1 :metl'l. ....... car:er :mcac:s iinc:iJcinc; :::-:anges In 'Jsa of ~~ttler quantity "r :ype or ~nergYJ? ~:::ialn ~rier!y. 'J. ~S 7"HE?E. ::A ;S 7i-iE?E :...::<E;L':" 7"0 3E. C~NT;:;OVE:::SY =!.E~IE::J 70 ?OTENT!AL ),QVS~S2 :::'lVIRCNMeJ,":'L ~MP.1,C73? _':'es '- No :f '~es. :xclam :)fie!!y ?ARi IIl-DEiE:RMINAiICN OF SiGNIFICANC:;: ITa ~e comoleted ~y Agency) INSTRUCTIONS; For e3C:l adverse etfect identified accve. determine whether it is substantial,large. imccrtan[ or otherNise signific. :3.Ch eifec: snouJd be assessed in connection with its (a) setting (Le. urban or rural); (t:) probaoility ot occ:J?1.ng; (c) duration' irreversibility; (el geogracnic ,3coc;e; anC (f) magnitude. If necessary, add attachments or reference stJpponing materials. ::1sure !!xclanations cenIain sufficient delail to snow that all relevant adverse impacts have been identified and adequately ace res seC. C:'ecl< this box if 'fOU have identified one or more ;Jotenrially large or significant 2G'IerSa imoac:s whic:1 MA'f oc:::.Jr. Then :)rcceec direc~ly to :he FULL :::AF ana/or prepare a positive. declaration. _ C:-Jec;< ~his ~ox if you :-lave derermined, based on the information and analysis above and any SUQoortJi1C doc:Jmentaticn. :ha! ;lle ::](0005eO ac:ion I:/ILL ~~OT result in-=*f1Y significant adverse environmental imcac::: AND ,Jravice an 5i.taC:1ments as necessary, the ieasons supconing thiS determination: .....,,'I! ')1 _.:...0 ,......I.'nc.' :1I1~ 01 -<~"OOOUOI'" \.)ll,,~r ,J"Ol:J1 VCt: 'l..m+!' .)l "~"von~'OIt: ''';lll(~r ,n ;..:...0 "'~O:"("I ).'(n..:ul<:!' ;)1 r"':'..J.lt~r ~It '':Il:~'t:.,t :rom II!'Soon~IOI~ t.\11,c<,rl ;.>:nJIUI~ ')I ""~con\'OI~ .":f:lc~r ,11 ~t:Ja ....I;.:ncy .~ J..IC 2 Boa. of Trustees Application . .'- AUTHORIZATION (where the applicant is not the owner) I, ~\.\ \l (;.eA.'f= (pr~n owner of property) residing at_4(-A55 ~1'\u.W"'"f'p.JP ~'E. (mailing address) C.J.'1r"A,\,o)l.I~ ~~5 do hereby authorize r:A.l2.O\..-\\ol~ (Agent) u.\7"'''':: to apply for permit(s) from the Southold Board of Town Trustees on my behalf. ~1t- (OWner's signature) 8 . . PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS w&NJ- ~ 6. ~~V\ SL<)V"'-.. \l,.& )J,v'7' f.J 1:CM":jI~ Address: ~~O ~\l\\~~ ~,~~'^-DS~ t1~ \Y\3.) 4to:sq ~ \:1\~~ ~ " 'J-S ~ ~\ \l~ ~ \CJJ12- Name: NOV 2 0 2Ull2 STATE OF NEW YORK COUNTY OF SUFFOLK &;~ c. ~ ~ . remdmg" t.;f; S \b \\"b \>^ },.",. _ \.\, '\ ~ C; , being duly sworn, deposes and says that on the day of k\O\J , 20~, deponent mailed a true copy ofthe 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 South old; that said Notices were mailed at the United States Post Office at ~,\.\~& . ,that said Notices were mailed to each of said persons by (certified) (registered) mail. \-\n~~ Sworn to before me this d0 Day of ~O\l ,20 0"2- J-rJ-~{3u Notary Public LYNDA M. BOHN NOTARY PUBLIC, Slale of NIlW Volf( No. 01 B06020932 Qualified In Suffolk Coun1Y. Term Expires March 8, 20 .ll;3 . . NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: .'J\U",W 6. ':;'C...",\ 6~ SCTM#lOOO- \?". 