HomeMy WebLinkAboutTR-5744
.
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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
February 25, 2004
Mr. Robert E. Herrmann
En-Consultants, Inc.
1329 North Sea Rd.
Southampton, NY 11968
RE: DAVID SCHULTZ
2745 WICKHAM AVE., MATTITUCK
SCTM#139-2-3
Dear Mr. Herrmann:
The following action was taken by the Southold Town Board of Trustees at their Regular
Meeting held on Wednesday, FebruC!ry 25, 2004:
RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to
Permit #5744 to reconfigure and relocate approved dock such that "T" dock located 12'
from northerly property line becomes "L" dock located 10' from northerly property line,
and as depicted on the plan prepared by En-Consultants, Inc. last dated 1/29/04.
This is not a determination from any other agency.
If you have any questions, please call our office at(631) 765-1892.
Sincerely,
oj-n nuo }[ ( n~
James King @
Vice-President, Board of Trustees
JK:lms
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Telephone
(631) 765-1892
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
CONSERVATION ADVISORY COUNCIL
TOWN OF SOUTHOLD
At the meeting of the Southold Town Conservation Advisory Council held Monday,
February 23, 2004, 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
CONDITIONS of the Amendment application of DAVID SCHULTZ to Amend Permit
#5744 to reconfigure and relocate approved dock such that 'T' dock located 12' from
northerly property line becomes "L" dock located 1 0' from northerly property line.
Located: 2745 Wickham Ave., Mattituck. SCTM#139-2-3
The CAC recommends Approval of the application with the Condition of a 10' non-turf
buffer and no treated lumber is used.
Vote of Council: Ayes: All
Motion Carried
Albert J. Krupski, President
James King, Vice-President
Artie Foster
Ken Poliwoda
Peggy A. Dickerson
.
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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
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.
Se-h-J \-t2:..
INSPECTION SCHEDULE
Pre-construction, hay bale line
1 sl day of construction
y, constructed
J Project complete, compliance inspection. 1\ \4114-
H-jL~
Board Of Southold . Town Trustees
SOUTHOLD, NEW YORK
PERMIT NO. .~?i.J<fH
ISSUED TO .....H.HJ?J.\:Y.P?:P.:...He<::.I:lY.:L.-T:z:H
DATE: ..~p.:ri13g.'...?g03
...n.......................... .............
1\utqorilutiou
Pursuant to the provisions of Chapter 615 of the Laws of
the State of New York, 1893: and Chapter 404 of the Laws of the
. State of New York 1952~ and the Southold ToWn Ordinance en-
titled ."REGULATING AND THE PLACING OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBUC LANDS and the
REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN W A TERS;t'; and in accordance with the
Resolution of The BOard adopted at a meeting held on .Apr.H..JQ.....
. 2~~~.., and in consideration of the sum of $H.?o..o.,..o.O"H paid by
Da,yi<l.})....S~h'*z.. .............,..... H............H............HH...........H.....
of .....H.H........M~.H~t!!sk...H... . . ... N. Y. and subject to the
Terms and Conditions listed on the reverse side hereof,
of Southold Town Trustees authorizes and permits the foRowing:
Wetland Permit to construct a fixed timber dock consisting of a
1 4'X12' on-ramp; a 4'X45' fixed catwalk; a 3'X20' hinged ramp'
and a 6'X20' float secured by (2) pilings. and as depicted or: th'
plan prepared by En-Consultants, Inc. las1 dated 11/03/01 . .
aM in accordance with the detailed specifICations as presented In
. the originating apprlCation. .
IN WITNESS WHEREOF, The said Board of Trustees here-
by causes. its Corporat<<: S~al to be a~xed, and these ~nts to
be subsenbed by a malority of the said Board as of this dat.e.
Albert Krupski Jr. abstained)
.
.
TERMS ilnd CONDITIONS
The Pcrmil.Ue
David P. Schultz
reslcIIag at 2745 Wickham Ave.. Mattituck N. Y.. IS
put. 'CIIcbe coasideratioo for che i<'a....,... of die PUmit does \1~pd and p.-ribe to cbe fol-
lowlIlB:
1. That: che said Board of Trustees and the Town of SoutboId ate Rleued from aI1f and
all damages, ex daIms for damages, of saIa adsiog cIlrecdy << indhecdYIS · resuk of aI1f opec-
atloo pdoaaed p<i"P'.nt to this permit, and the said p.rn.I- will, at Ids << her own arc-.
defeod aAJ and aU IliCh lUiu.ft,lH......by tbl1d parties, and cbe said.... I...., ..- fall JiabIUcy
wiIb Ie$pect thereto. to cbe CO""f'1cte.adusloa of cbe Baud of TrasUes of cbe Town of s..,d ~
2. That this Pem2lt Js. 'ftIid fOr .pedod of 24 mos. which Js OlGSiil.td to be cbe
('<timo."'" dme.teqaired to alinp/de die wod< inwhed, butihoaId ~....... warraar, request
for an exIaISiOll may be made to die Board at a ~ cIate.
~. That: this Permit should be reiained indefmitely. or as long as die said Permittee wisbCs
to . .,...l_ln die sttueture or project involved, to provide eridence to ~ <OOCel'lJed chat auth-
.orizatioo was originally obtained.
4. That: die ...odcilm>lved will be subject to die i~ and approva1 of die Board <<
its ageots, and 1lOCHlOOlP1laoce wiIb. the provisioDS of die orl&'-tl..g app1icadoa, may be - f<<
revocadoo of this Peanit by RSOludou of die said Board.
5. That there will be no Ul1tea$OD8b1e lnterfereoce wilh aavigaIioo as a .-.1t of die wod<
herein aU'd1orhed. . .
6. That: there sbaI1 be 1IO imerfemu:e with the right of die pub1k to pass and .. a10ag
che beach between high and low _ter marks. .
!.
