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HomeMy WebLinkAboutTR-6745 James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall Annex 54375 Main Road P.O. Box 1179 $outhold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0460C Date: September 1, 2009 THIS CERTIFIES that the patching of existing bulkhead to prevent soil wash-out~ 10' non-turf buffer along the bulkhead, gutters to drywells on dwelling~ pipes leading out of bulkhead capped off At 1465 Shore Drive~ Greenport, New York Suffolk County Tax Map # 47-2-28 Conforms to the applications for a Trustees Permit heretofore filed in this office Dated 9/19/07 pursuant to which Trustees Wetland Permit # 6745 Dated 10/17/07 was Issued and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the patching of existing bulkhead to prevent soil wash-out, 10' non-turf buffer along the bulkhead, gutters to drywells on dwelling, pipes leading out of bulkhead capped off The certificate is issued to JOSEPH & BARBARA DAI owner of the aforesaid property. Authorized Signature James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall, 53095 Main Rd. P.O. Box I 179 Southold. NY 11971 Telephone (631 ) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: V// Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1 st day of construction ½ constructed Project complete, compliance inspection. INSPECTED BY: (~O~ ~-~. COMMENTS: CERTIFICATE OF COMPLIANCE: James F. K~ng, 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 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 V~Project complete, compliance inspection. BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 6745 DATE: OCTOBER 17~ 2007 ISSUED TO: JOSEPH & BARBARA DAI PROPERTY ADDRESS: 1465 SHORE DRIVE~ GREENPORT SCTM# 47-2-28 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 October 17, 2007, and in consideration of applicat/on fee in the sum of $250.00 paid by Joseph 8,: Barbara Dai 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 patch the existing 100' bulkhead to prevent soil from washing from the property into the Bay, with the condition of the installation of gutters and drywells to contain roof runoff and in accordance with Chapter 236 of the Town Code-Storm Water Runoff, a 10' non-turf buffer along the bulkhead, and all pipes leading out of the bulkhead are to be capped off, and as depicted on the project plan prepared by Costello Marine Contracting Corp., last dated October 31, 2007 'and received on November 2, 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 Joseph & Barbara Dai, 1465 Shore Drive, Cn'eenport, 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 evidc~nce 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 umeasonable obstruction to free navigation, the said Permittee will be required, upon due notice, to remove or alter this work project herein stated without expeflses 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 October 17, 2007 BOARD OF TOWN TRUSTEES TOWN OFSOUTHOLD Mr. & Mrs. Joseph Dai 81-88 Street Brooklyn, NY 11209 RE: 1465 SHORE DRIVE, GREENPORT SCTM# 47-2-28 Dear Mr. & Mrs. Dai: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, October 17, 2007 regarding the above matter: WHEREAS, JOSEPH & BARBARA DAI 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 September 19, 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 October 17, 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 JOSEPH & BARBARA DAI to patch the existing 100' bulkhead to prevent soil from washing from the property into the Bay, with the condition of the installation of gutters and drywells to contain roof runoff and in accordance with Chapter 236 of the Town Code-Storm Water Runoff, a 10' non-turf buffer along the bulkhead, and all pipes leading out of the bulkhead are to be capped off, and as depicted on the project plan prepared by Costello Marine Contracting Corp., last dated October 31,2007 and received on November 2, 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: $50.00 Very truly yours, 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 OFTOWNTRUSTEES TOWN OFSOUTHOLD Southold Town Board of Trustees Field Inspection/Work session Report Date/Time: JOSEPH & BARBARA DAI request a Wetland Permit to patch the existing 100' bulkhead to prevent soil from washing from the property into the Bay. Located: 1465 Shore Dr., Greenport. SCTMg47-2-28 Type of area to be impacted: Saltwater Wetland Freshwater Wetland Sound '~B ay Distance of proposed work to edge of above: ~c]of Town Code proposed work falls under: __Chapt.275 Chapt. 111 other Type of Application: t//Wetland __Coastal Erosion ~Amendment __Administrative __Emergency Pre-Submission Violation Planning Info needed: ModificatiOns: Conditions: L) Ut9 Present Were: .