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HomeMy WebLinkAboutRadovich, Edwin 0 0 James F. King, President ��Of soyo Town Hall Jill M. Doherty,Vice-President 53095 Route 25 Peggy A. Dickerson P.O. Box 1179 Southold,New York 11971-0959 Dave Bergen CA Bob Ghosio, Jr. : �� Telephone(631) 765-1892 COUrm 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't day of construction % constructed Project complete, compliance inspection. James F. King,President ��QF SO(/Tyo Town Hall Jill M. Doherty,Vice-President ,�O l� 53095 Route 25 P.O. Box 1179 Peggy A. Dickerson Southold,New York 11971-0959 Dave Bergen G Bob Ghosio,Jr. �O Telephone(631)765-1892 � COUNTI N Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 6513A Date of Receipt of Application: January 2, 2007 Applicant: Edwin Radovich SCTM#: 88.-6-13.47 Project Location: 140 The Esplanade, Southold Date of Resolution/Issuance: January 24, 2007 Date of Expiration: January 24, 2009 Reviewed by: Board of Trustees Project Description: Perform selective vegetation clearing, landward of staked hay bales. Hay bales must be placed at the conservation easement line 85' landward of the wetlands, during construction, and left in place after construction; There is to be no disturbance of the vegetation seaward of the hay bales; and all as depicted on the plan surveyed by John Metzger revised September 11, 2006 and the project plan prepared by Edwin Radovich dated September 21, 2006, and approved by the Board of Trustees 2/2/07. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth by the Board of Trustees. Special Conditions: Hay bales during construction. Hay bales to be left in place after construction; Final inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth by the Board of Trustees, a Wetland Permit will be required. This is not a determination from any other agency. )Xo�- James F. King, President Board of Trustees JFK/hkc 0 • James F. King, President ��OF SOUryQTown Hall Jill M. Doherty,Vice-President ,�O l0 P.O. Route 25 P.O. Box 1179 Peggy A. Dickerson Southold,New York 11971-0959 Dave Bergen CA • O Telephone(631) 765-1892 Bob Ghosio,Jr. Q Fax(631)765-6641 BOARD OF TOWN TRUSTEES January 25, 2007 TOWN OF SOUTHOLD Mr. Edwin Radovich 221 Beebe Road Mineola, New York 11501 RE: EDWIN RADOVICH 1400 THE ESPLANADE, SOUTHOLD SCTM# 88-6-13.47 Dear Mr. Radovich: The Southold Town Board of Trustees reviewed the survey prepared by John Metzger revised September 11, 2006 and determined the proposed construction to be out of the Wetland jurisdiction under Chapter 275 of the Town Wetland Code and Chapter 111 Coastal Erosion Hazard Areas in the Town Code. Therefore, in accordance with the current Tidal Wetlands Code (Chapter 275) and the Coastal Erosion Hazard Area (Chapter 111) no permit is required. Please be advised, however, that no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal wetlands jurisdictional boundary or seaward of the coastal erosion hazard area as indicated above, without a permit. It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation within Freshwater Wetlands, Tidal Wetlands jurisdiction, and Coastal Erosion Hazard Area, which may result from your project. Such precautions may include maintaining adequate work area between the freshwater wetland boundary, tidal wetland jurisdictional boundary and the coastal erosion hazard area and your project or erecting a temporary fence, barrier, or hay bale berm. However, any activity within 100' of a Wetland line or seaward of the Coastal Erosion Hazard Area would require permits from this office. This determination is not a determination from any other agency. Sincerely, r James F. gg President Board of Trustees JFK: hkc 0 James F. King,President ��OF SouTyo Town Hall Jill M. Doherty, Vice-President 53095 Route 25 