7. That iffucure operatioas of die Town of SoutboId require die telDOftI and/<< a1tendoas
in die 1oc:atioa of cbe wod< herein .,."-1.""'. or if, in cbe opialoo of che Board of Tmscees, die.
waG sbaI1 cause _..,..,.J,le obstruclIOCl to free aavigadoa, die said p.rn.I...... will be requhecI.
apoo due oocroe, to remove or alter this work or project herein stated without ....j>eOSCI to cbe Town
. of behold. . .
8. That the said Board will be aodfled by the Permittee or cbe ~. Of the -" ....
orb.ed.
9. That die permittee will obcaln all ocher peanits and c:oasent. that may be required sap:.
plementaI to this permit which may be subject to reYOIre upon fallate to obcaln -.
..:
'.0"
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,
.
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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
April 30, 2003
Mr. David P. Schultz
2745 Wickham Ave.
P.O. Box 624
Mattituck, NY 11952-0624
RE: 2745 WICKHAM AVE., MATTITUCK
SCTM#139-2-3
Dear Mr. Schultz:
The Board of Town Trustees took the following action during its regular meeting held on
Wednesday, April 30, 2003 regarding the above matter:
WHEREAS, DAVID P. SCHULTZ applied to the Southold Town Trustees for a permit under
the provisions of Chapter 97 of the Southold Town Code, the Wetland Ordinance ofthe Town of
Southold, application dated October 28, 2002, and,
WHEREAS, said application was referred to the Southold Town Conservation Advisory Council
for their findings and recommendations, and,
WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on
April 30, 2003, 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 standards set forth in Chapter 97 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 of the town,
NOW THEREFORE BE IT,
RESOLVED, that the Board of Trustees approve the application of DAVID P. SCHULTZ to
construct a fixed timber dock consisting ofa4'X 12' on-ramp; a 4'X 45' fixed catwalk; a 3'X
20' hinged ramp; and a 6'X 20' float secured by (2) pilings, and as depicted on the plan prepared
by En-Consultants, Inc. last dated November 3, 2003.
Permit to construct and complete project will expire two years from the date the permit is signed.
Fees must be paid, if applicable, and permit issued within six months of the date of this
notification.
Inspections are required at a fee of$5.00 per inspection. (See attached schedule.)
Fees: $1,085.00
Very truly yours,
}.:-B-t
Board of Trustees
JK/1ms
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4/98
Albert J. Krupski, President
James King, Vice-President
Henry Smith
Artie Foater
Ken Poliwoda
Telephone (516) 765-1892
Fax (516) 765-1823
Town Hall
53095 Main Road
P.O. Box 1179
Southold, New York 11971
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
TO: David P. Schultz
Please be advised
has been reviewed
April 30, 2003
that your application, dated October 28, 2002
by this Board, at the regular meeting of
and the following action was taken:
( XX) Application Approved (see below)
(____) Application Denied
(____) Application Tabled
(see below)
(see below)
If your application is approved as noted above, a permit fee is
now due. Make check or money order payable to the Southold Town
Trustees. The fee is'computed below according to the schedule
of rates as set forth in the instruction sheet.
The following fee must be paid within 90 days or re-application
fees will be necessary.
COMPUTATION OF PERMIT FEES:
4'X45' catwalk = 180'X$3.00 = $540.00
3'X20' ramp = 60'X$3. 00 = $180.00
6'X20' float = 120'X$3. 00 = $360.00
Final inspection = $5.00
TOTAL FEES DUE: $ 1,085.00
i
041742
AMT.PAID
BAlANCE
DUE
J
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EN-CONStlLTANTS INC.
,.
1329 NORTH SEA RD.
SOUTHAMPTON, N.Y. 11968
631-283-6360
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1. PrOject location: 214!7 W,ckhan Ave,
MaliIW. 5CfM No. 1000-159-2-5
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PROPOSft? t?OCK fOR t?AVIt?
5CHUl fZ ON WNw CI(f~K,
MAfll11JCK, 5UffOlK CO" NY
5H~~f1 Of I 10/ B/ 05.11/5/ O?
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El\1-CON~ULTANTS INC.
1329 NORTH SEA RD.
SOUTHAMPTON, N.Y. 11968
631-283-6360
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1. Project locat",,: 214S W,ckhan Ave.
MabtItuck. 5CfM No. IOOO-I?9-2';, S::!
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PROP05fD DOCK fOR DAVID
5CHUL- 17 ON L-ONc:i Cr-ffK,
MAf1l11.CK. 5UffOL-K CO" NY
5Hfffl Of I 10/B/0:7.II/:7/0:7
.
EN-CONSULTANTS INC.
1329 NORTH SEA RD.
SOUTHAMPTON, N.Y. 11968
631-283-6360
t:',olat:.
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Water dep/J1s rearded MItl:;j
I1M' tide (7::7OPM. 7-2-07)
Patl'" of catwak 5eaN"..d of A'-W
to be ~d b4 :7-pile beriD
Project locatJ",: 214'7 W,ckhan Ave,
MattlhJck. ::CfM No, 1000-1:79-2-:7
Adjacent OwMl'S:
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PROPOseD DOCK fOR DAVID
5CHUL.17 ON WNe;; Cr<r~K,
MAf1111JCK, 5UffOL.K CO" NY
5H~~1I Of I 10/ B/ 0;'.11/;'/ Q;>
.
.
1329 North Sea Road
Southampton, New York 11968
631-283-6360
Fax: 631-283-6136
E-mail: encon@peconic.net
www.enconsultants.com
~
EN-CONSULTANTS, INC.
,~ .
.~
Lauren Standish
Board of Trustees
Town of South old
53095 Main Road
Southold, NY 11971
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November 4, 2003
ENVIRONMENTAL SERVICES
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Re: David Schultz. 2745 Wickham Avenue
Dear Ms. Standish:
In accordance with my discussion with Jim King, please fmd enclosed a revised project plan for David
Schultz, last dated 3 November 2003, which depicts a proposed fixed timber dock consisting ofa 4' x 12'
on-ramp; a 4' x 45' fixed catwalk; a 3' x 20' hinged ramp; and a 6' x 20' float secured by (2) pilings. The
overall seaward extension ofthe dock from the seaward corner of the existing dwelling is approximately
106 feet, as currently staked.