3 - ~..:!:> YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: ~~ ~ ~o~ o~ ~ ~'De OF ~\'i"~lA \b.:IitS. , 2. That the property which is the subject of Environmental Review.--is located adjacent to your property and is described as follows: 1-U55 '7n\N\4.L~ ~'e,~U'e, "d \\~65 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:J.!o" 70{ltJ)t- You may contact the Trustees Office at 765-1892 or 1n 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. PHONE #: llA~ \\~~~6. OWNERS NAME: U. . ~ MAILING ADDRESS: Ene.: Copy of sketch or plan showing proposal for your convenience. NO/l 2 0 lOt7? i .s ~l -JZ:.- t~ o ~ I ~ b o. Co 10 o Ol <0 W r-....- I " , "'--'-. I --.... / -'-'-.., I I I I I EXISTING CARPORT I I I I I I I I I I I I - I -'-.- " --._- "- '" " I I I I I I I I I I I I I I I. I I I I I I I I I I I I I I I I I I I . ~ EXISTING I-OUSE ---- . - '" "- "- -- -, '- -'- -, -- '- ---":"'.... . PROPOSEDCECK CONSTRUCT1ON: UNCOVERED . PROPOSED DECK CONSTRUCTION: PROPOSED ROOF L "i' ., ---- S 1 0~07' '20. E . -112:72- EUGENE' SITE PLAN SCREEK ~ ~ " - - o ~ ..,. w b o Co 10 o Ol <0 Z HIGH WA r, . '.~MA~ SCALE 1 :200 ,. U,_i CERTlr '0 MAILM RECEIPT (Domestic ",",(Only; No Insurance Coverage Provided) ~ . ~ D lr D r'l ru 10 Ylili<, NY 10022 0.37 LWIT ID: 0971 p~~";l,V\) ? Postage $ D D o Return Reclept Fee o (Endorsement Required) Certified Fee 2.30 1.'15 Here o Restricted Delivery Fee m (Endorsement Required) D ru Clerk: KWBI14t 4.42 11/14/02 Total Postage & Fees $ ru D entTo j ( /' 1. - ) . ~ Si,;;,;c~'iJ:J'-)j-j=k.l:Sul:~{? ""'dF,S;Jc:'Jl:;!~.--... ~:"::!_~~~_"!~:_~",,)mn'5.iJ..._aa'.:~mJ..LQ~.e"mmm..n...m. City, Slate, ZIP+4 AJ . 63~ ~_ rn rn rn ::r- ru '" I"'- ~ ,Iii llGm Postage $ 0 . 37 2.30 , i 1. D D o Return Reclept Fee o (Endorsement Required) o Restricted Delivery Fee m (Endorsement Required) D ru Certified Fee ru D D I"'- Postmark V I 4 I'D"'!' Clerk: KWlll14T 11/14/02 4;42 Total Postage & Fees $ D ::r- rn ~ ru '" I"'- ~ cuEWi,;; flllQ r Postage $ 0 . J"1 I Ini'097i '. , Postmark Here Clerk: KwSwtT 11/14/02 D D D Re"m Re,'ept Fee o (Endorsement Required) Certified Fee 2.30 1.'15 o Restricted Delivery Fee m (Endorsement Required) D ru Total Postage & Fees $ 4.42 ru o SentTo , k ~ S;,;;,;'X f fJJ1!tiu!2.(.nu.'........:j;;,n.4-.......n---------.n--- ~':.~.~x.N~:.n11::v...)_h.tLW;!.uu.(_.L...---n.n--.nu.u...u City, State, ZIP+4/l L. t.~ .- :11 \ \ . . Town Hall . 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda 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 hl~_t~-(iJ~----- COUNTY OF SUFFOLK) -,--pr-- STATE OF NEW YORK) NOV 2 0 2002 l AFFIDAVIT OF POSTING I, (' (y.~v..L C. ~~ , residing at 4..b)< S\'\\\lyt~ k br~g~d~~ 1:~o~~de;~~~~nd say: That on the 1 I personally post d the property known .~ by placing the Board of Trustees official post r 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~yh~ ~. ~ pp'~lj.c A.l}eari~gJ' Da~e of heH-ri'}g noted thereon to be held ~. (/-# df111f. v~ tv f.IlA'-()--M-- '1 O.