P.O. Box 1179 Peggy A. Dickerson ( # Southold, New York 11971-0959 Dave Bergen co Bob Ghosio, Jr. �� Telephone(631) 765-1892 Courml Fax (631) 765-6641 BOARD OF TOWN TRUSTEES n TOWN OF SOUTHOLD TO: EolWin Ralv�zk Please be advised that your application dated ( 2- �� has been reviewed by this Board at the regular meeting of I Zy (a`i and the following action was taken: ( V ) Application Approved (see below) �) Application Denied (see below) �) 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. COOM��PUTIATION OF PERMIT FEES \�,Ll l le InS1X �+e�, Ltn �l TOTAL FEES DUE: $ BY: James F. King, President Board of Trustees M u • ` ..w 1A % ;T � a 1 9 "d. tt r �i'� � f r 33 a�. a It 1 � �, ,�. •, �, rte_ JM 4 r n 4� •r 1 . i . 1 ,� `��' w�' t - ��� � tit: , �u!• 4 � i � ,S a. :1 titi'�e�J�iI�{. ,}!r'R �••¢'t�,�y- tie... r`4 d � . .' •3'�Fti♦ 14"`x. a``Y r C '+ r Y, ter.' Is-,.j 1-33A" r - 3i i� 'tai'—d•3*r( e it w James R King, President .Jill M. Doherty,Vice-President Y O y�l � - Town Hall 1 p 53095 Route 25 Peggy A. Dickerson # ?9 P.O. Box 1179 Dave Bergen cn Southold, New York 11971-0959 Bob Ghosio, Jr. 42 �O Telephone (631) 765-1892 yCpUWN 0 Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOVdN OF SOUTHOLD Southold Town Board of Trustees Field Inspection/Work session Report Date/Time: EDWIN & ROB RADOVICHLL�r""equest a letter of Non-Jurisdiction to construct a single-family dwelling and an Administrative Permit to perform selective vegetation clearing. Located: 1400 The Esplanade, Southold. SCTM#88-6- 13.47 e of area to be impacted: Saltwater Wetland Freshwater Wetland —Sound Front _Bay Front Distance of proposed work to edge of above: (60 �t ctom hCVSe _7of Town Code proposed work falls under: hapt.275 Chapt. 111 _other Type of Application: Wetland_Coastal Erosion_Amendment /Administrative c�ea""5 _Emergency Pre-Submission ✓ N T S hn u s e Info needed: I - !fie � ase VuuYe m2c,S� re j 0 G +fL> , lnndw� �A e)yc ©� LJ'-04.A Tl,-e-m lncs 6Rt,, ClearI-kR LAIN :s� w n loo aI Elw d, cnd n -0— n je 4- f ue en.4 f d ? k 'f912 ofc S /4- TJ f4 Y�Q/ T ` {ear"I ( a-vl j6k\a- I15'' Modifications: Conditions: f �� �( ';\4resent Were..:"dying xd/Doherty_P.Dickerson D. Bergen B. Ghosio, Jr \ _A�/ H. Cusack_D. Dzenkowski_Mark Terry other Mailed/Faxed to: Date: Environmental Technician Review A-C46­-.ip. 1 Q t-k ke 1,22 �-` l j 1- m�� jC' IJT 4o— ��St l6L)' no, LjkT\.a�+ q � G�A 'h.�- C,m• Senn.�e, eac.r..�,-� ctr A p n a..,^ ut um n.u.0 ' •'^ xrw .t m rm [on [vote Rrsrwpx 5 119p1 ..... .^w -- ..o.. .. .....�....... .. .i...� ..nn.rm w Ynrxmr. M (Y m,m,� vi.a +nn u�w...w xTwrr ru mxu amxr. � e •� � p J� m�mn t a sd.rWo en-er ws orfee nt 6 Y vum s t.0 m / / a su e w , x wwv � �i 1 4 a is g w b a B4YV�Yv, � �jl wL yv �p be 'b. • x eta �� m �u A. 14 i a i t ' NECM BAY mo� � l [ "^ '^ �"^ -- "— ^"'^—_"—_- -rE COUNTY OF SUFFOLK © a SDUTHOLD sccnox xo E _ — izei e zO _ "` Bed Property T.Service d9eMY r' 088 UM_=e.. ..__'._ ... —_— ,. .v...,�—..—_ .a ., ..,�,. — r^""r n. x�r.r.Wxt mm a d m IOOO wovcxn u \ 1 \ 1 i 1 � _ E7G � � � \ OEG/N G/Yl/7 G/NE•SsS \ Z�5 I W g�9 (� �'�\o� \ \ \ O'v �/9�✓.29/98B � �o�o,QdE/\per' 1 -- -- Aj Nk 451 ��, �`�✓�'� /13 � � � � \ � / old � � �=.�� N D D a 1 vNZF \R` .JN r'w a 1 \ c'• �/ � � � // e 53 \ Tic/ 447 9/i3' z z 0 65 �j N�i E�B/� 9' o✓G 2/52202 ' 41 y6•O� X50 �, \ Z�.9/5Z3G�• v No7E: .(J.vo �Es7-E.elY_/S 3'r/dJECTCovE,v„yyT G is Qc ii7/7S P9�/3 To T s - SURVEY OF PROPERTY A T SO UTHOL D TOWN OF SO UTHOLD v �L SUFFOLK COUNTY, N. Y. � 1000-88-06-13.47 V y �z WETLANDS y SCALE: 1'=40' u EL 51 APRIL 11, 2006 y -V 1 JUNE 30, 2006 \7h73 SSa �A O OT ° Pvsc s ......... .. ... . . ..... . .. N£TLANDS ... . . ... .. .. .. .... sJ. oF, v � c Hie / 0� t, cllq" N�p153 0 Y io LP y�- O. e _ /3'm,n Z CEJ O ' � PROPOSED SEWAGE DISP0.SIL SYSTEM J P00L5 _ C D WITH CLEAN SAND 3'COLLAR 1000 GAL. PRECAST CONCRETE SEPTIC TANK BOTTOM OF LEACHWG POOLS TO BE 2'GROUND WATER ��\ A ' O� �/�/•� \��, `� _ CROSS SECTION- SEPTIC Q YOL '\t" SYSTEM CUT 45 �:Se LOT 41 FxEDAfAP �° cYiiVew� x0 OAZ; p \ TESRT OLE ?I BY MCOONALD GEOSC/ENCE COT 44 Ec. - - - I' BROWN LOAM OL N4Cj v J "/� */ c k ,�•G, pk - -- G BROWN S+Lr M COT 43 r) NZ8430 , 7„w nt \o[�,v !