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Home My WebLink AboutTR-6696 James F. Kin5 President Jill M. Doherty, Vice-President P~gy A. Dicker~n Dave Bergen Bob Gho~io, Jr. Town Hall Annex 54375 Maln Road P.O. Bax 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 August19,.2009 BOARD OF TOWN TRUBTEES TOWN OF SOUTHOLD Mr. Philip Milot 140 Woods End Drive Basking Ridge, NJ 07920 RE: 4185 CAMPMINEOLA ROAD, MATTITUCK SCTM~ 123,5-26 Dear Mr. Milot: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, August 19, 2009: RESOLVED that the Southold Town Board of Trustees grants a One-Year Extension to Permit//6696, as issued on August 22, 2007. This is not an approval from any other agency. If you have any questions, please do not hesitate to contact this office. Sincerely, President, Board of Trustees JFK:eac 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 So[YrHOLD 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 1st day of construction ¼ constructed ~Project complete, compliance inspection. BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 6696 DATE: AUGUST 22~ 2007 ISSUED TO: PHILIP G. MILOT PROPERTY ADDRESS: 4185 CAMP MINEOLA ROAD~ MATTITUCK SCTM# 123-5-26 AUTHORIZATION Pursuant to the provisions of Chapter 275 and/or Chapter 111 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on August 22, 2007, and in consideration of application fee in the sum of $250.00 paid by Philip G. Milot and subject to the Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and permits the following: Wetland Permit to repair/replace the existing bulkhead using vinyl sheathing/non-treated lumber, with the condition the non-turf buffer to remain, and as depicted on the plans prepared by Philip G. Milot, received on July 27, 2007. IN WITNESS WHEREOF, the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. TERMS AND CONDITIONS The Permittee Philip G. Milot, residing at 4185 Camp Mineola Road, Mattituck, New York, as part of the consideration for the issuance of the Permit does understand and prescribe to the following: That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will, at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold. That this Permit is valid for a period of 24 months, which is considered to be the estimated time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later date. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that aUthoriZation was originally obtained. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. That there will be no unreasonable interference with navigation as a result of the work herein authorized. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation, the said Permittee will be required, upon due notice, to remove or alter this work project herein stated without expenses to the Town of Southold. The Permittee is required to provide evidence that a copy of this Trustee permit has been recorded with the Suffolk County Department of Real Properties Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety (90) calendar days of issuance of this permit. That the said Board will be notified by the Permittee of the completion of the work authorized. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit, which may be subject to revoke upon failure to obtain same. 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 August22,2007 BOARD OF TOWN TRUSTEES TOWN OFSOUTHOLD Mr. Philip G. Milot 140 Woods End Drive Basking Ridge, NJ 07920 RE: 4185 CAMP MINEOLAROAD, MATTITUCK SCTM# 123-5-26 Dear Mr. Milot: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, August 22, 2007 regarding the above matter: WHEREAS, PHILIP G. MILOT applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated July 27, 2007, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, in accordance with Chapter 268, said application was found to be Exempt from the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on August 22, 2007, 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 275 of the Southold Town Code, 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 PHILIP 6. MILOT to repair/replace the existing bulkhead using vinyl sheathing/non-treated lumber, with the condition the non-turf buffer to remain, and as depicted on the plans prepared by Philip G. Milot, received on July 27, 2007. 