Should you require any additional information, please let me know at your earliest convenience.
Respectfully yours,
~
Robert E. Herrmann
Coastal Management Specialist
Enclosures
cc: David Schultz
.
.
.
SEQRA RESOLUTION RE: DAVID P. SCHULTZ SCTM#139-2-3
Resolved by the Board of Trustees of the Town of Southold that the application
of DAVID P. SCHULTZ, more fully described in the public hearing section #1 of
the Trustee agenda dated Wednesday, December 18, 2002 is, pursuant to the
SEORA rules and regulations, an Unlisted Action; and be it
Further resolved that the applicant is required to submit Part 1 of the Long
Environmental Assessment Form (LEAF); and be it
Further resolved that upon receipt of the LEAF the Clerk of the Trustees is
hereby directed to commence a coordinated review pursuant to SEORA.
.
.
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 Monday,
November 18, 2002, the following recommendation was made:
DAVID P. SCHULTZ to construct a 4'X 64; catwalk, 32"X 20' aluminum ramp and 6'X
20'f1oat.
Located: 2745 Wickham Ave., Mattituck. SCTM#139-2-3
The CAC did not make an inspection, therefore no recommendation was made.
~
:MAR INE CONTRACTING
DOCK BUILDING JETTIES FLOATS BULKHEADS PILINGS
P.O. Box 1611, Mattituck, NY 11952
631-298-5412 (FAX) 631-298-1814
Job Prooosal/Estimate
Job Name and Location
Dave Schultz
Wickham Avenue
Mattituck, NY 11952
Phone:
Date: 10/5/02
Job Soecifications
Construct 4'x64' catwalk with 6"x6" outside stringers and caps, 8" piles (12'-30' in length) 8' on center, 3"x6" inside
stringer, 3-pile bents, %" hardware and 2"x6" decking
Supply and install 32"x20' aluminum ramp
Construct 6'x20' float with 2"x8" bottom stringers. 3"x10" top stringers, 6-Dow foam billets, y." timber bolts. 2"x6" decking
and 1 0" cleats
Install2-2pile dolphins with 10"x35' piles
All lumber treated with CCA
All decking #1 CCA
All hardware hot dip galvanized
Total Cost $18,350.00
Permn Service available
Pavment to be made as follows: $500.00 on signing, $9,000.00 on start up and balance due on completion
.... RIII~rIIIll5 guaranteed as to be IS specified. ....work to be CO.'ld in I worknw.nlU ITlInller acoonllng 10 SlIndIlrd pnlctlen. I'vrf ahraliOns or deviations fromaoove speclllClltloll$lnvollting eldnl cost wi. be OKt"::uted only upon wrillen orders,
and wl. become In extT1 cll8rge overtbe lbove estimale. All agreements contingent upon strikes, accidents or delllys beyond Ollf control OWner 10 CIllTlar ftre, tornado and othe, necessary Insuranc..
Authorized Signature~ Date: 10/05102
"We may withdraw this proposal if not accepted within 30 days
AcceDlance of Prooosal: The above prices, specifications and conditions are satisfactory and are hereby accepted. You are
authorized to do the work as specified. Payment will be made as outlined above.
Signature ~/..f? ~~ Date of Acceptance: /tJ /25/(} 2--
UG i 2 8 '2UU2
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:M:ARINE CONTRACTING
~
DOCK BUILDING . JETTIES. FLOATS. BULKHEADS. PILINGS
P.O. Box 1611, Mattituck, NY 11952
631-298-5412 (FAX) 631-298-1814
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631-298-5412 (FAX) 631-298-1814
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ANY AL TERA110N C1t AtJDf'f1(JN 111 TN/S $URlEY 1$ A ~ 1ION
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IIHOSE SIGNA 7lJftF: APPE:AIfS HtrfEON.
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12JO TRAVELER SweET alo 307
SOUTHOLD, N. Y. 11971 IG-
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1329 NORTH SEA RD.
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Mabtitu<:k. 5CfM No. 1000-1;,9-2-:?
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5UffOlKCOUNIY, N~W YORK
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EN-CONSULTANTS INC.
1329 NORTH SEA RD,
SOUTHAMPTON, NY 11968
631-283-6360
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EN-CONSULTANTS INC.
1329 NORTH SEA. RD.
SOUTHAMPTON, N.Y. 11968
631-283-6360
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PROP05W DOCK fOR DAVID 5CHUL:rZ
ON WNCi CRffK, MAfllruCK,
5UffOlKCOUNIY, NfW YORK
SHffll Of 110/8/~.lln/~.1/29/04
Albert J. Krupski, President .
James King~ Vice~President
Henry Smith
Artie Foster
Ken Poliwoda
.
Town Hall
53095 Route 25
P.O. Box I 179
Southold, New York 1 1971-0959
Telephone (631) 765-1892
FAx (631) 765-\366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
LE'ITER OF REQUEST FOR AN AMEND
o
f~B ~: ~4 ~ ,~
DATE FEBRUARY 2, 2004
Southold Town
Board of Trustees
OWNER DAV:IDSC~TZ
PHONE 631-298-9340
ADDRESS P.O. BOX 624, MATTI11JCK, NY 11952
AGENT EN-CONSULTANTS, INC.