_ShO CA/V YELLOWISH BROWN FNE TO B. L Or 42 3'COARSE SAhO SW %{\ - Q 1 (VgCAA/7) 21 p FI TER IN YELLOWISH BROWN A'EBAA, FINE TO COARSE SAND SW % �0, 0,0 O 0� CERTIFIED TO, a o oo QJ ROBERT RADOVICH 15, CD ` ` EDWIN RADOVICH l om familiar with T the STANDARDS FOR APPROVAL CO AND CONSTRUCTION OF SUBSURFACE SEWAGE 41 STEWART TITLE INSURANCE �VAOjIV, COMPANY DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES or NEW yo and will abide by the conditions set forth therein and on the permit to construct. The location of wells and cesspools shown hereon ore �1c from field observations and or from data obtained from others. ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION YS. IC. NO. 49518 OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW LOT NUMBERS REFER TO "MAP OF ANGEL SHORES” All R EXCEPT AS PER SECTION 7209-SUBDIWSION 2. ALL CERnFICAnDNS FILED IN THE SUFFOLK COUNTY CLERK'S OFFICE AS (631 mP9� v 31) 765-'1797 HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF FILE NO. 9729. SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR 1230 RES WHOSE SIGNATURE APPEARS HEREON. ELEVATIONS REFERENCED To N.G. VD. AREA=40,043 SO. FT. TRA TsourvoLO, N. Y. 11971 F06-14,9 SURVEY OF PROPERTY A T SO UTHOLD TO WN OF SO UTHOLD y y y " To COUNTY, N. Y. V WETLANDS y v 1000-88-06-13.47 SCALE: 1'--4o, EL. s APRIL 11, 2006 \7111 s... ........ EDGE .... CF N . . .. . . . . .. . .. .. .. . .. .... £lLANOS R. a vi 1' NJP \ S 2O' F C If,`� fn A. c l la N'0.1 ra - I B /000 ie !c L P � { O p. rl ?.Si e I s'm,� ,Q V O \ O / F•. iJ�3'.`�'.::.'.�fM C�ro�n d- -`---- .�.__—_— _—L_ Q O r 0 qq A 1A PROPOSED SEWAGE 06L. PAESPOSAL SYSTEJ.! J POOLST S V S E\7' v \ WITH CLEAN SANG J'COLLAR 1000 GACA - _ rI CONCRETE SEPTIC TANK BOTTOM OF LEACNNG POOLS TO BE 2'GROUND WATER CROSS SECTION- SEPTIC rn LOT 41 FRED MAP SYSTEM A LO' 45 ;.d TESTHOLE ^ o, ' ?I, h �,vY RIII06 IF/ /I BY McDONACD GEOSCIfNCE ( 0. GOT 44 S Q l' BROWN LOAM OL �/ - -- G' BROWN sxr ML 07- 4j (VAC - - - COARSE YCLILWISAND BROWNFINE TO LOT 42 (VA OA^,T Ws, fL WA IER IN YELLOWISH BROWN ?70 00' tD �� FINE TO COARSE SANG SW RfBAR �-pa � \G � NN CERTIFIED TO, ROBERT RADOVICH am familiar with the STANDARDS FOR APPROVAL EDWIN RADOVICH AND CONSTRUCTION OF SUBSURFACE SEWAGE LOTSTEWART TITLE INSURANCE DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES 41 (VACANT) COMPANY and will obide by the conditions set forth therein and on the Permit to construct. The location of wells and cesspools Shown hereon ore1vs. OFNCtV from field observations and or from data obtained from others. T. ANY AL TERA 770N OR ADOl TION TO THIS SURVEY IS A KOLA 77ON OF SECTION 7,909 OF THE NEW YORK STATE EDUCATION LAW. LOT NUMBERS REFER TO '"MAP OF ANGEL SHORES" Y.S. LIC. NO. 49618 EXCEPT AS PER SECTION HIS MA UBOMSION 2. ALL THERE-Of- ONLY Ir s FILED IN THE SUFFOLK COUNTY CLERK'S OFFICE AS CO y HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF � P.G. SATO MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR FILE NO. 9729, ( 31) 20 A (631) 765-9797 wHos£ SIGNATURE APPEARS HEREON. ELEVATIONS REFERENCED TO N.G. V0. AREA=40,043 SO. FT. S S �` 1971 T 06-149 James F. King, President ��q soyo Town Hall Jill M. Doherty,Vice-President 53095 Route 25 P.O. Box 1179 Peggy A. Dickerson Southold,New York 11971-0959 Dave Bergen John Holzapfel '0 �� Telephone(631)765-1892 ly��Uv Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application _Wetland Permit Application Administrative Permit _Amendment/Tram fear//Extension -7teceivedApplication: 'Received Fee:$ !M�T'� Completed Application / ,- U _Incomplete Type Classification: Type IType 11 Unlisted Coordination:(date sent) JA N LWRP Consistency Assessment Form -CAC Referral Sen. Sn/a ,..Hte ate of Inspection: / _Receipt of CAC Report: _Lead Agency Determination: _Technical Review: --Public Hearing Held: / Resolution: Name of Applicant ED VV j&I R,4 J) /YG R Address 221 :BcF3E Ile cDAD J✓/in/Eo<A �/V'y PhoneNumber:06) 71/2" 9_ �65 Suffolk County Tax Map Number: 1000 - 98 - A5-- Property 8- A5--Property Location: {46D%f ,6 Z St KAVA DF C Fo2Nr',e //tiE�krE or %er~�s) L14CO i'e/e &-/O (provide LILCO Pole #, distance to crpss streets, and location) AGENT: (If applicable) Address: Phone: Ward of Trustees Applicato GENERAL DATA Land Area(in square feet): 4 ;o �3 Area Zoning: /4?E'S1DENT/AL Previous use of property: Intended use of property: RAS/c�erni�I Prior permits/approvals for site improvements: Agency Date 1J No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspend y a governmental agency? No Yes If yes,provide explanation: Project Description (use attachments if necessary): Gro'2S74-"C � dwcI/, A Dard of Trustees Applicat& WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: C0Ns:,WC1-16f! o �F D n e &m;9y Area of wetlands on lot: square feet Percent coverage of lot: �' /4 Closest distance between nearest existing structure and upland edge of wetlands: --' feet Closest distance between nearest proposed structure and upland edge of wetlands: JD 9 feet Does the project involve excavation or filling? _ No ✓ Yes If yes, how much material will be excavated?32 D cubic yards How much material will be filled? -,TO cubic yards Depth of which material will be removed or deposited: J� feet Proposed slope throughout the area of operations: / Manner in which material will be removed or deposited: �Y /Y/C�/4/'//LQ/ ��'�i�r✓�c'7r1� �- �JPJ✓/C� 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 jjattachments if appropriate): 617.20 SEQR PROJECT ID NUMBER APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1.APPLICANT/SPONSOR 2.PROJECT NAME �D JrN /Zf�AGL)IC �I Ane F•fr*�cy >�L �,iv� 3.PROJECT LOCATION: / Municipality Joel kz4 t:�/d County 4. PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc -or provide map Lvr /1 TGre �s�/cFc«.�,/e C 14 5. IS PROPOSED ACTION: M New ❑Expansion ❑Modification/alteration YN 6. DESCRIBE PROJECT BRIEFLY: C—/ 'r , %� 0/welle�� A Iteid �t ✓R� L� € c�a e���. 7.AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8.WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? LL�IYes ❑ No If no,describe briefly: 9.WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) F\7 I X Residential ❑Industrial ❑Commercial Agriculture 0 Park/Forest/Open Space Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) Mes M No If yes, list agency name and permit / approval: RC A-/n, 191-ti ld(L l 7 f) 0!V 1414,(e-"4 11.DOES ANY ASPECT OF THE ACTION HAVII A CU ENTLY VALID PERMIT OR APPROVAL? EYes F�/I No If yes, list agency name and permit / approval: 12.Oyes A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? Oyes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant I Sponsor Name 4)vv"N 4 ) V/ Date: Signature �• Z U" 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. ❑Yes ❑ No 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. 