HomeMy WebLinkAboutRusch, Emmie
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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
TO:
E y-n ()'} '1
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Rl-ISc'v1
Please be advised that your application dated (P I' (. (0(,
reviewed by this Board at the regular meeting of -=w ' Cj 10("
following action was taken:
has been
and the
( ~) Application Approved (see below)
L-) Application Denied (see below)
L-) Application Tabled (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 Chapter 97 of the Southold Town
Code.
The following fee must be paid within 90 days or re-application fees will be necessary.
COMPUTATION OF PERMIT FEES: .r ~t;t:J
n'~ I iM rec-/-lorJ
TOTAL FEES DUE: $1)0 ~
BY: James F. King, President
Board of Trustees
.
.
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
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Project complete, compliance inspection.
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.
James F. King, President
Jill M. Doherty, Vice.President
Peggy A. Dickerson
Dave Bergen
John Holzapfel
Town HaIl
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
Southold Town Board of Trustees
Field Inspection/W orksession Report
DatelTime: 7/;.,)./ () c:
Name of Applicant: C~,~- teu...<J--..,-d...
Name of Agent:
q-go 1~ ~ ,&).-..
/000- 7" '1- 76-.~~/<I
Property Location: SCTM# & Street
BriefDeSCriPtio~F
Typp'ofarea to be impacted:
~altwater Wetland _Freshwater Wetland _Sound Front _Bay Front
Distance of proposed work to edge of above:
Part of Town Code proposed work falls under:
.....e11"apt.97 _Chapt. 37 _other
Type of Application: _ Wetland _Coastal Erosion _Amendment ~inistrative
_Emergency
Info needed:
Modifications: ? c::z.d.dL ~ r .# ofl ~ ~./)( 1L
lib II ~~
Conditions: . . ' ~ --' t<;
dtJ~ :J~
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"Present Vi ete: J.,JJ(ing l..--f.Dohetty ~ickerson. t..--n. Bergen ~o1zapfeJ
Othet:
Mailed/Faxed to: .
Date:
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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) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Vse Only
_Coastal Erosion Permit Application
_Wetland Permit Application .-/ Administrative Permit
AmendmentJTransfer/Extension
~eceived Application:~
.....:::Received Fee:$ 9.J /
_Completed Application
_Incomplete
_SEQRA Classification:
Type I_Type II_Vnlisted_
_ Coordination:( date sent)
_LWRP Consistency Assessment Form 1\ \ Q.-
,
CAC Referral Sent:
..LDate ofInspection:~
_Receipt of CAC Report:
_Lead Agency Determination:_
Technical Review:
LPublic Hearing He~
Resolution:
S,it,)",), r( (G--~-~, ,~,~ TF",'"j'::-\
I/L'Jr--.__ .. l l~ "'"
iin')'---i!fl
I U !', JUN, , 1 6 2006 i 1_/
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L~____~_C~'1{TJi~:;~'~) I
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Name of Applicant f.'fuCYlI'{ Q\ 'E;c.\.r\
Address ~('Y-.1 ~ r ~o."- Or(. qf!()
R(),B~ ~39' Phone Number:( ) 7(:,(: :22.../:>1
Suffolk County Tax Map Number: 1000 - fL.? ~ 389 7e> -~- I SL
.
Property Location: CD(V\S2A d"'~Y9 ({"..QQ.\::: ('Q"'\ G\\b2.,-r
'S(')\.)~ ~ OL.\C) 0.'1' . Her., \
._ __(provide LJLCQ Pole #,_distance to ,cross streets, and location)
AGENT:
(If applicable)
Address:
Phone:
4Itoard of Trustees APPlica9llr
GENERAL DATA
Land Area (in square feet): l (Ac ('-
Area Zoning: R e.( I J en+" '\ I
Previous use of property:
<) c, ('1"'-<'
Intended use of property:
Prior permits/approvals for site improvements: Voe ~
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): .p \QY~ ~\ \ 10..0
Cfo..~ses o\{"'\ b0'-f.. ~ ~).~ ~~
.(4('t":6\0V\ ~t"'L ~ ('OC\tR.f "\ 4.62a.\ CW:::.'^~ 1\ )rotO.