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 $50.00 per inspection. (See attached schedule.) Fees: None Very truly yours, James F. King President, Board of Trustees JFK/eac 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 To: Pt I;? G, m,'lo/- Please be advised that your application dated ,-~-~,~1 ~ 0200 -7 been reviewed by this Board at the regular meeting of '~/~ ,~ ~z.~ 1/~P:2. and your application has been approved pending the ¢omp~tien of th~ following items checked off below. has __ Revised Plans for proposed project __ Pre-Construction Hay Bale Line Inspection Fee ($50.00) __ 1st Day of Construction ($50.00) __ ¼ Constructed ($50.00) Final Inspection Fee ($50.00) __ Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: BY: James F. King, President Board of Trustees Telephone (63 l) 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 Wed., August 15, 2007, the following recommendation was made: Moved by Don Wilder, seconded by Jack McGreevy, to TABLE the Wetland Permit application of PHILIP G. MILOT to repaidreplace the existing bulkhead. Located: 4185 Camp Mineola Rd., Mattituck. SCTM#123-5-26 Inspected by: Don Wilder The CAC Tables the application until a detailed plan is submitted, and recent repairs have been made on the bulkhead using treated lumber. Vote of Council: Ayes: All Motion Carried 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 Southold Town Board of Trustees Field Inspection/Work session Report Date/Time: PHILIP G. MILOT requests a Wetland Permit to repair/replace the existing bulkhead. Located: 4185 Camp Mineola Rd., Mattituck. SCTM#123-5-26 T~5~e of area to be impacted: Saltwater Wetland Freshwater Wetland __ Sound Bay Distance of proposed work to edge of above: Pc~,of Town Code proposed work falls under: __Chapt.275 Chapt. 111 other Type of Application: __ Wetland __Coastal Erosion Info needed: Amendment __Administrative __Emergency Pre-Submission. Violation Modifications: Conditions: Present Were: __J.King VJ.D°herty __P.Dickerson D. Bergen__ B. Ghosio, Jr H. Cusack D. Dzenkowski Mark Terry~other Form filled out in the field by Mailcd/Faxed to: Date: Environmental Technician Review iq ~ J~ · ~ o~ ~ .~r~ ~c I ? - 123 OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold, NY MAILING ADDRESS: P.O. Box 1179 Southold, NrY 11971 Telephone: 631 765-1938 Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM COORDINATOR TOWN OF SOUTHOLD MEMORANDUM To: James King, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner ~x~i LWRP Coordinator Date: August 8, 2007 Re: Request for Wetland Permit for Philip Milot SCTM# 123-5-2f~ PHILIP G. MILOT requests a Wetland Permit to repair/replace the existing bulkhead. Located: 4185 Camp Mineola Rd., Mattituck. SCTM#123-5-26 The in-kind replacement of existing timber bulkhead as per Town Code is an exempt Minor Action and not subject to LWRP review pursuant to Chapter 268-3; Items A and B of the Town of Southold Town Code. The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is exempt from review pursuant to Chapter 268-3, Exempt Minor Actions, item B which states: "Replacement, rehabilitation or reconstruction of a structure or facility, in kind, on the same site, including upgrading buildings to meet building or fire codes, except for structures in areas designated by the Coastal Erosion Hazard Area (CEHA) law where structures may not be replaced, rehabilitated or reconstructed without a permit". MT/hkc 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 SO?!'