PHONE 631-283-6360
ADDRESS 1329 NORTH SEA ROAD, SOUTHAMPTON, NY 11968
PROPERTY LOCATION 2745 WICKHAM AVENUE, MATTlTUCK, NY 11952
TAX MAP NO. 1000-139-2-3
IJWe EN-CONSULTANTS, INC. request .. AIDe.dment to Permit # 5744
TO RECONFIGURE AND RELOCATE APPROVED DOCK SUCH THAT "T' DOCK LOCATED \3' FROM
NORTHERLY PROPERTY LINE BECOMES "L" DOCK LOCATED 10' FROM NORTHERL Y PROPERTY d
LINE. 91 ~~'\n
_Or- ti
ROBERT E. HERRMANN, COASTAL MGMT. SPECIALIST
.
.
1319 North Sea Road
Southampton, New York 11968
631-283-6360
Fax: 631-283-6136
E-mail: encon@peconic.net
www.enconsultants.com
~
EN-CONSULTANTS, INC.
ENVIRONMENTAL SERVICES
February 3, 2004
REOlJK'>T FOR AN AMENDMENT
Town of Southold
Board of Trustees
Post Office Box 1179
Southold, New York 11971
Attn.: Lauren Standish
~~ f~B~: :}'~ i~
Re: David Schultz
2745 Wickham Avenue, Mattituck
SCTM #1000-139-2-3
Southold Town
Board 01 Trustees
Dear Ms. Standish:
In regard to the above referenced property, enclosed are the following for the Board of Trustees review:
I. Three (3) Request for an Amendment Applications,
2. Three (3) copies of authorization & disclosure forms.
3. Three (3) work plans.
4. Three (3) copies of survey.
5. One (I) set of site photographs.
6. Application fee of $40.00.
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.
~
Rob Herrmann
Coastal Management Specialist
Ikhs
Ene.
.
.
.
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
APPLICATION FOR AN EXEMPTION FROM THE
MORATORIUM
DATE /{p/J'/ Z 2) 20tJ.3 PERMIT#
OWNER J)If(V;tI f? Jehu #z PHONE (63/) 2q8'-Q 3 'ItJ
-
ADDRESS 27'15 Me/ham IlJlf'nt/e. ;:'t?&K ~zt/. /l);ff,/t,ck)lf 111I.5Z.7JbZ1-
/ ./
AGENT/ATTORNEY
PHONE
ADDRESS
CORRESPONDENCE SHOULD BE SENT TO:
PROPERTY LOCATION 21tf5 JI},c/dJCIm 4VMt/C' Jt1all/fflt'~ NY /ltfSZ.
)
TAX MAP NO. /~l1tJ -/39 -tJ z- - (J 3
~ iJ4v'/tll? &/)l/lIz request lial #.f &ar/,,/ '/C{//'/J
7t1{~ltt rttk VI A ",CAltiJ bn/Va e",k/tf ref/JJ. And -/I~~~
elfei.. -Iv acqs..f f'/7j' 6/~'(:: <"IdAaA~ II' /711.j ;::Jn1fr/(y,
PLEASE ATTACH A LETTER EXPLAINING WHY YOU QUALIFY FOR THE
EXEMPTION TO THE MORATORIUM-BE SPECIFIC REGARDING YOUR
PROPOSED CHANGES.
Signed By: ~/I P tit Wp
Print Name: 2J~tI,iI f? J't'hu/ff
'. ..
APft 2 3 2003
u
FORM NUMBER 97-1000
Southold 10wn
Board o}~~-
,.
. '
.- ~
.
.
David P. Schultz
2745 Wickham Avenue
P.O. Box 624
Mattituck, New York 11952-0624
April 22, 2003
Board of Town Trustees
Town of Southold
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Dear Board of Trustees:
My application for a permit to build a catwalk, ramp, and floating dock to access Long
Creek adjacent to my property was filed with your office in late October of 2002. The
matter came before the Board of Town Trustees during meetings in November and
December 2002 and was postponed until January 2003 while we jointly determined the
water depth and compliance with the "one-third" rule. It is my understanding that these
issues were resolved and that the Board was prepared to rule on the application at the
January 2003 meeting. However, this was precluded at the beginning of that meeting by
the announcement that the moratorium had begun that afternoon and the Board would not
be able to rule of our application (and others) that night.
As our application was submitted long before the beginning of the moratorium in
January, and as the delays incurred were mutually agreed upon in order to determine the
accuracy of the proposal, I respectfully request an exemption be made to the moratorium
that will allow the Board of Town Trustees to rule on my application.
Sincerely,
~I//? ~
David P. Schultz
Tax Map No.: 1000-139-02-03
PROOF OF MAILING OF NOTICE
A IT ACH CERTIFIED MAIL RECEIPTS
Name:
Address:
Town Clerk, The Town of Southold Main Road, Southold, NY 11971
Matt-A-Mar Marina
2255 Wickham Ave., PO Box 1235, Mattituck, NY 11952
Dr. Ali Agarabi
675 Westview Drive, Mattituck, NY 11952
EIH ~
APR 1 8 2003
STATE OF NEW YORK
COUNTY OF SUFFOLK
Southold Town
Board of Trustees
.
David P. Schultz, residing at 2745 Wickham Avenue, Mattituck, New York 11952, being duly
sworn, deposes and says that on the 18th day of April, 2003, 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 their 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; and that said Notices were mailed at the United States Post Office at Mattituck, New
York 11952, that said Notices were mailed to each of said persons by certified mail.
t2~fJ ~
Sworn to before me this 18th
Day of April, 2003
~f/~
Notary Public
.....1ICHBIf
"*,"""'_01__
~3047i! s'
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CJ Return R
o (Endorsement
o RestrIctedOeI
r'l (Emlarsement
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o
o
I'-
.
.
