HomeMy WebLinkAboutTR-6541A
.
James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
Bob Ghosio, Jr.
.
. 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.: 6541A
Date of Receipt of Application: March 9, 2007
Applicant: Mattituck Park District
SCTM#: 99-3-14, 99-2-19.1, 126-6-18 & 17, 126-5-20.1
Project Location: Bailie's Beach, Breakwater Beach, Veteran's Memorial
Park, Boulevard Ball Field
Date of Resolution/Issuance: March 21, 2007
Date of Expiration: March 21, 2009
Reviewed by: Board of Trustees
Project Description: Periodic beach maintenance; removal of debris from park
beaches from 10' above mean high water to bluff toe/bulkhead, for width of
beach. Manual or rubber-tired tractor only - no treads, as needed, Maintenance
to be conducted four times a year - Spring, mid-Summer, Fall and one additional,
as needed.
Findings: The project meets all the requirements for issuance of an
Administrative Permit set forth in Chapter 275 of the Southold Town Code. The
issuance of an Administrative Permit allows for the operations as indicated on the
maps received on March 9, 2007 and approved March 21, 2007.
Special Conditions: None
Inspections: None
If the proposed activities do not meet the requirements for issuance of an
Administrative Permit set forth in Chapter 275 of the Southold Town Code, a
Wetland Permit will be required.
This is not a determination from any other agency.
J,t:.;,~=tt
Board of Trustees
JFK:eac
\.
.
.
'!.,/'"
r
..--.--.". .-...- ..-.. ---- ,- '.- --~"'... --", .
';..,!,':'.lp?
I " ." '"
::;~-::::. - .
SUlCveVEO FOR
/'/lAP OF LAl.JD
~lV!p,TTlTUCK PAR/<_ Di,ST8/1. r
kT
lVlATTlTUCK, N. Y.
':;..:; (,/(!.
G = .'Y1o...,u'''n~nf.
r
I.
.1:'
,I
;.-
,lD
\.,0 6(~
,\'I^
01
N
j 10 (0' a1oov~
~CllVVe..l-~W.
:C' .,...... I
\'::,'1:4-.'/
~':"'~~:":7 .
1'\
. .
. ~\
.;~ \
. ,
D
,
<,
,
.. II
:~Uw.~ AJ. TICU 0':, .,.t(,rcQtl;
:TO Tt~:>lRVry IS ^ \'1(}UUO....... e,'
\-Slc;n H ~:ro, 01 III....... '<;;lltH~
: lOOC. TIO~ u.:",./!
~'COtl 01 THIS srr: IMP I<<)T IIAlQ:<<J;
'ill;;: SllllV!~ 's l~;ns~\ C'C.
;. [MIO SED SE^l 5~ NOT tI. CCmlijl;~(1)
~!O . A VAUD ~iCO'T'
(GO), m 1/;01 10 /I[~!ON SHA\J. .uti
~ ONLY 0. TIl! ~EI: ~ FO. WHOM TlU IIII'H\
f~~l~: ~:: \:^~:~ ~~V:~; ^~
lUl(;1 a IHH1I\JnOH USHO muo..., NlQ -
i 10. i^SSIGtllU o.r TIll llSDINC 0011:
. rUT CUARAmIU Atl I<CT UA..i"....UI
TO. ^ IIIOw.!,. 1~IITVlIO"l 0.1 SII."ClWlt
O} . .
,/
"
<>
-'<$
-'<
'"
-r..
"
/'!.)..
'^
""f. tl:-.
0.../ :..
<>- 0
"-
////
/
I{; ()'.::: I"
,9
\
?'
'/
,0
,
,..
t,
^,
(;
.,l
"
70
v' \~
() ~ ~~
;~\ .'" '~", .
\r~~\~""-"
.. (,.\
~
,
"
".
"
.~
..
,
-,'
t,
"-
,
,
,.
\.~
,
,.
,
'.":\
^,'
,
,
,
,
I b ,
\..'?........-
.,
.,
\~~~
'(.>:"
,d
( "
"
~
,,~'\
."
,\. ,
.
;1'\1
~ .
.....(1'
"
,
,
,
"
~
I \
:~\ \ \
,Ie' ',,,,\ \
\~.\ \..- \"~:\~'1~'
(-;, \ \ '\.t~:.,.\,
'."-\ '. \",
Ii" \'.'