. HOLD _..zC~. a.stal Erosion Permit Application ~J[retland Permit Application Administrative Pemait __RRe Amendmenffrrans[er/E~te~ion ec~d Application: 7~,17~9 / ceived Fee:$~.. ~"~'~--- ___~6'mpleted Application '~ ] __~ Incomplete SEQRA Clas~iflcatiom Type I Type II Unlisted _~_Coordhmlion:(date sent) ~..[WRP Consistency Assessment Fora, ~Receip( orCAC Report: __Tech~fical 9eview: Name of Applicant ,~/o b Phone Number:( Suffolk County Tax Map Number: 1000 - Property Location: (provide LILC~ Pole #, distance to cross streets, and location) (If applicable) Phone: trd of Trustees Applicat: GENERAL DATA Land Area (in square feet):_ ~ Area Zoning: t2 Previous use of property: ~ Intended use ofprope~y: ~ r Covenants and Restrictions: Yes If "Yes", please provide copy. Prior permits/approvals for site improvements: -, A~ency __ ____ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? Yes If yes, provide explanation: trd of Trustees Applicat£~ WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: t ~/h~.//~L tf//~/~ ~ Ama of wetlands on lot: t4Y//fi square feet coverage of lot: ,~//0 % Pement 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 Yes 6~",v ~ 0 ~ ~'P~'O If yes, how much material will be excavated7 cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): of Trustees ADDlicati~ COASTAL EROSION APPLICATION DATA Purposes of proposed activity: Are wetlands present within 100 feet of the proposed activity?. No ~'~Yes Does the project involve excavation or filling? If Yes, how much material will be excavated? How much material will be filled? (cubic yards) (cubic yards) Manner in which material will be removed or deposited: ~l tuc tuu nature trod extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) PROJECT ID NUMBER PART 1 - PROJECT INFORMATION 1 APPLICANT / SPONSOR 4, PRECIS~E LOCATION: StreeI Addess and Road Intersections. Prom~nel~t landmarks otc -or provide map 617.20 SEQR 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 5. IS PROPOSED ACTION: [] New E] Expansion Modibcatior~ / alteralion 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED Initially acres Ultimately 8. 'WL~,-', o, R.~POSED~' A,~,~'T'~,~N' COMPLY ~MITH .... EXISTING ZONING OR OTHER RESTR!CTIONS? E~es [] No If no, describe bdefly: 9. WHAT !S PRESENT LA. ND USE iN VICINITY OF PROJECT? (Choose as many as apply.) 10. DOES ACTION iNVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTNER GOVERNMENTAL AGENCY (Federal, State or Local} ~Yes ~o [f yes, ~;st agency name and permit / approval: II. DOES ANY ASPECT OF ]HE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ~Yes ~ If yes Fist agency name and pe~it I approvah 12, AS A ~ OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? ~Yes ~ No CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE B po :o, t d' Da,.: If the action Is a Costal Area, and VOU are a state agency, com~ete the Coastal Assessment Form before proceeding with this assessment PART II - iMPACT ASSESSMENT (To.___~be compl~ A DOES ACTIO~ED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? if yes, coordinate the review process and use the FULL E~F. [] Yes L~ No If No, a negative B, WiLL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 d~iOn may be superseded by another involved agency. C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, it legible) CI. Ex[sting aP quali~ surface or groundwater quality or quanti~y no se eveis existing traffic pattern, solid waste production or d,sposa,, ootentiat for emsiOnr drainage or flooding problems? Explain bdefiy: · ,f~'~~ Ex.