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
-----------------------------------
- E CE 1111: ~
g
J APR ':I n 2003
Southokl ToW1l
Board of TruslBes
BOARD OF TRUSTEES: TOWN OF SOUTHOLD
In the Matter of the Application
of
_ _ Pau6- ~_.. _S.ChU-\.11.. - - - - - - - - --
COUNTY OF SUFFOLK)
STATE OF NEW YORK)
AFFIDAVIT OF POSTING
I, Da.I/,'d P. Sc.h/A Hz
!f/aM-!u(!1.. N~uJ led IJt?SZ--062-t/
being duly 'sworn, depose and say:
That on the J 1tb day of II;.J"; / , 200.3, I personally osted the
property known asZ1t/5 d1e ~ '/?v~ ,/tAd:...AI oCTIl1:/PPO 13-tJ2-(3)
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 eight days prior to the date of th~
l2ublic h~aring. Date of hearing noted thereon to be held LlQnL~1 Q.CD.3
~O(\ e:ctl.QD..t..'t 1',0) Py().
, residing at
Z71./S
W,ckhCi/?1 AVMue'
/
Dated:
U~L:{?~t
Sworn to before ~e this
a/? day of ftpro'/ 200~
~M~~t;
ot: ry Publ'
CHRISTINE ZAWESKI
NOl'ARY pUBUC. State of New York
No. 52-4791196
Qualified in !,uffo1k County --;;;00 {p
Commission Expires June so,.-nnt.
.
.
Albert J. Krupski, President
J aines King, Vice-President
Henry Smith
Artie Foster
Ken Poliwoda
tf~
d18-1g~o
J)b4// d 5 e..ht.tArLBOARD OF TOWN TRUSTEES
~ TOWN OF SOUTHOLD
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-1366
Office Use Only
_Coastal Erosion Permit Applicatio}l"
_Wetland Permit Application ~ Major Minor
Waiver/ Amendment/Qha~s
_Received APplicn;: /0/;;"6/0 y'
Received Fee:$ -, 1 _J
Completed Application I 0/ ~ () v
_Incomplete
.;"S"EQRA Classification: .' _..,.,.J 1d-\a:>)00-
Type I_Type II _ Unlisted~ SO-~\- SfGlW (0 ()1V'
_Coordination:(date seny I ~ ~
_CAC Referral Sent: I I~D _ .'
_Date ofInspection: I t I ( 0
_Receipt ofCAC Report:
_Lead Agency Determination:
Technical Review: I
_Public Hearing Held: It 1'h/6Y
Resolution: I I
Name of Applicant [)AVIO f'. .5CflULTZ
Address ?145 WICkHAM AVENUE) Po Box 6:z.~ 1114rrmA:/5
NY IN52-{)bZ4 PhoneNumber:(~~ Z t:(g-93i/-O
Suffolk County Tax Map Number: 1000 - Sec:/-, 13 q 13 /Ot' I:;? f& I. 3
"" ./
Property Location: 211/5 WrCKHI//YJ 4Vt:.J./uE-.' Aj)J;4t.ENT ro(We.sr s/&>E.J
" ADJ4CGl>lr (E45r OF.)
Sovrl/€/<?N fJtJli'17t1J1 Or rife 6tf.4N.LJ AVeNUe gRIl:)(!7c,' lH14rr-I(-MI/R mll~Nt4
(provide LILCO Pole #, distance to cross streets, and location) ~ ,/ f"t('o Irtery,
If "l
AGENT:
(If applicable)
OCT 2 8 ?f!f':'
Address:
Phone:
L._
.
,
.
Board of Trustees Application
GENERAL DATA
Land Area (in square feet): "0 500 t .s~. R.
Area Zoning:
Previous use of property: re .5/ dtn --h a /
Intended use of property: re 5/den f/~ / - p /anfJIl1j Ie tit!!
t( catula/I<) r4mp; C(nd -f/~a-hn~ dodc -k acce.J.5 Loo/ Creel:. '
Prior permits/approvals for site improvements:
Agency
Date
L No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspended by a governmental agency?
~No_Yes
If yes, provide explanation:
Project Description (use attachments if necessary): I'lea~e .5t't'
aft"'t-heJ Job frrJp/Jsa{Jisluna.fe
rrJdfl/l/3 tM.fr~cf/'Y .
..fiwn s. /17. f4 Wh k
..I
oei 28.'1'"
~u;
.J
.
-
.
Board of Trustees Application
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: 7ht' CAlttlP/;( /AntfJ; 4/'7~
.flo~ W~j ~c'): tvJI/ 4/J~u/ 1/.5 at!L/5~ It? L/Jl).3 Cae/:.,
1J;/6 J{)//I /J/'()V~ 1ft k/lSf /;'ffl/.5/ve frl/J/e/ ,&t/t!/' ~~
//J/e-,-fld; I ?one o-f!he creek.,
Area of wetlands on lot: 0
squarefeet{~e ~r,p~r~,p~ L)
efIf ~ hl~;:' uA,,*r /FM"'~
Percent coverage oflot:
o
%
Closest distance between nearest existing structure and upland
edge of wetlands: .3 01: feet
Closest distance between nearest propesed structure and upland
edge of wetlands: 0 feet
Does the project involve excavation or filling?
V 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:
OCT 2 8 2002
-
--
Statement of t effect, any, on the wetlands and tidal waters of the town that may result by
reason of such proposed operations (use attachments if appropriate):
7/J-t t'al/Vtl/1S (':IJH1fJ; ttM' -:f'iP41i0l dtJCK IV,'/! prov;/t'
IItI /etal/hlrt/s/ie ffdlle J lOVe, !tt 1'rJ-krh~/ ZL7r7~
t1f L(J~q Cr~e/:.,
J
.'
1.4-16-4 (21a7)~ Text 12
I' PROJECT 1.0. NUMBER
II
-
.
617.21
Appendix C
Slate Environmental Quality Review
SHORT EN~RONMENTALASSESSMENTFORM
For UNLlSTED ACTIONS Oniy
PART I-PROJECT INFORMATION (To be compieted by Applicant or Project sponsor)
,. APPLICANT ISPONSOR DAv I D .p, SCHul... T z.. I 2. PROJEC7 NAME
3. PROJECT LOCATION:
Munlclpall'y Y/l-l.l/~/E (JP lf14rr!TI/(!/(. 'SoU II. Lj) ounty .sUrroLI(
4. PAEC:SE LOCATION (Street address and road intersecUons, prominent landmarks. etc., or proviae mapl
SEQ
Z1'IS M~KIII1M AVbl/tle
A1.4rnrt/tl< NY IIf5Z
4.oJ/!CeAlr /'t)' .