, ,
\ b"\ \
i \
, \
\, I
.'
,
" r
'u
r
,
,
\
,
,
.'
,
,
,
()
, -l.
, -.J
\ \1<-
I
, /Q
t, ()
" C:,
1\ \J
Bv-eak Wa.W 5eQCh.
""
v-
.\
~I
~
I
l
I
I
I
0/
i
'"'
~ ,
0 ~
", JO.I 11 .
FlIRPCl.NJ.
SEESEC.J<<l.
125.0~-02~.2]
5QC q Cj
/
--~- ~_tlhl --K--
DR~1K
.,T>W<
!II
Horton Creek
SEEflSERT
.'
N 27~](lIl
PllOPERKS
t1ISTRI;TSo>
.."
NOTICE
"
1l.5Alc:l
/~~
~
\
COUNTY OF SUFFOLK ~
RealPropertyJodervice Agency
'cMty.eenter R1v~ NY llSOl .
" . - -. . ..." ,. 'Il.rin~-,~-
~
~1
'"
m "" ~ SOUTHOLD'
SEC
l2IO.,_~~;
1
"""
stIllE ]
.
....
r-
'"
.
I
-=-- 7l
I
:
'5
"-g
1\
o I ~
i- :;
J~ I
h~
"I
.'
.
p
o
.
o~'
"o~
o~
,,)
~/
~
:,,'!
"...
0>
'!'I!I
1"
i"ll
..11'
~ ~~;~~
. t"
:iil
1m;
i~
'l
:'1
~;
i;:1
"1
~ ~ ~
~~ ~i n
;;.1~.1-
; i . ~
: i ,~ . .
inn:
+
I 'I., t!i'i
'1'.II~",I"
I \'1;.... .11
1 Uill_,_ "c~ _ _.L-~,_
" '
..... ~ .., . . - ._ - _n.__''': . .....
'<
,
81~
,
o I
6 :0
~ '0
~ 6: o.!
V) i!l i 1
, ; '.'
~ ~ ~ J
>
v
c
.
",,0>
~<(
2 ~ "~
u.. ';: J
~...; ..
V) Q.l;; Z
LL. V> u.:
o ~...-'
>- I- ~~.
l- >- 0 .
z - u..c
=' ~ u
o g ~
Vc::
@g
'"
.
i
. .
~~
.. .!
~'j:
8!:~==
,
II II' d
11 1.
Ii.
n@R;
, ,
-! ~ !
if J
~ ~ J d
lJiJJ
i! j!!
'!- ~ -I " ~
IIIII
"'g I tit'
" ;J! ~.!!
",,,~!~ljl
ClDa-ii!.
1l!1 J
! It ij
Iii \i
1
"
lJ1P'
)dl
I til i
J ~ i
iJl
. .
IJ'ilJ
l. ],:
, !
, "~I
1 i~ ~
...:1
. ~n
! .
'.'
:~; .
"'~'
0'
: . .... ~
:-:: ~ '
~.
.'~."
.("
~"\
4-
...~.,
<.r;>
.~...
'""
"'.- ~ i.
'"'..,
- .,to ';!-
....,i........~,.
. ~C~;X\~~
~. " ..:....-.,y~.....
:~...;i:.\;>:.'
'S.:"':''''),..'
.l'", '.
'Vl' ...~..
'Zffi:, .
....~::.
.'.~:;;
,:{\;
':1.
",f;.. .
lit,
:t?"
. 'J.
.,~~
. '~'.;
, ,"e.
'"'!
. ,.,~.
";
,~.....::>:..:,...,.
: v: '.'"
f, _ " ,
, '.
. .
'~;,::;. '
.. .,'.'
.' :2::.'.
,.,-:-
J.:.
.n,'".. .
-'<7
,
.t~ .
.j. "'1,-
". ~'",;,
'~"~
",,'
','
....,..
"'"
,..
','z,'
..'
.~ '''.
"""
\.
.>
",.;
>'~';~":_fr.:...
'~';~~>r: .
')i; ~~.{ ;~: ~~~:.
.'..
:.~ ',J, .
. .
'. .
'\';"':~~??;}7;'7:':;~;' :""":'.>"i::'~!Vi+;;.~:~
....:"
"
.
",.>
:'.
';.:;:-,';","
"~" .
/a~',~
.,.
':..,':';;;;.:i "
..:.
...:.........0..-
-
.~
:Jtj.'t~ .