~n briefly' C2 Aes[het~ agrcutura ache g ~l'nb~ nelly: Cfi. ~ C6 Long term, shod term, cumulative, or other effects not idect~fied in C1-C57 Explain brielly: C7 D. WiLL THE pROJECT HAVE AN ,MPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENV!RONMENTAL AREA !CEAI? (if ~,es, ex~la!n bdef~ ~ISTHERE, ORIs~MPAC ST ? If es ex lain: ~ART Ill - DETERMINATION OF SIGNIFICANCE (To be c~mplated by Agency) INSTRUCTIONS; Fore'chadverseeffectident~edab~ve~determinewhetheritissubstantia~iarge~imp~rtant~r~the~wisesigni~cant~ Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (bi probability of occurring; (c) duration; (d) irreversibitity; (e) geographic scope; and (fi maoni[hde, If necessary, add attachments or reference supporting materials. Ensure that expianationa contain sufficient detail to shew that al~'relevant adverse impacts have been identified and adequateiy addressed, if queation d of part ii was checked yes, the determination craig nifica nce must evaluate the potentiai impact of [he proposed actJ0 n o n the environmental characteristics of the C EA. Check this box f you have identified one or mom potentially la rge or significant adverse impacts which MAY occur, T hen proceed directly to the F [ ii [ EAF and/or prepare a positive declaration. Cheek this box if you have determined, based on the information and analysis above and any supporting documentation, that [he proposed actiol WiLL NOT result in any significant adverse environmental impacts AND p¢ovioe, on a[tschmenis AS necessary, the reasons supporting determination. Date Name of Lead Agency Pr n or Type Name of ResDonsible Officer in Lend Agency Ti¢l~ of Responsible Officer . ^ , ~; , Signature of Preoarer (If different from responsible officer) Signature of Responsl~)te ,.~ffice n ~.ead Age ,c'i · 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 BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of ...... ........................... COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTiNG , residing at ~t' ~' C"tg~r/'~/~',-,,t,,,~-o'f~,-~ being duly sworn, depose and say: That on the -~'l~/~day offf ~ ¢-~f'-, 2007, I personally p,o. sted the property known as by placing the ~3oard'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 the public (signature) heating. Date of hearing noted thereon to be held Dated: ~'//o~l, Sworn to before me this ag~z, day ot/9d2/200-/ lqotary Public PATRICIA RICH~IRT NN~ (~blic, ~;t~te o~,New,..,Y~ gO. 30-47411M '~'~ ~~SSaU / SUffeib~U~.~ Town of Southold LWRP CONSISTENCY ASSESSMENT FORM INSTRUCTIONS 1. Ali applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency'. *Except minor exempt actions including Building Permits and other ministerial perm its not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area (which includes all of Southold Town). 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review' law'. Thus~ each answer must be explained in detail~ listing both supporting and non- suooortinR facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold ' s xvebsite (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all !oc~_! li~hrafies and the Town Clerk's office. DESCRIPTION OF SITE AND PROPOSED ACTION The AppH~fion has been submi~ed to (check appropriate ~s~mc): TownBoard ~ Plaan~gBoard~ Bu.d~gDept. ~ BoardofT~stees ~ Category of Town of Southold agency action (check appropriate response): (a) Action undertaken directly by Tox~a agency (e.g. capital ~-] construction, planning activity, agency regulation, land transaction) [-~ (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: ~ Location of action: Site acreaae: Present land use: Present zoning classification: If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant:-- (c) Telephone number: Area Code ( )~'~0~ (d) Application mtmber, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes [--1 No [~ If yes, which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southoid that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section IIl- Policies; Page 2 for evaluation criteria. Yes ~-] No Mot Applicable Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III - Policies Pages 3 through 6 for evaluation criteria I I Yes ~-~ No ~/Not Applicable ARach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southoid. See LWRP Section III - Policies Pages 6 through 7 for evaluation criteria ~-~ Yes ] ] No ~Not applicable A.ach additional sheets if necessary NATUR Al, COART POI,ICIES § 16 Section iii - Policies Pages through [--~ Yes [~ No ~"~Not