1/1~ G/f.4ND AI/eli/tit: ,B{:'IOGC (lI/eJr dQ
/114 rr - 4~ /J'J19~ t7!,Pie/A/A ;:;tbAseTy(Eti:')
5. IS P~OSED ACTION:
lJ!J New 0 Expansion
6. DESCRIBE PROJECT BRIEFLY:
L'MS frvc-I a ce?~~':'~ 4/)'/ 4Q '14~ A('~ ~
a~55 LtJ/lf &~E');: -,f-I/Pl //lJfrrtY 41 271/5 tUdll4n1 4Vl3-A/t/E"
o Modification/alteration
7. AMOUNT OF LANa AFrECTED: 1h1f 4M Iv 4'/7,J( 4 ~-Ir- / pIJ '/I ~ ~ "/i' ~ p,-)...s e?n
Initially acres l:1ftimatelv acres
3. WILL PROPOSED ACTION COMPLY WITH exISTING ZONING OR OTHER EXISTING LAND USE RE5TrlICTIONS?
\Ef'yes 0 No If No. describe briefly
9. VJHAT IS PRESENT LAND USi: IN VICINlrf OF PROJECT?
~eSjdential O.!nCustrial 0 GQmmerciaJ 0 Agricu;ture U Park/Forest/Deen soace LJ Other
oeWibe:f'I1J{lf"1y t:. ~S'OD t .5f' -II- t/.I:-!h a S/~kk:j hotlS'~ d/J/ ~k,t-/f..~~;1w
iO. DOES ACTION INVOLVE A PERMIT APPROVAL OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (F::uERAL.
STATE OM LOCAL)?
ffies 0 No
~v '~ZZ'51 af)~:;";?61/n;"t1l'7mM>t, / CHJ.Yrt/C/*";' - O-fP/,a, ~ni
~ In f?rtlflT'..c..J
-'r
11.
DOES ANY A!,5CT OF THE ACTIOI"! HAVE A CURRENTLY VAllO PERMIT OR APPROVAL?
DYes. t..!1 No If yes. list agency name and permit/approval
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REOUIRE .'vIODIFICATION?
DYes IB'No .__
1 CEi1TIFY THA T THE INFORMATION PROVIDED ABOVE IS TRUE 70 THE aEST OF MY KNCWL:DGE
Applicantfsponsor name;
DCJ..vid
/II?
P Schuf+z
D.,e /tJ/z.5/ClZ-
SIgnature;
If the action is in the Coostal Area, and you are a state agency, complete the
Coastal Assessment Form beiDre proceeding with this a,~~essmen8L I
OVER
PA"T 11_"NVI"C~JMEcJT,o,'.SSMENT ::-0 .Je.,erea J'/ .Age~c .
I ""-. OOES AC7~C~ :::":CE=::; ;",'~Y :, .-==., Ti-i?:E,Si-iOLJ!N '3 ,'~~C2;:;.=-:"r.T 5;7,":, ;/ 'feSt .:ocrClnate :ne re'fleW :roces, ana tJsa ,r.e F:JL:.. :;:';\..=
I
I 3.
I
I c.
I
I
I
I
I
L'f~S
1_:--lO
WILL AC71CN .~E':2.:V~:::;CP.OINA~:J ~EvrEw....$ ??C'JIOE::) =.:;:<. UNLS7~J
may ~e suoerseaec =-y ::.nctl'':er ;nvClvea a~ency.
L..: Yes ~o
..:..C7iCN$ iN:5 .'l'fC?R. ~'~M.7 ';;7.57
it ,'lo. 3 neq:W'Ia -::ec:ar;;.
C'::UlO ...:..Ci.lCN .~ESUL7 ,N ).NY AovE::::SE ::::==,:75 A$SCC;..; 72.:J '.....ITl-! "':"'l-t::. ,='::lLl..'':WING; ~).ns....,ers :nay :.e .unGWrHten. ;/ ;eg1clet
C1. ::.'Cistlng air quali.ty, :;urtac2 or- ,~rolJnaWaCef ;::ualily .or ::::uantlty, ,101se ;e'leIS. :!x~s~lng :raific oac,ems. sClid,vas;:e .JrCCll.:c:::::n
potential for :!fosion, :::ralnaga or :loOding ;lroclems? ":..,,:olam ::lrieily:
or ols.;::;
C2. Aesthetic. agric~lturaJ. 3.rc:naeoJogical. :-'is.onc:. Jr Olher :"1a{~ral ::lf cuitural ;esources: or ';::Jmmunlty or "elgnocrnood .:~afac:er'? ~o!aJn J'
C:=:. Vegetatlon or :auna, :Isn.sr:ellfisn or 'Nlldllfe soecies. slgmficant ~aoitats. Of :r1fearened or '!nGangereC3 sc:ec:es? S:clam :lrlarly:
C~. A c~mmunity's exis.ing ;Jlans or goalS as otflc:aJly adoated. or a cnange in use or intensity of use ot land or other natural resouress.? Explain ::r
cs. Growlh. subseouent:evelooment. or related activities likelY to ~e induceo jy the orcooseo action? :.xolaJn ~rzeiJv.
C5. I..ong :erm, snort :erm. c:.JmulalJve, Of otf'ler etfects nOI icentitied in C--;.cS? :,'(olaln~(1eil'l.
Cmer imoac:s ;jnc:~Cing :::-:anges In 'Jse at ;!ther C!l.!antity I)r type or ;nergYJ? S=,ialf' ::rietly.