'~';".
","
1.3~()
. ,,;4:;,~;~' ~ .
J(~; .
T:~l.;
..l........~..~.:
'j'
.' ',~
::
.{"
...~.
"
..~
..,);'
t
l"
'\l
".,:.
.1,"
\ "
...:.... . i
.'. ..lI\.
'ti:,~;1
..l'.,:~.j
... .'. :tf' f
. .i"~{ f
:\"i~i"
.;'f.....,~tf.,
.' \\;:.~~~'Wl ;~' .
".'. .
. """
'""., ",
... "t.,.:..,
.\ '.'..
g;
. .
.:r.'''~~
S "';N
:;;"~
k I. ft\
.'P . i:)
\:;
'.~:!
~:'
IS
..~.
..
j
'''':'i::.~':.'''......
.:' :'''''''':t' ,':
",' ~".
. "T."
'f' f'
!i::.~ r
.?ffio .
i ,6',: ~~'_.
'Q:. . ~"
""~~~~~~~tl:;;' 'j'"''
. '., :'''jr~~~'~~I' ',.
. ... ,~l~J.;~~r'lt
",;;::,,~~":~::'!;S~*~~. (..: c. ':>:';':;:!i~';'."..
'"""""":""""" ..... "'''. ','. '..f'. r 'C'
~'.'x .'~......';:'.;.. ;~..'."..; <i\.~:(."?,,i:~~.;./ ':Pt
.,"; " -;. 2:).~> _ <~ .,
':~/i;::", ..... .
'," ,),i,~;"''',>T
."'!""~:"......
,.!'
,;",
""
"',,-
,..:.
.r-;
~,
><;.
. j
-'::'J
,
\.
<
""..
"'.
;,
" ~r
>
;-."
F,
-'-.
,.~', ;.
.1.
. ~. ,"
:".
'-- ,.-
.,.
I
~.'.
',,'
,
:)j.
"&
~'J .
~si
....~......~
l> "''';'; ........ ...
',',
.
.
SuO..i".." D~, USERN~ME PIOI Dot.., OO-l.IMM-YHY HN,Mr.!
nsU...'..UII....'......"IUnn............... FILE NAME ................."..........U...................
"'
."
"
I
0 -,;"""",,, -.- 0
I .~ , i .
. i I
II ,I ! J
,
:}" 1! ~ I I 1
, ! ,
, ! I' .
I I ~ ,
, . " I
"' I' . 11 <D
H I, 1/ i
I, ~f 'l'!
I Iti
I It J'
J' " "!
" ., I
Ii !! I' I' I If
! ! .' ,
I ,
; , ;
! I ! i !
i i I ,
00 I , 00
I I ,-
" "
EIOYrion,IINClVD EI_I....IIN:lVl
-q . ~ ::: ::; ~ 2
.,c . i ~-------,----l~._~ I
c
;' I I:
,
. ,
i 1/ ,
0> ! )J i 0>
I . , ,
,~::'::: -<;;~~~:~: ,t .
. 0 u
I Ii f I!
y~";;'.,,,,-- . ;. , i " . "
~ ":'" ~~f;..~;;::~'." , '.t#~ i !!I i (, .'~
[ i~ I I 1=
- f"i~ . i
. ~, ~
~ L' ~ ;, !I :; ,
(J' " -, '~~ -'4~ I ; (J'
'. ~~'li-.J2-~ II i
"i\U I II I i
i
~
... ...
'"
N
I
,
I
~
o
MArmucK INlET SECTlON 111
I'AOl'OSEDAlTERNAWElAYOUT
U,S.ARMYE~f.EEflOlSTACT
CORPS OF ENGItEERS
/fCW YOR1(,NEW YORK
,.
OJ
o
()
'"
N
/<
If'flll
If 0
"'
"
I
."
.
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
_Coastal Erosion Permit Application
~tland Permit Application -X- Administrative Permit
Amendment/Transfer/Extension
--=:::Received Application: 3/9/07
_ReceivedFee:$ lU(\.fu"~ ~~t@s
~ompleted Application __ \1LID-
_lncomplete
_SEQRA Classification: AD 0 r 07
M l\ -::i I~
Type I_Type II_Unlisted_
_Coordination:(date sent)
_LWRP Consistency Assessment Form
CAC Referral Sent:
---Pate ofInspection:~/LJ/l:l)
_Receipt of CAC Report:
_Lead Agency Determination:_
Teclmical Review:
~blic Hearing Held: ,31~\ It!,J
Resolution: .