~ (/ JI1 . ~~ ?o11t01--- r~Q (s1gnature) ~~ Dated: Sworn to befqre me this $0 day of ~\oy 2002- ~tduc '(YI ~ NOr. LYNDA M. BOHN MY PUBLIC, State of N N? 01 B06020932 ew York QualifIed in Suffolk C Term Expires March 8, ~~n.t . , . . /.....-J \ e. \..,.,..N.Q6eL. .I , e. , / . t Te~h:>~,'.;.:,<,:;:f.. ';.: . " ~ , \ - \ ~ \ . ':t. ..----; ~\.O '. " ~'. . -.>.~:I' '. " .,..... '; : I,. :.~:. " ',' ,. .' ..:' ", .' ,', . "':. ~ . . .' , r--u-, L, ',ouea ! , I , I 1.._.. ,.-J AN~J~seL_ ..... l'j I: ..... .' ,', . ." .' ..... . : ".~'. ........ . '.' . ". 'l.. '. .... .'~ ..J." . _. .. '. . .:. 'MAP OF: POOP~QTY . SUf2YeYGD FOI2 ~JOH"I ',;t' ,CH12ISTINE C~f2?jCCil-~ ___.................___....._.__.___........... _.,._,._... _.. ...._._._._._ _.. __0_." AT _ CUi ::l-i~G!..!= Tar-IN 01= 5.:xJTkOi..C."'1 "'''.''(~ .' . ~/c;: SO'#I''': c ...1!.OCO :;'1.f-I-~ "tOt~u".,(:ttrf- .. ir~~ pit~.tt:. , I 00+...111 .", eleva+iOt'ls - 10 ~ "feci". aa:r It!VeJ. N&IO ~l i1J Ill: .Ci () if H vV/ . / .!? It ... '" I1J l!J & '''1 '.' i CaviSed'Ua;:'~' :?I. i985 "', ' .' Moi:i'..~' /985. .. . . ".~i1p-I;' 9; 1993 1.1"''1/8. '993 Guotr-al~d To The 7i+le GuOl~ ec".,pa"~ .' a$ nrve~..Sep+._=./~e". ..: O..'!O~RICKJANnlYL....f. " ;.: ~~.V_""T--,.J. .. , LICENSED LAND SURVEYORS . . GREE'N..oRT ' NEWYORK ' .. . -':: ~,~.,:.:;:?(S~S~';~:~-t~~f~~ir.~~?~:l~~.~j1U,i.~);)~:,: . . .0' ~ ;', ~ 5u,.ru..." """"', "~"'~." ......- t. __.-n...,...u.. H.S, NO, '3-sO"/6-4 ,". ":' , ' ~ ST....TEMENTOF INTENT THE W....TER SU,I'I. Y ....ND SEW....GE DISPOS....L - SYSTEMS FOR' THIS RESIDENCE WILL CONFORM TO THE ST....ND....RDS OF THE SUFFOLK CO, DE". OF HE....LTH SERVICES. 151 ...."LIC....NT DE'T. OF HE....L TH ...."R o V"" L OF , SUFFOLK COUNTY SERVICES - FOR CONSTRUCTION ONL Y D....TE: H. S. REF. NO.: It- SO. 16-4 A'..ROVED: " SUFFOLK CO. T....X M....~ DESIGN....nON: " DIST. . SECT. BLOCK, 'PCL. '000'. '1~"7 9:.'". ~8 OWNERS ADDRESS: ' . . . .' .' , :. Ie L.in..";' :L;".... . '. . ,~r""'i,.'1v,71., N.v.:'rrr.S8:. . . . :.,' .....:.;... (Te', "762-0&1.//)'. DEED: L.ISE>.. EST HOL '. ...510.6/~ ,STAMP r.Ul'nt". ~<oil ................-=.,~ :.:.a-=::.-=-~...::.-; t~l.- ,.' ....."......,....... . . . ..r'..J". ~..;.! .. ."~ .. "":.Il.,a:,:~.a::_.:.; ..l.:....w.lIlI;tuIi.... c\o~~......Ih\:'"_, .,....,... .............,,1'1 ............ - ...... II.. ........,..-_. ....d.....,.. ...................... .. lie................ .... ..... .................. .......... ................ - . ,,' cleon,- sorT"'; / . -.1- I , ~. .... , t , <..n~) KtE2NAN (,; ! ! E. ,.,. q I \ t:lNN"'BEL.. q i ' !.ti~ 1 i i R ~ f .. ' / / S. / / NGt.,-ew'OO"E," / ~.~'9.~lO'D:)~W. LTtSS+ /woli :if.,' '~. :-:.. 'bI.~;t.~.~ \)~ ..,..... .\\ ..,~ ".:'ii'~".---'!' 'c.-'" .N't::. ~,'r:.._~ a,....."\I ...':. ~ '{':~.'C> -;orG '5-1:iL.,I-.-":." T.t::ISH-lIAN , J' L, hou.;.e ~NNASEL , "'t , . ., F. ,.. 4, . Dcr+.J1f1 for etl!",o+ior:$ - 10 ... 1TIearr $eO" Ie-.I'e.l. NOVO 1~.3 .f~S.O -~ " r- :l~ ! '.-... ;",W',f J b'" 1.(\1.' :.....t .:: ! 