0 Yes ❑ No 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: C2. Aesthetic,agricultural,archaeological historic,or other natural or cultural resources;or community or neighborhood character?Explain briefly: C3. Vegetation or fauna,fish,shellfish or wildlife species,significant habitats,or threatened or endangered species?Explain briefly: 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: C5. Growth subsequent development,or related activities likely to be induced by the proposed action?Explain briefly: C6. Longterm,short term,cumulative,or other effects not identified in Ci-05? Explainbriefly: C7. Other impacts(including changes in use of either quantitj or tXee of energ ? Ex Iain brieFl : D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA(CEA)? If es,ex Iain briefl : El Yes 11 No rff�' OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? Ifesex Iain❑No PART III-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(i.e.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. Check this box if you have determined,based on the information and analysis 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 the determination. Name of Lead Agency Date Print or Type Name of Responsible Offlixir In Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(f different from responsible officer) i Board of Trustees Application County of Suffolk State of New York � L) A//h1 RArD©✓AGN 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. 7iv+ G e zg' Sign urc SWORN TO BEFORE ME THIS a3 DAY OF (V-r 20 0 U*---- Notary Public PAARYSETH PASCALE SCISCEN", t4Ti:`u CI I C,SPATE CF NETS YORK CCrLYLI iGN I:SYIREb..1,:Iz'$,�� ! APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of outhold's Code of Ethics prohibits conflicts of interest on the Part of town officers and employees.The purpose of this forth 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 NAME: /� /I o c,V I G vy 914 (Last name,first name,middle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other',name the activity.) _ 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 th hares. 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 Southold 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 describe in the space provided. The town officer or employee or his or her spouse,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 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 t Submitted this 2 vb day of cu a 0 Signature 4 +ten s jTi Print Name X17 vd:N 1q.4y0✓1CH Form TS 1 221 Beebe Rd. Mineola, NY 11501 September 26, 2006 Board of Town Trustees Town Hall 53095 Route 25 Southold, NY 11971-0959 RE: PERMIT DEFERENCE Dear Sir or Madam; Hereby we request permit deference for construction of a one family dwelling on Lot #45 located at 1400 The Esplanade (Lilco Pole #10) Southold, NY. The dwelling will be located on the property approximately 109' from the wetlands. Enclosed is one copy of the Property survey showing the proposed structure; also enclosed is a check for $50.00 for inspection fees. Sincerely Yours, 6��Avz-f-19 Edwin Radovich, Owner /4 Rob Radovich, Owner / / PRSIPCIISEDRESIDENCETJF— /� EDWIN AND ROBERT RADOVICH -VV 1000-88-6-13.47 / DATED: September 21,2006 A N Prepared By: Edwin Radovich I GENERAL NOTES � AL � �� '�. S' �Q � STRUCTURES _ _ _ __ % �oGq 4J(Iimpervious T Dwelling witltnattached garage-'Zd-62 sq fl V ` - I A 3 l \may\ ,�osl0w CS' Deck - 390 sq It // *•,, r3, , Driveway(paved) 1350 aq ft Total— -- 4402 aq ft �/ ✓ �S� , % adjacent area of lot coverage-11% ROOF RUNOFFS: Roof runoffs to be directed to �\ II Two dry wells _ 1"7� �� 1Z 2^of rainfall x 2462sq ft of roof area--410 cu ft ofwater afl� tD Q \ I Dr}wells— B'ix4'drywell bolds 200 cu ft VEGETATION CLEARING: V ` y{� J 1-1110 Selective vegetation clearing within the designated boundaries only. 0� E(` •/• i• �/ I Selective vegetation clearing not to exceed 52%of lot area. / ' 41 h eel)5 LSC - 1 P �•`' / EXCAVATION AND GRADING: j .60V P Exnvation--320 cn yd A `� I E;�2., , �•� ,! I'`�, \. ��x ItI OS Regrrdethe existing grade inrbee15ftfrom dwelling footprint �I 1„ 0 005 R�E�L 0 0 s i.� ` � pl . 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