__J.King ~J.Doherty__P.Dickerson H. Cusack D. Dzenkowski Mark Terry other Form filled out in the field by MailedfFaxed to: Date: Environmental Technician Review ~on. D. Bergen__ B. Ghosio, Jr Donald Wilder, Chairman Lauren Standish, Secretary Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631) 765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., October 10, 2007, the following recommendation was made: Moved by James Eckert, seconded by Don Wilder, it was RESOLVED to SUPPORT the Wetland Permit application of JOSEPH & BARBARA DAI to patch the existing 100' bulkhead to prevent soil from washing from the property into the Bay. Located: 1465 Shore Dr., Greenport. SCTM#47-2-28 Inspected by: James Eckert Vote of Council: Ayes: All Motion Carried ri s,pp 0 '~ 0 Bl~ 0 Other I .P,~n~c f'l Unk. OYe~ 0 ~'.a~ ~ 0 If~dl~n 0 ~ 0 unk~ 73. Stat~Js DCJS-3205 (2/97J *FALSE 76. COmplainant Plea by Mail (NOT FOR VTL VIOLATIONS) TO PLEAD GUILTY: COMPLETE THIS FORM AND MAIL OR DELIVER TO: Southold Town Justice Court 53095 Main Road, P.O. Box 1179 Southold, NY 11971-0959 FINE TO THE PRESIDING JUSTICE AT THE SOUTHOLD TOWN JUSTICE COURT: ][, 6 0' ¢~0 ~/~" ~J ,residing at ~ ~'j~' ~t,t'~ ,-i¢~,u,,~ I~ , have been charged with a violation of ' ~ 2,7~' ¢'.~ , under the Code of the Town of Southold. I hereby elect to dispose of this matter without appearing in open court. I hereby waive arraignment in open court and the aid of counsel and understand that a plea of guilty is the equivalent to a conviction after trial. I hereby plead guilty to the offense as charged and elect and request that this charge be disposed of and a fine/penalty be fixed as agreed to below. I understand that the agreed upon penalty is contingent upon the Court's approval, and that my appearance may be required on a future date if the negotiated disposition is not accepted by the Court. Ticket/Summons ff.. 4 L/cO In Satisfaction of: Fine/Disposition Recommended: EDWARD FORRESTER DIRECTOR OF CODE ENFORCEMENT TOWN OF SOUTHOLD Southold Town Hall Annex 54375 Route 25, P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1939 Facsimile (631) 765-6639 e-maih ed.forrester@town.southold,ny,us STOP WORK ORDER TO: Joseph and Barbara Dai 1465 Shore Drive Greenport NY 11944 YOU ARE HEREBY NOTIFIED TO SUSPEND ALL WORK AT: !465 Shore Drive, Greenport NY TAX MAP NUMBER - 1000-47-2-28 PURSUANT TO SECTION 275-t6A. OF THE CODE OF THE TOWN OF SOUTHOLD, NEW YORK, YOU ARE NOTIFIED TO IMMEDIATELY SUSPEND ALL WORK AND BUILDING ACTIVITIES UNTIL THIS ORDER IS RESCINDED BASIS OF STOP WORK ORDER: Construction without valid permit Section 275-5A CONDITIONS UNDER WHICH WORK MAY BE RESUMED: Issuance of valid permit,from Southold Town Board of Trustees FAILURE TO REMEDY THE CONDITIONS AFORESAID AND TO COMPLY WITH THE APPLICABLE PROVISIONS OF LAW MAY CONSTITUTE AN OFFENSE PUNISHABLE BY FINE IMPRISONMENT OR BOTH. DATED: October 19, 2007 ~ / AUT.ORIZEI~GNATURE I1~1 11. Date 14. Date 73. DCJS-3205 J2/V7J *FALSESTATEMENTSAREPUNISHABLEASACRIME. PURSUANTTOTHENEWYORKSTATEPENALLAW. .. .,~ Town of Southold ' A- 17 6 6~ Suffolk County, NY The People of the State of New York vs. OC~ 2 9 2007 4.,~. OCt:. 2=1, ~ o 07 ECEB~Ei~ 2007 OFFICE LOCATION: Town Hail Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold, NY MAILING ADDRESS: P.O. Box 1179 Southold, NY 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~' LWRP Coordinator Date: October 9, 2007 OCT - 9 2007 Seuthhold Town 8oard of Trustees Re: Request for Wetland Permit for Joseph and Barbara Dai SCTM# 47-2-28 JOSEPH & BARBARA DAI request a Wetland Permit to patch the existing 100' bulkhead to prevent soil from washing from the property into the Bay. Located: 1465 Shore Dr., Greenport. SCTM#47-2-28 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 SOUTHOLD Office Use Only ~Cwoastal Erosion Permit Application etland Permit Application Amendmentfrrans~er/Extension eceTved Application: Received Fee:$.~%"~~ . ~---~C0mpleted Application Incomplete ~SEQRA Classification: Type I Type II Unlisted ~Coorchnafion:(date sent). .~LWRP Consistency Assessment Form 7CAC Referral Sent: ~ate of Inspection: Receipt of CAC Report: Lead Agency Determination: Technical Review: .~.~Public Hearing Held: Resolution: Name of Applicant Adminislrative Permit Address 65J-4 ?