Office Use Only
Name of Applicant !)7AT/ J 77A'/< PAk'K DI577</(/
l,-/f.!J
Address fJ()j~y' 'N:i:i:::? I) )c.--fill-udc NY j/q51
Phone Number:C:,;f) C(,72 _. 52-<;;''7
Snffolk County Tax MaPNumbe!\ooo- qq- 3 - ILt-, 2) IOOO-CJ9~ /'1.,
_ 3)Iaoo-Iu,-Io-I<bJ-I/4)/OOQ-I2b-S-dD.'
Property Location: I) 'BaIlie's -p,.,nd-. .:y 12,tfpn\cIAldhA...-16eotk-
3) Ve-~ )1'kyY)cm'~?ClAk. l{}:B::v(e.Vct~4 -gJ1P~JJ (V\(JI.lA~}c~ CIv~
(provide LILCO Pole #, distance to cross streets, and 10cation)---nU-
AGENT: Abl~Q'\..1 WIL-ic.ho,W'.
(If applicable)
Address: 'PO f,ox I t.j.:z..Lf) M cdt~+uc1: I AN Jl Cfs-z...
Phone: Ie 7,1- 7q9:'-'iY;::s
f^lc. 'ZQ,S
4It Board of TrusteesAPPl~tion
Land Area (in square feet):
GENERAL DATA
See. a. tta. c.J., e.4
Area Zoning:
Previous use of property:
:v '" _ 0 I
f(.WI(, AfP(/E' 4-t-, <J 'v-,
Intended use of property:
"
,..)<'", In€?_
Prior permits/approvals for site improvements:
I)
Agency
Date
_ No prior pennits/approvals for site improvements,
Has any permit/approval ever been revoked or suspended by a governmental agency?
-A No_ Yes
If yes, provide explanation:
Project Description (use attachments if necessary):~ I";rv! I '(, h,,., (.h ma ~YI+-fnaV)c.L
n~'R"Y)Y>\IP awns; ~Y-om pl"k. beaL~s)~rOVYl
10 te.eJ- a lonv e.. m 1-\ \AI ~l \J~ f:' t-np IIo.u.l...kko.d )
tDv w;Jt\;, 1---h~o.(}.,. fY]a.\'H)CIl0 crI TLJbloe,lf-
-H.lfQr\) -trClr-h,y DiIl10 - no kach. f\s he"eAe.& I
~ LfY--/ lJ.,.eAr.-'. Sp;ln~) m;d -SUWlt'Y\QAI) \="oJ11 ,J-
OV\e-~oJl c\,';:, he.e..ol-e..cL
.
.
Schedule of Properties for Mattituck Park District - application for Administrative Permit
for Periodic Beach Maintenance
I. 1000-99-3-14 1900 Bailie Beach Road, Mattituck, NY
Parcel size 22 acres
Structures: Scout Lodge
2.1000-99-3-19.1 Breakwater Road, Mattituck, NY
Parcel size 1 7 acres
Structures: Concrete Block bathroom/lifeguard bui Iding
V olleyball courts
3. 1000-126-6-18 and 17 Veteran's Memorial Park
10960 Peconic Bay Boulevard
Mattituck, NY
Parcel size (combined) 7 acres
Structures: Two frame buildings, new maintenance/parks office building
Playground
Misc. recreational facilities
4. 1000-126-5-2.1
Boulevard Ballfield Park (near Yatcl1tClub)
8908 Peconic Bay Boulevard
Mattituck, NY
Parcel size 5 acres
Structures: Ballfield
411 Board of Trustees APP1IIrtion
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: -to ( e 117:] ve de h ri 5
~f'orn pOI/I< /J(inchp~), ('nlA-'{~~J( b~ /.I)a~h-up) ?Ubl;0J~fbs~
v- WlI1h v ,sf-()rrYJ.S : J22./~l-oclcu l?7at'1~aMU2...../
/
Area of wetlands on lot: V(J(Y'\'ous
square feet
Percent coverage of lot: Yo-I/' \005 %
Closest distance between nearest existing structure and upland
edge of wetlands: feet
Closest distance between nearest proposed structure and upland
edge of wetlands: II! /A feet
.
Does the project involve excavation or filling?