Applicable Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III - Policies Pages 16 throug~h 21 for evaluation criteria [] Yes [] No ~Not applicable Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III - Policies; Pages 22 through 32 for evaluation criteria. Yes No Not Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies Pages 32 through 34 for evaluation criteria. ~-~ Yes [] No ~,d~ot Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria. ~ Yes [] No ~Not applicable PUBLIC COAST POL!C!Eg Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section II1 - Policies; Pages 38 through 46 for evaluation criteria. ~ [] Ye~] No t Applicable WOR_K!NG COAST POIJCIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III- Policies; Pages 47 through 56 for evaluation criteria. [] Yes ~ No [~ot Applicable Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary. and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. ~ Yes [] No [-~Not Applicable Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section HI - Policies; Pages 62 throug~$ for~ion criteria. ]Yes No Not Applicable A...ach add,_'fiona! sheets LC necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section IH - Policies; Pages 65 throut~h 68 for evaluation criteria. [-q Yes ~] No ~Not Applicabl~ PREPARED BY ?~/f fc¢~ ~'~,~ F//'~~ TITIE ~t~r~'- DAT.L~)''z' q' ~ ~ Board of Trust~es Application County. of Suffolk State of New York //-//Z/,~ ~, /'~/Z-bvfi-~ BE_.t~qGDt~_YSWORN ~I~ TO T~ BEST OF ~S~R KNOWLEDGE A~ BEL~F~ ~ THAT ~L WO~ ~LL BE DO~ ~ ~ MAWR gET FORTH ~ T~S ~PLICATION ~ AS MAY BE ~PRO~D RV T~ SOU~OI,D TO~ BOA~ OF TRUSTEES. T~ ~PLICANT AGREES TO HOLD T~ TO~ OF SO.HOLD A~ T~ TO~ TRUSTEES HARMLESS ~ FRFF. FROM A~Y A~ AT,I, DAMAGES ~ CLA~S ~S~G ~ER OR BY V~T~ OF S~ PE~T(S), ~ G~TED. ~ CO~LET~G T~S ~PLICATION, I ~BY A~HO~E ~ ~US~ES, T~ AGENT(S) OR ~P~SENTATI~S(S), TO E~R ONTO MY PROPERTY TO ~SPECT T~ PR~SES ~ CON~_~CT!ON ~TH RE~W OF THIS ~PLICATION. SWORN TO BEFORE ME Tins DAY OF ~ ,20c~ 7 No..~u- 'q* . Qualified in Nassau / S/.Jflqlk CoupU~ Commission Exp res JO/~ //~7 of Trustees ADDlicatio~ (print owner of property) residing at (mailing address) do hereby authorize (Agent) (Owner's signature) APPL!C A NTiAGENTFREPRESENTATiVE DISCLOSI)'RE FORM this fora is to n~vide in fo~ation which c~ Mefl ~o to~ of ~ible ~nfli~ of ~t~,~st ~d ~low it ~ ~e whatevor ~on is fOUR NAME: t ~ (L~t name, fi~t nme,~iMle ~itial, ~le~ you ~ applyi~ in ~ n~e of mm~ne el~ or o~r en6~, such ~ a comfy. If ~, ia~ ~e o~er NAME OF APPIICATION: (Check all that apply.) Tax grievance uuiiding Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning (lf Other". name the activin.) ~ You ~nally (or through your comply, s~, stonng, ~t~h u~ ~m,~ ,~ ~. ~ ...... ~,],o,,.~ ,..~ ~-~ oft~ieTSwnofSouthold7 ,*Relationship"inclu~sbybl~d,~age, orbmme~m~ B~me~lnt¢~st including a pa~ne~hip, in which the town offi~r or employ~ h~ even a p~al owne~hlp of (or employment by) a ~ration in which the town officer or employ~ owns mo~ th~ 5% of~e shes. NO Descri~ the relationship ~twcen you~lf(~e ~plic~ff~enff~p~nmtive) ~d ~e ~wn offi~r or employee. Either ci~ck the appropriate line A) through D) anchor descd~ ia the space provided. .......... ~:~ ~ h ........... ;~1; ...... nt or ~hild is (check all that (when ~e applicmt is a ~.B} fl~ legal or ~ficial own~ of ~y inmmst in a non-co¢o~te enti~ (when t~ applier is not a ~r~on); ~.C) m~ officer, di~ctor, p~er, or employce of the applicant; or D) the actual ~p{icant. Submitted this~2'~'T{day of .~-~'~ 200 JUL 2 7 2007 Southhoid Towtl Board of Trustees 10.58 - I AI;t~ROVE~Y j J TOI~IWN OF SOUTHOLD SURVEY OF PHOPE TY A T MA TTI TUCK TO WN OF SOUTHOLD SUFFOLK COUNTY, N. Y ~000 - 12.~, 05 - 26 Scole I"= 50' FEB. 7, CER T/FlED TO' PHILIP G. MIL 0 T MERCANTILE MORTGAGE BANKERS LTD. SECURITY TITLE & GUARANTY CO. I CERT: ol/ol,/clZ /~ECONIC ~U~VEYORS, P.C. ~ ~6319 765 - 50~0 FA~ (631l 76~ - 1797 P. O. BOX 909 1~30 TRAVELER STREET SOUTHOLD~ N. ~ 11971 86 - 585a