0" r,-.,- ~Q ., 7"-- . ~ '. -::.- 8~O.O 1 -.ji ,I 01 ! !v1AP OF Pr2opr-:'!2TY ( sul2Ve....EiO FOe ...JOHt':.i..*. CH.R)~TJ,'Y.f;:c: ci~df;~Q?_ = 'I CU;~I-i06:"!= [ TOWN OF 'SOlJTHOi._C', ['..1..j : I . ..... '..0 ~L' ~l \l:' {,-g~ ~~~. SGotl.~ so'.:=: ,~ Are::r=.JIfI,OOO ~'f+. f1l1tnOt'f(JtncStr!- Q . il"Ort pip~ I i .' 0; u. I!i r:s () ^J I ,,, " / / .. ~'i ~. ~ /}j (!J & ,. , /. ;/ " /1 , . / " / ! { I l ; ....J.. , / ~ eevi~o .Jan. 21,/985 Feb. 6. J985 April .. >.1993 6uarerrrfee:::i To TIre 7i+le &Ja~ Cor!'fpertty ",. Eurveyed s"p+. a:::, ''Oe;t. ItOQJRICK VAN..1JJYL. ...C. k:. \1_7--,>. LICENSED LAND SUltV-a'ORS GiREENJI01tT NEW YORK SUFFOLK CO. HEALTH~. ~VAL H.S. NO. ,~.S$.1&4 (\ , I ..... , .,,( Ii STATEMENT OF INTENT THE WATER SuPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT. OF 'HEALTH SERvICES. (SI ~ICANT SUFFOLK COUNTY SERVICES - FOR CONSTRUCTION ONLY DATE: H. S. REF. HO.: 13- SO.lfA APPRovED: DEPT. OF HEAL 1H APPROVAL OF' SUFFOLK CO. TAX MAP DESIGNATION: DIST. . SECT. BL.OCK ,a". 1000 13' :I P/o S OWNERS ADDRESS: 18 L.ind_ Lc~. Far-mi"1vzi I., N. Y. : f7:sB (7,,1. 7S2:....fII) P.510,5f..... .. ST..... DEEO:L..'5':.tO TEST HOL ~. humu. -Ie ftoil ~. .--..... . .::,;=.,..-=~~--_. -' ,....~""Ill.......IIlll....,p'~". --............. :.'~~........1WIM*"'!~ '::'.'"...--...~....... l"~"'."''''''''t:J.. ::,:'~.........IIIII~. .,~~~.;.~:=~ cleay """d SEAL 0-1- " . . Board of Trustees Application County of Suffolk State of New York L~~ul...l'F_ ~, (A~ 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 APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. ~S;:~:C ~ Signature (J SWORN TO BEFORE ME THIS a.5 DAY OF Orl,,-~oJV..... ,20 02- ~O~iCYn ~ LYNDA M. BOHN NOTARY PUBLIC. State 01 New'tbrll No. 01806020932 Qualified In Suffolk Countv Term expires March 8, 20 ~ . . . \ ArPLtt!AN'l' TRnNS^CTION~L DISCLOSURE FORM The Town of Sou~hold's Code of ~thic6 ~tohibibs contlicts ot interest on the part of town officers and employees. The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR HAHRI I ,:'!, :.~lr;",,;'!~i~~rii.~:.\ !!- C:~ . ,\.,"~'Il;~;"".\"....,.,t~ft. Last name, first name. m ddle you are applying in the name of someone else or oth~r entity, such ~s a company. It so, indicate the other person's or company's name.) .," ,;':':' !.,:~')'t ,::,:/,:,:~~'~' :'~;!/" ~::!.:/ "ATURR or ArPLICATIONs (Check all that applY.) Tax grievance Variance Change of zone Ap'p~~al of plat . Ex~~ption from plat or official map other (If "other," name the activity.) ,." .... Do you perBona11y (or through you~ c~Mpany, sp~use. sibling. parent. or child) have a relationship vith any officer or employee of the Town of Southold1 -Relationship- includes by blood. ~arriage. or business interest. -Dusiness interest" MeanR a business, including a partnership, in vhich ~he tovn officer or employee has even a partial ovnership of (or employment by) a corp.oration in vhich the tovn of ricer or e~ployee ovns more than 5% of the shares. YES NO ~ .;:,~'! " If you ansvered