.~ \V"'\.<,~\\ \ --to '2. \~<, dOClV\ SQ.~ -\0(" Q'ctll\-TW~
5.PW+M\ b..~ f7lHf4 M /h{.W, &';'0 '1r&<5J 'YfCttl-4" /)"01 ~
411fard of Trustees APPlicat..,
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose ofthe proposed operations: ~ 01'~~ ~
f>_('"~\a\f"\ ~ ~\...o ~\cn-\\wy-(bcY ~ IL'h\~
~~ +'n\,\w>Ol .\1\..\0 ChJ:)o\!
\ -
Area of wetlands on lot:
square feet
Percent coverage oflot:
%
Closest distance between nearest existing structure and upland
edge of wetlands: feet
Closest distance between nearest proposed structure and upland
edge of wetlands: feet
Does the project involve excavation or filling?
No v' Yes
If yes, how much material will be excavated? ,.- cubic yards
How much material will be filled?
It)
cubic yards
Depth of which material will be removed or deposited:~ - -z.
~ w"\c.\N2.S
Proposed slope throughout the area of operations:
Manner in which material will be removed or deposited: WI' \ \)<..0
l. ~ OQ) 'OO;(',DWS..l \o..\C1L tu. \ruwQ. I '(\ D C"m('~'~
c<:" +\o.c..~
Statement ofthe effect, if any, on thewetl~dsand tidal waters ofthe town that may resllltl>Y
reason of such proposed operations (use attachments if appropriate):
PROJECT ID NUMBER
617.20
APPENDIX C
STATE ENVIRONMENTAL QUALITY REVIEW
SHORT ENVIRONMENTAL ASSESSMENT FORM
for UNLISTED ACTIONS Only
(To be completed by Applicant or Project Sponsor)
.
SEQR
PART 1 - PROJECT INFORMATION
1. APPLICANT/SPONSOR 2. PROJECT NAME
~ I"'\"'(li~ (< uSJ-,
3.PROJECT LOCATION:
Municipality Sr. ^ 1M ~), County S'v1--ff ilL
4. PRECISE lOCATION: Street Addess and Road Intersections. Prominent landmarks ate - or provide map
~~O ~ Drl\/( I ~ol/J1h,,~~
J OG~'l Guk
5. IS PROPOSED ACTION: D New o Expansion ~difiCatiOn I alteration
6. DESCRIBE PROJECT BRIEFLY:
S-\-o-bo.\\2ll- O\lf"~ o.~ ~\a.,^," <\o.-Tw'Q.,. ~~ -b ~('~
l2."O~:"'()V\ ~ \0 \~-f- ~ 6\\~ I \\..)~ ~ \V\~~\\
\tc"2 \~ c.\.Qo.V'\ I SC-~ ~wS)... -ttx- '1~Sl.S ~ ~O\&
~ .QX \~\""\ 'o""~~.
7. AMOUNT OF LAND AFFECTED:
Initially acres Ultimately acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS?
~es D No If no, describe briefly:
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.)
~Sidential D Industrial D Commercial DAgricu,ture D Park I Forest I Open Space D Other (describe)
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
AGENCY (Federal, State or Local)
DYes ~o If yes, list agency name and permit I approval:
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
DYes ~o If yes, list agency name and permit I approval:
- -
12. AS A ~LT OF PROPOSED ACTION WILL EXISTING PERMIT / APPROVAL REQUIRE MODIFICATION?
[]yes No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant I Sponsor Name Date:
Signature
If the action is a Costal Area, and you are a state agency,
complete the Coastal Assessment Form before proceeding with this assessment
.
.
'{
PART II - IMPACT ASSESSMENT (To be completed by Lead Agency)
A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF.