X 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 ~aterial will bqemoved or deposited; Af- (-ea 5.+ (O I /a-'VIduJarl. (,) /11 Hvtl
11'105+ wo".l~ WI II t>11.. ho.nc1 rcck.(!.<Q. OVlOC.CCl'>lOi'lr IF StAA+,;).") 1""'7Y,~!:,~-1J
, I-ofkl,(:'\- bucker in Yemo\l-e. locs 5+Un)~S letv'< e..Ob €Ct.S
z) '10'11<. I"ake- in I"e.Yluye.- Svru\\e.v' I YT'f.>) , , ~
3) So....'l~b t}ck:e.+ (S<~''Z''h-"d h. Jrket1 *' SI~1- out- svna.U olQ\ecn, y-()V)'\...'
t-op :::t""v o~ 5CVV1d,. .' ...1...
N\ buclaT<; ~ ra~ ote... c:t+\uchn1e~ rl\/'.,j~{ nVQ(Q +rucic{'/ f'Y)\V'<:tr Ic.<-.
Some.. hGl.",cA"-O-kll'\4 iD COl7\pll1..-t->z.' 3d:;..
Statement oft.~e effect, i(an'y,on!J1ewll!l~l1~.san~_tid.aJ~atllrs.?ft~e tow.n t1~<l!!!!.<l.Y!~su!U~y
""reason of such proposed operations (use attachments if appropriate):
Nohe..- i-h.s;~ 10 t"'Qsrolle... loeo..ch fu
'-pI-e..- st-o('"yy') .sI-n.+lJS ctS 10 de b7S
~ iD VVnoy~ jQv~e dlepos'd-~(~ hI ,~
617tt
APPENDIX C
STATE ENVIRONMENTAL QUALITY REVIEW
SHORT ENVIRONMENTAL ASSESSMENT FORM
for UNLISTED ACTIONS Only
(To be completed by Applicant or Project Sponsor)
2. PROJECT NAME
SEQR
PROJECT 10 NUMBER
PART 1 . PROJECT INFORMATION
1. APPLICANT I SPONSOR
f)lATT ITUC.K. 'PAgy.
D I STT~ ICT
BE A. C H I'Yl A I rVTE. tV IlNC-E-
3.PROJECT LOCATION:
Municipality "')~l ih+ucl'-. County So~ f'ol \.z.
4. PRECISj:: LOCATION: Street Addess and Road Inter~ectjons. Prominent landmarks ate. or provide map
I) 'Bo. \..<is ~.I5a.,Ie.Q& lZ.oa.&. I lMo,;\t ,tude. NY . 1.\)
"8*.Ak~~ 'BJ'l?a..kwtdo;...; (l~) K:"a."-, '"WIo.1+.+.-;-, ~ \]J Y
"3 Vd. ~ ; ~o.o..k Ave.- ~ N~.
5. IS PROPOSED ACTION: D New D Expansion D Modification I alteration
6. DESCRIBE PROJECT BRIEFLY:
R~move.. &Qb~,S t:"vo,,,," p<wk 61".c<<.h. Q.CC:L.)1111'.,.\ula.+e,\
-pVI(;l~o.Y"II'I ~vO,"Y\, vV(.\~hl1~'1 '--1::> dU'(':IU\ Vl)Wlttv ::-,-toIfWlS)
SfLCtLJOYlaJ t,0Q.sh-u-p; <I -puloll'01~1t('vljQ.v.Io~,
7. AMOUNT OF LAND AFFECTED:
Initially acres Ultimately acres
6. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS?
~Yes D No If no, describe briefly:
9. WHAT IS PRESENT LAND USE IN VICINITY
o Residential 0 Industrial o Commercial
OF PROJECT? (Choose as many as apply.)
DAgriculture lRf Park I Forest I Open Space
DOther (describe)
10.' DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
AGENCY (Federal, State or Local)
~ Yes 0 No If y~s, list agency name and permit I approval:
--PuSs .61'1 ""DEe.... .
P RMIT OR APPROVAL?
DYes DNa If yes, list agency name and permit f approval:
12. AS A
[]yes
ULT OF PROPOSED ACTION WILL EXISTING PERMIT I APPROVAL REQUIRE MODIFICATION?
No
I CERTIFY
MY KNOWLEDGE
Dale: .~ 4::> Iz.oo7
Applicant
If the action Is a Costal Ar . and you are a state agency,
complete the Coastal Assessment orm before proceeding with this assessment
.