'J. :S :HE?E.JR is 7i-iE:=iE '_:KE.::' 7"0 5E. C~NTMOVE?S'( ~E!...A.T:::0 70 ?QTENT!AL. ACIJS::!SE ~?'lV1RCNME~H":'L :t.1Pl1.C7S?
'_ Yes
'--.: ,'Jo
:f ':'"es. ~xclain Jriefly
OARi 1I1_0ETERMINAilON OF SiGNIFICANCE ITo Ole comoleted by ,o,gency)
INSiRUCT10NS: For eaC:1 adverse eifect identified .accve. determine whether it is substantial. large. important or C3therNise signiric
:ac:' eifec":. silould be assessed in connectiC3n with its (a) setting (Le. urban or rural); (b). ;)rot:laOility of oc:::~!n9; (el duratior:
irreversibility; iel geograonic scope; and {f} magnitUde. If necessary,add attachments or reference supporting materials. ::1sure
eXClanalions contain sufficient detail to snow that all relevant adverse impacts have been identified and adequately aCcressec_
C;'eck :his box if :/QU have identified ene or more ootentially large or significant ac';srse imoac:s whicn MA'
oe::ur. Then ~rac~ea direc:ly to the ,=ULL =A~ :mO/or prepare a positive- declararicn.
C:-Jec:< ~his ~ox ~f you have derermined, based on the information and analysis above and any supoortiiil
COC:Jmenr3ricn. :har :he prooaseQ ac~icn WILL ~~OT result in.-?.f1Y significant adverse environmental impac:
AND .:lrCIIICe on 5.i.tac:1mentsas necessary, (he reasons supcorting this determinarion:
'<..,t\~ nl :.c~u ."".;cnc',
:'"nl -Jr : "C~ '\l,lfT'lP. )1 >(L'~ocn~;OI'" ";11'C~f .n ~c"'o ......;cnc'/
:,(l~ 01 >{....~oon~'clC' UIIICtr
~..:n.:all.He ')1 ~",~con\lCI~ ':;I:,o:.::r ,n ~<:JO ....~~ncv
j,\(nd:\,/re.)I r':....J.:a.r~r ,tr~lr:e:",n( :rom ":~OO'HIO'<! :Jll'(lfl
""'""jl.:i 2. 8 '200'2
.).l{C
2
.
. 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
IOf
~~~~~:_--------
STATE OF NEW YORK)
AFFIDAVIT OF POSTING
I, [)~I/id ~ SUJul-lz., residing at zJi.l-S W,eKh~d1 .4Mnve,
tJbH,-.j-H.d~ Alf..u/ }'e.rk. /195Z-dh2-t.j
being duly ~orn, depose and say:
That on the ;Z,,/ day of NcJl/. , 2002. I personally posted he
property known as 2-1'1-5 ulicKIIA/l1 AVE./Vi/E: T/7VC..K AlY S(I/11~ IOtJO-/39--i!lZ-oV
by placing the Board of Trustees officia 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 ot-~he ~
RubliC hearinp. 9ate of hearing noted thereon to be held ~~
co:P- /J.. hJ.. 6v (L.IJ-hLr 1 'i.l!ttd- f /YI /
Dated:
lOM'/vtP f}r~
(signature)
Sworn to before me this
16~ day ofnDVtrnbRA 2002
(lhJdPih~ttlIxii
Notary publi
CHIIIST1NE ZAWESKI
NarARY pullUC. Stats of_Yadl
No. 52-4791196
Qualified in Suffolk CountY - . ~L1
Commission ExpI.... June 3O.-llI9 c::ivv--r
PROOF OF MAIUNG OF NOTICE
ATIACH CERTIFIED MAIL RECEIPTS
Name:
Address:
Town Clerk, The Town of Southold Main Road, Southold, NY 11971
Matt-A-Mar Marina
Dr. Ali Agarabi
2255 Wickham Ave., PO Box 1235, Mattituck, NY 11952
675 Westview Drive, Mattituck, NY 11952
STATE OF NEW YORK
COUNTY OF SUFFOLK
David P. Schultz, residing at 2745 Wickham Avenue, Mattituck, New York 11952, being duly
sworn, deposes and says that on the 2nd day of November, 2002, 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 their 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; and that said Notices were mailed at the United States Post Office at
Mattituck, New Yark 11952, that said Notices were mailed to each of said persons by certified mail.
~jp~
Sworn to before me this 2nd
~~--------- -
U.S. Postal Service
CERTIFIED MAIL RECEIPT
(Domestic Mall Only; No Insurance Coverage ProVided)
Day of November, ~
.-'I
.....
U1
.-'I
~; ",. 1197~
V~QWMJ.ry-~
NotarY Public
.....
m
.-'I
""
Postage $
{
Certified Fee
ru Return Receipt Fee
CJ (Endorsement Required)
CJ
CJ
Restricted Delivery Fee
(Endorsement Required)
MELANIE V. BROYIN
Notary PIAlIc, SlaIt aI NlIw YclIk
No. 48111712
QuaIItled In MDIk ~ ~
Commlstlon ElIphe Oc:l. 19. J \Jl)S
CJ
,...::'I Total Postage & Fees $
U1
CJ s,,, T01j)t.(./n CI(r~ I.
ru -Street:APt:-No_;--}'Jij~----:---I-/j--"-
CJ or PO Box No. 111tJt1/} 1((Jt!J
';'.aiY,-Siii;-ZiP-----~Ih~/;j-)jV--j/?"jT-----m----------
tiki
~ard of Trustees ApPlicati~
County of Suffolk
State of New York
DAy I 0 f. .s (! H UL T Z 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.
t. O~.f? Uk tp-
Signature
SWORN TO BEFORE ME THIS d.-(;
DAY OF Od-
,20 O}-
}=~~
MELANIE V. BROWN
NcUry PWIc, SlaIa 01 NIw YOlk
No. 4801712
0UaIIIId In MDIl~ .--
Commlllllan &phi Od. 1t. c:f- DOS
.1'
OCT 2 8 :.