DYES.". complete the balance of ~hi~ 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) and the town officer Qr employee. Either check the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or his or her spousei sibling, parent, or child is (check all that apply). A) 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 inberest in a noncorporate'entity (when the applicant is not a corporation) , c) an officer, director, partner, or employee ot bhe applicant;, or D) the a~tual applicant. . . '>:'1 . . ,..' , " ',"'j'.:" DESCRIPTION OF ttELATIONSIIIP . '.. '. ,,'~., > . .-'... '.~ .~ " I.' . ...."...,...".,...,;~.;;.....r'..;"J\~; '"" 'iw.'i:"r'j . .,'" ,,:;.J.'.';;~~"" . 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"OPACIC ARCHITECTS "- NO. 424 P.8 "-<' ~. ,.......--........ , ~-~~--~ I : ! D1."NQOIRI'CR1' / ~ [E (G [~l.5J:lL~ '0~ I l -._- ., II I I ^0C' , / il M/\Y en.] ~ -...J__....~._ ---J ...: ;..,'il -...., ~(' " R,.,,' ,,' . .,-",'tl:PS - -~-~,:..~ I , , I , ..- '- '-" w SCIIT1NC1lI-1OIJ11 ...................... ..'""................... -- -- ...~~---~-~ - , I , I /. - , I , I . I / C! I I ~ I I / , I - c q- ~ ~ I ~ g. is i en -. . :=c:< ~-""t8QC . CONl~ ..~ y l SITE PLAN S10.07'20. E"1i7i- EUGENE'S CREEl( H'GH'~~~~~_J SCALE 1:200 ,.~ ~XXXXY)(X)(X " ~I:CIUH YV< )( X)( ~'X XxX, x x ><)\c)< ~ x)( / XX XYx x X 'Xv x'X)()(){h ?~~~~~X~~x MAR 3 1 2003 ~ 0Yx )(Y;X ')( 'it' X X x x" x X ~0Nbpxv:>Vvx0XX ~ Southold Town XX xfi' X~ Yv 'XX Board of Trustees ~ x.XXX V X X X X0~ IX X Xx ~ xXx X ~ X~ X>Q< Xx X ,. 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TASHJIAN ..-:~J:~;~~~~\:~-~ .;.:~.~~:.-;:.., -.'. ., .JOI--jt) * Scctle; SO'", ,~ Area:sJfI,OOC :!tl.f1". El"'tnQtf1t,JtrfSrr-!- 6) . iron pip~ ~NN~SEL "S. , - '1-. tJ r: ;:-d~ /.~ : .ID.l ! 0-" I JI.,_" '....i: : b". Q t' "' 'ril ,I '1 ! 'V' , ., ~- Oa+.;m. for ef~",~+ior:s - ~ .. ",eo-t1 5eO' lC"-te.l. N6VO ..:; 11.' tJ {j' U tv j i , I " I i. I .1;; 1:1. <: iii <!l & ,/ I ; ! I' . I ! .. I: I I , , i . I i /./ ; ---J._~ i .' o I :~.. '~il;\:~ /' J~l APR 2 3 J9g3 &r~.n~Fl. ,"""",,.'~'" TOWN c;. sOU;r(O; r;.~~ eevi~cI ..Jan. 2/. (985 Feb. "'. 1985 April 9 >.1993 6ua"C1~ To The -n+1e 6Ua~ ~pat1<j ::5 E~'Fd Scp+. 0::, '983". RODERICK VAN---.IJ.lYL, ".C. 2. \/_,--;). LICENSED LAND SURVUORS GiREENPOftT NEW YORK SUFFOLK CO. HEALTH ~PT. ApPROVAL H.S. NO. '3-~te4 ('. , '~ l" STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE ST ANOARDS OF THE SUFFOLK co. DEPT. OF "HEALTH SERVICES. ISl APPLICANT SUFFOLK COUNTY DEPT. OF HEALTH SERVICES - FOR APPROVAL OF CONSTRUCTION aNL Y DATE: H. S. REF. NO.i /3- 50.16-4 APPROVED: SUFFOLK CO. TAX MAP DESIGNATION: DlsT. . SECT. BLOCK PeL. 1000 (';31 3 ~ 8 OWNERS ADDRESS: J e Linden La".. FarlTli~v:"lJe-, N. Y. : ('758 (,eC.7S2;Eo-4ltj P.510,51'" STA.... DEED: L. '5~~ TEST HOLE f humulo w,p.oit ,: . '~~ . -,-:,1=--'-:=:l~-'-' . -'~~"''''''IlllC''a:xP':-., -.. :... ~"""'1ll:Wo ::,<:~~~,--~",,.... f::;==~':,,~::-' :~~-~~ . '~:.~=~.- ....:t"~U'~.._: cl<<w- =d SEAL -I- I ~.