.
PART II. IMPACT ASSESSMENT (To be completed bv Lead Agency)
A. DOES ACTION EXCEED ANY TYPE 1 THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF.
DYes 0 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.
DYes D No
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOllOWING: (Answers may be han~written, if legible)
C1. Existing air quality, surface or.groundwaler quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal,
[nlial for erosl~n'_drainage or~~'ng prOblemS?EX~lainbrie~,:,: ~:'n ,_. . ", J
C2. [estheliC' agricu!'ural, arChaeOlogi":al'hisloric,or ~ther naturnlar cullural resources;.orcommunity.arneighbarhOOd characte~ Explain brienY'1
C3. relat~n.or taun~'fish'~hellfishorWHdllfe specles'SlgnlfiCanlh~lats,orlhrealened.orendangeredspecies? Explain brieIlY.......... ..... I
C4. rommunilY'S existing plans or goals as o"iciallyadopted, or a change in use or intensity of use 01 land or other nalural resources? Explain brieny. J
C5. rmh~ SUb5eqUenlde.velopment,orre~ated:ClivitieslikeIY to cbe. indU~edbY the proposed action? Explain brielly
C6. Long term, short term, cumulative, or other effects not identified in C1.C5? Explain briefly:
L ...... 'c" ..cc 'c' _
C7. Other impacts {including changes in use of either auantitv or tYDe of energy? Explain briefly:
I
....
.I
D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL
ENVIRONMENTAL AREA (CEA)? pfyes, explain brielly
DYes 0 No r I
E. ICr~:sE, 00 ~~rUKEL Y TO ~~' CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? II yes explain I
PART 111- DETERMINATION OF SIGNIFICANCE (To be oompleted 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
)'6SrtRe4etefmiRa-ti9F1'Gf-si~RifiGaRGe-m1;J6t-evall;Jate-U:te-peteAtial-iml*let-ef-tfle..pF6p6sefrae~ieA-eA-U:le'6flvirenmental-ehar-aeterislies-oHhe-6CA.
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 andlor prepare a positlve declaration.
.... CheckThTs-box if you havecfeterminei(basecf"on-fhe}nformation"and.analysTs'above ancfanysuppoiting. documenta'tfon, fhalthe-propos-ecr.iICtlo
WILL NOT result in any significant adverse environmental impacts AND provide, on aUachments as necessary, the reasons supporting lhl
detennination.
Name of Lead Agency
Date
Print or Type Name of Responsible Officer In Lead Agency
Title of Responsible Officer
Signature of Responsible Officer In Lead Agency
Signature of Pre parer (If different from responsible officer)
e
Board of Trustees
e.
Application
County of Suffolk
State of New York
G-e (o.,,-&? G-o.~h ('I n~ I -::f7. BEING DULY SWORN
DEPOSES AND AFFIRMS THAT /SHE IS THE APPLICANT FOR THE ABOVE
DESCRIBEDPERMlT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE
TRUE TO THE BEST OF mS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK
WILL BE DONE IN THE MANNER SET FORTHIN TillS 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 PERMlT(S), IF GRANTED. IN COMPLETING nITS
APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR
REPRESENT ATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE
PREMISES IN CONJUNCTION WITH REVIEW S APPLICATION.
SWORN TO BEFORE ME THIS
Iv-th
DAY OF March
,20 sa...
~~t/lJ}JJ~
olary Pubhc
ABIGAil A. WICKHAM
Notary Public, State of New Yortc
No. :;2-4642871 . SUffOlK County
ComrnIsalon ExpIra Sept. 30, 20:.i;;l."i
;...'...:
. Board of Trustees, APpUeion
AUTHORIZATION
(where the applicant is not the owner)
.t
I, ~,(<I/l.c\~~..h"'~r,:r;:~ LDmm,,;s;OMqesiding
(2r~nt own of roperty)
JY\Cl..tt,tuck r~ ()~st";d-
at-PO&.J'i I i/-OS. M~c.k. NY
(mailing address) I
do hereby authorize
~ A,vJ,~W\
(Agent)
to apply for permit(s) from the
South~ld Board of ~~n T~ustees
VYhttAucPL -P~"O[stVldY" V-
b ~ /r c:
(Owner's signature)
on my behalf.
t
4
/./
//
~;~i-- -- ,- ~ '._--==~
,
8
:
.