.
.
.
NOTICE TO ADJACENT PROPERTY OWNER
BOARD OF TRUSTEES. TOWN OF SOUTHOLD
In the matter of applicant: David P. Schultz
SCTM#I000 - Section 139 - Block 2 - Lot 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:
Construct a catwalk, ramp, and floating dock at the edge of said property and Long Creek (a
branch of Mattituck Creek). The catwalk will begin near the center of property which borders Long
Creek and project into the creek in a manner that is consistent with surrounding docks. The job
specifications as provided by S.M. Pawlik, Marine Contracting, are as follows: Construct 4'x64'
catwalk with 6"x6" outside stringers and caps, 8" piles (12' -30' in length) 8' on center, 3"x6"
inside stringer, 3-pile bents, 3/4" hardward and 2"x6" decking. Supply and install 32"x20'
aluminum ramp. Construct 6'x20' float with 2"x8" bottom stringers, 3"xlO" top stringers, 6-
Dow foam billets, 1/2" timber bolts, 2"x6" decking and 10" cleats. Insta1l2-2pile dolphins with
lO"x35' piles. All decking #1 CCA. All hardware hot dip galvanized. A sketch showing a cross-
section of the proposed catwalk is enclosed.
2. That the property which is the subject of Environmental Review is located adjacent to your
property and is described as follows:
BEGINNING at a point on the northwesterly side of a 20 foot Right of Way which said point is
distant southerly 3 J17 feet from the point of intersection of the southwesterly side of Wickham
Avenue with the northwesterly side of the 20 foot Right of Way;
running thence along the northwesterly side of the 20 foot Right of Way South 220 20' 10" West
47.22 feet to the land of Agarabi (formerly Cambria);
thence along the northeasterly line of land of Agarabi (formerly Cambria) North 520 57' 40" West
168.0 feet to the ordinary high water mark of Long Creek branch of Mattituck Creek;
thence northeasterly along the ordinary high water mark of Long Creek to a point which is North
28020' 20" East 46.20 feet from the end of the last course;
thence along a the southwesterly side of a 8 foot Right of Way South 520 57' 40" East 163.0 feet
to the point or place of BEGINNING
TOGETHER with an easement of the 20 foot Right of Way to Wickham A venue.
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: . 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: David P. Schultz
MAILING ADDRESS: Post Office Box 624. Mattituck. New York 11952-0624
PHONE #: (631) 298-9340
Enc.: Copy of sketch or plan showing proposal for your convenience.
UL I 2 8 2t{',c
L
.. . ."--
l\.PPLtCl\N'l'
TRANSl\CTIONAL DISCLOSURE FORM
~
The Town of s~ukhold's code of ~bhics fohibibs conflicts of
nberest on the parb of town off cers and employees. The
purpose of this form is to provide informabion which can
alerb bhe bown of possible conflicbs of inberest and allow
it bo bake whatever action is necessary to avoid same.
tOUR NAHBt
Day;; p. Schu ilL
(Last name, first name, middle 1~ltlai:-~nless
you are applying in the name of someone else or
oth~r entity, such 'S a company. If so, indicate
the other person's or company's name.)
"."""
'" ", :.I,:,~'-.~f~'+i:\
i "....~\I~ l~' r_. ~(" ,,!t1l:f;.h.'....
. ,\.,V:~; ""'^;''':''''''''T~~''
I, ~;: _
d.' """., :.._. .'~"r, ~; t....'
. . - -.-.'..s;.....:.:.' . ......., "'~ - , -.' .;.
,.',;-,. 1',1't.}.l' ;,';'",;.' "":. ";' ."'.-~'
Nl\.TURE ot APPLICATION! (Check all that apply.)
Tax grievance
Variance
change of ~one
Ap'p~~al of plat ,
Ex~~pbion from p~ or official map
~~~e;'Other," name the activity.) ~tV" 01 'Hili/} hv..s k~ I(I'tIM/ld ~,,~,'1j .
, /fIP/I i:A ,.., t!'l
Do you personally (or ~hrough you~ co~pany. spoune, bibling.
pll~en~, or child) have a relntionohip vith any officer or
employee of the 'l'own of Southold1 "Relationship" includes
by blood, marriage, or buoineos interest. "Dusineos
interest" Meano a busineoo, including a partnership. in
vhich ~he tovn officer or employee hns even a partial
ownership of (or employment by) a corp.oraHon in which
the town of[icer or employee owns more than 5% of the
shares.
ns ('
,to
NO
';;'lll"
If you ansvered .tBS,M. complete the ba1ance ut ~hi~ torm and
date and sign where indicated.
Name of person employed by the Town o~ SOUthold JOClI1, Z~/J/es*,'
Title or position of that person CIt!,.K ~is7) ~fh"':t:. nPIJ}'.t1/;c~ J.
-eU"'~ ~1?4;;menT
Describe the relationship between yourself (the ap~11cant)
and the town officer Qr employee. Either check bhe
appropriate line ~) through D) and/or. describe in the space
provided.
The town officer or employee or his or her ~pousei eibling,
parent, or child is (check all bhat applY)l
A) the owner of greaber bhan 5% of the shares of the
corporate stock of the applicant (when the applicanb'
is a corporation),
a) the legal or b~neficial owner of any interest in a
noncorporate'entity (when the applicanb is nob a
corporation) 1
C) an Officer. director, ~artner, or empluyee ot the
applicantl or
D) the a~tual applicant.
. ~.'
ULI 28"
. ":)<'.':'
. .
." .
"
. .,"
DESCRIPTION 01;' ItELATlONSll1P l.;'
Joan Zal'7le..f J;. J61.k4j?if, 24/!,:{:(J,./!!'p"(4et:iJ.:sIilK.",;:,J:li;
sublnl t ted
I,\'~:'J
. '.,';'5,;;",
. " ~ .'~A:~
'print