DYes DNo
B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative
declaration may be superseded by another involved agency.
DYes DNO
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible)
C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal,
potential for erosion, drainage or flooding problems? Explain briefly: I
I
C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly:
I I
C3. Vegetation or fauna, fish, shellfish or wildlife species. significant habitats. or threatened or endangered species? Explain briefly:
I I
C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly:
I
CS. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly:
I ~ . " m "",___
C6. Long term, short tenn, cumulative, or other effects not identified in C1MC5? Explain briefly:
I ~. ~ I
C7. Other impacts (includinn chanoes in use of either Quantity or type of energy? Explain brieflv:
I I
O. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL
ENVIRONMENTAL AREA (CEA)? (If yes, explain briefly: I
DYes 0 No I
E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain:
DYes ONO I I
PART 111- DETERMINATION OF SIGNIFICANCE (To be completed by Agency)
INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each
effect should be assessed in connection with its (a) setting (Le. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e)
geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain
sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part Ii was checked
yes, the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA.
Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FUL
EAF and/or prepare a positive declaration.
Checkffilsbox-ffyou!1ave-determTned, based-onthe-in-formation- alldanalysis above and any supporting- documentation, that the-proposed actio
WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary. the reasons supporting thi
determination.
Name of Lead Agency
Date
Pnnt or rype Name of ResponsIble OffIcer In Lead Agency
Title of Responsible Officer
Signature of Responsible Officer in Lead Agency
Signature of Preparer (If different from responsible officer)
. .
Board of Trustees Application
County of Suffolk
State of New York
Ll""IV"\ ~ c::. ~l ^-5r' h 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 SOUTH OLD 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.
8'~__,~ rf,<~
Signature
SWORN TO BEFORE ME THIS _\ \. 0
DAY OF :\ LA(\~
,2001...0
~r>A"A l~
otary Public
"'~'lbIk
o.JBJl~
Cclmmillion ~.....,~~\O
. .".....'" .
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APPLICANT/AGENTIREPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town of South old's Code of Ethics orohibits conflicts ofinterest on the Dart of town officers and emolovees. The DUmoSC of
this iann is to nrovide information which can alert the town of oossible conflict.; of interest and allow it to take whatever action is
necessarY to avoid same.
YOUR NAME:
~(V\\"IIi e ~I..I.<;C~
(Last name, first name..r;niddte initi8J. unless you are applying in the name of
someone else ornther entity, such as a company. Ifsa, indicate the ather
person's or company's name.)
NAME OF APPLICATION: (Check all that apply.)
Tax grievance
Variance
Change of Zone
Approval of plat
Exemption from plat or official map
Other
(If "Other", name the activity.)
Building
Trustee
Coastal Erosion
Mooring
Planning
Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee
of the Town of Southold? "Relationship" includes by blood, marriage, or business interest "Business interest" means a business,
including a partnership, in which the town officer or employee has even a partial ownership of (or employment by) a corporation
in which the town officer or employee owns more than 5% of the shares.
./
YES
NO
If you answered "YES", complete the balance of this form and date and sign where indicated.
Name of person employed by the Town of South old
Title or position of that person
Describe the relationship between yourself (the applicant/agent/representative) and the town officer or employee. Either check
the appropriate line A) through D) and/or descn.be in the space provided.
The town officer or employee or his or her spouse, sihling, parent, or child is (check all that apply):
_A) the owner of greater than 5% of the shares of the corporate stock of the applic~nt
(when the applicant is a corporation);
_B) the legal or .beneticial own~r of any interest in a non-corporate entity (when the
applicant is not a corporation); .
_C) an officer, director, partner, or employee of the applicant; or
_D) the actual applicant.
DESCRIPTION OF RELATIONSHIP
Submitted this _day of 200
Signature{l~ A'(....tvl<tL
Print Name E fYl f11 \ i" r<;: <> 'Sr.:f-l.
Form TS I