.
APPLICANT/AGENTIREPRESENTATlVE
TRANSACTIONAL DISCLOSURE FORM
The Town of Southard's Code of Ethics orohibits conflicts of interest on the Dart of town officers and emotovees. The Durnase of
this fonn is to orovide information which can alert the town ofoossibl6 conflicts of interest and allow it to take whatever action is
necessarY to avoid same. '
G<....OIlcl -Po G-oeJwIl"l<-leV :r7 .
(Last name, first name, .q1iddle initial, unless yo'u are applying in the name of
someone else or other entity, such as a company. If so, indicatethe other
person's or company's name,) .
YOUR NAME:
NAME OF APPLICATION: (Check all that apply.)
Tax grievance
Variance
Change ofZane
Approval of plat
Exemption from plat or official map
Other
(Jf"Other", name the activity.)
Building
Trustee
Coastal Erosion
Mooring
Planning
x
Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee
of the Town ~fSouth~ld? "Relationship" includes by blood, marriage, or bus"iness interest "Business interest'! means a business,
inclu"ding a partnership, in which the town officer or employee has even a partial ownership of(or"empJoyment by) a corporation
in which the town officer or employee owns more than 5% of the shares.
YES
x
NO
If you answered "YES", complete the balance of this fonn and date and sign where indica~ed.
Name ofpers.on employed by the Town of South old S.e.( f
Title or position of that person l1\embw, 2c.."n'1-&a,rd D~ "'pp"lJl~
Describe the relationship between yourself(the applicant/agentJrepresentative) and the town o.fficer 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 appliqmt
- (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 corporati~n); " "
_C) an officer, director, partner, or employee of the applicant; or
---X-D) the actual applicant.
DESCRIPTION OF RELATIONSHIP
Fonn TS I
.- /7 ~ /
Submitted this ~-fh da}'/ot mar ? ~200 1
Signature . ~ ~. L ~ ~ -
Print Name -fjnMd 'P. r-.OQJ/ljfo ev I $^.
t-
.
.
(631) 276-6215_
(631) 298-5195 Farm
~
Cooper Farms
P.O. Box 16
Breakwater Road
Mattituck, N.Y. 11952
.) ,
'I" L4,~k
f),S+nd
t"'\...1x.oI S ""
:\ <~'Y',n' ,~,+"v<. fc ......+
mc,+4-. Pc.r k (>,/ -h,~ f-
eD!?,,," 1'113
(Vl~"n h....L ~ S ~.
S'lo1
i"\~' 6-. G-v-e hr'''')'''''' ,
~.,.( (,"n,..< ~ d r\, :LCf~ 7033
FRESH VEGETABLES & STRAW
.oug Cooper
rn~1t.-
f:..rk- D,),h,tir
'2q!l .
C\1~3
.liJ,..,,^,~
r~.............,\- -(.M;t.;t-
~~,
~iJ' -TO: <) o,(j-i,!/ 0()'{,1I7 /t--tl~~1~d
.
,.",
''''''''f'
J' 'f
~ ". I,' K ., +e - '1
J). L" ,w,';,
YOUR ORDER NUMBER
DELIVERY DATE
.S o-v,J. l-lx
"
iJ ^''l J "-
QTY, DESCRIPTION
DATE
c3/;2~ o(
UNIT PRICE
AMOUNT
tVrt~
'.~
ORDERED BY:
,~
/J-
,
-TOTJ.L DUE:
AJ .. ,.
(~J5 '
RECEIVED BY:
"-
.
(631) 276-621.11
(631) 298-5195 Farm
~
Cooper Farms
P.O. Box 16
Breakwater Road
Mattituck, N.Y. 11952
FRESH VEGETABLES & STRAW
enoug Cooper
~Ic-
rn F""'- MI.'\-
'2.'1X'
G11~3
.(\'\""^'~
rt:......rv'l.t--~vc-
-n... ~<
~r 'TO:, ) 0 ,;I-L,Ir/ ~I ,II? =;-t-t15' "1 ~-e5
~
YOUR ORDER NUMBER
DELIVERY DATE
OTY. DESCRIPTION
..,.-.
DATE
-3/;2f o(
UNIT PRICE
AMOUNT
tv Pt~
'$...
ORDERED BY:
.~~
/J-
,
T0ThL DUE:
A:J "
~
RECEIVED BY:
r
,