-Z43o Suffolk County Tax Map Number: Property Location: (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: SEP l 9 2007 Southhold Town Board of Trustees of Trustees Applicatio0 Land Area (in square feet): Area Zoning: Previous use of property: Intended use of property: GENERAL DATA Covenants and Restrictions: If "Yes", please provide copy. Yes / No Prior permits/approvals for site improvements: Agency Date __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspende~d by a governmental agency? Yes If yes, provide explanation: Project Description (use attachments _ ,,.., .U ~d of Trustees Applicatio0 WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area of wetlands on lot: Percent coverage of lot: square feet % Closest distance between nearest existing structure and upland edge of wetlands: dJS" feet Closest distance between nearest proposed structure and upland edge of wetlands: o'r-~''' feet Does the project involve excavation or filling? f No Yes If yes, how much material will be excavated? How much material will be filled? cubic yards Depth of which material will be removed or deposited: Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: cubic yards feet 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 Ap~licatio0 COASTAL EROSION APPLICATION DATA Pmp~oses of proposed activity: C~ .-~J_~,,~t5 Are wetlands present within 100 feet of the proposed activity? No ,/ Yes Does the project involve excavation or filling? ~'~ No Yes If Yes, how much material will be excavated? .(cubic yards) How much material will be filled? (cubic yards) Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) 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. AXPLICANT / SPONS, OR . I2' PROJECT NAME . 3.~ROJE~,T LOCATION:/ , Z~~.~ 4. PRECISE LOCATION: SEeet Addess and ~d Inters~tions, Prominent landmarks e~ ~or provide map 5. IS PROPOSED ACTION: [] New [] Expansion [~,'~iflcation / a)teration 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER E~es [] No if no. describe briefly: IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) dential []industrial []Commercial [~lAgriculture [] Park / Forest l 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) ~ r~]N° If yes, list agency name and permit / approval: 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [~es []No If yes, list agency name and permit / approvah 12. AS A RES~OF PROPOSED ACTION WiLL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? r-]Yes UNo I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Spons~-~e /'~ Date: ~he action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment 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 at ~ ~sdl~m~;mmit~nl? I'lyes (Endowment Requi~) m TO~I ~ge & Fees i $ ~.21 ~ ~ ..................................... ~ a c.o.o. ...... ~~ublic ~ CYN~IA M. MANWARING NOTARY PUBLIC, STATE OF NEW YORK NO:01 MA61 ~507 QUALIFIED IN SUFFOLK COUN~ COMMISSION EXPIRES OCT, 20 ). as seen, and that r to the date of the public , am'?. PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS SEP 2 § 2007 Seuthhokl Tewa 8oar(I id Tmstee~ Address: // ,~/,~ ~ STATE OF NEW YORK COUNTY OF SUFFOLK _~/)~/~. ~ , residing at / ~ ,~ ~ ~, ~ , being duly sworn, deposes ~d says that on the / ~day of ~ ,2~eponent mailed a ~e copy of ~e Notice set fo~. in the Bo~d of T~tees Application, dkected to each of the above n~ed persons at ~e ad~esses set opposite ~ere respective nines; that the ad~esses set opposite ~e n~es of s~d persons ~e the ad.ess of said persons as shorn on ~e cu~ent ~sessment ~11 of~e Tom. of ~outhold; ~at said Notices were mailed at the United States Post Office at ~~ ~, ~at s~d Noti~ere mailed to each of s~d persons by (ce~ifie~~mail~ ' / ~ ~ Sworn ~efor~ me ~s ~ ~ ~ay~3~ , 20~ - I' ~ot~-~u~ 'l ~-' ~ ~0:0~ MA01 ~507 ~ QUALIFIED IN SUFFOLK COUNt/ ~OMMISSION EXPIRES OCT. 20 ~ GREENPORT MPO GREENPORT, New York 119441644 3548330944-0098 09/24/2007 (800)275-8777 04:19:00 PM Sales Receipt Product Sale Unit Final Description Qty Price Price NEW YORK NY 10013 Zone-1 First-Class Letter 0.50 cz. Certified Label #: Issue PVI: $0,41 $2.65 70070220000245308354 $3.06 PELHAM NY 10803 $0,41 Zone-1 First-Class Letter 0.50 cz. Certified $2.65 Label #: 70070220000245308347 Issue PVI: $3.06 HICKSVILLE NY 11801 $0,41 Zone-I First-Class Letter 0.50 cz. Certified $2.65 Label #: 70070220000245308330 Issue PVI: $3.06 Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS All 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 permits not located within the Coastal Erosion Hazard Area. 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). 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 supoortino and non- suooorting facts. If an action cannot be certified as consistent with the LWRP policy standards conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold ' s website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# ¢~" o~_ . The Application has been submitted to (check appropriate response): Town~oard ~ Piann~g Board T] Build~gDept. ~ ~oardofT~ustees Category of Town of Southold agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital construction, planning activity, agency regulation, land transaction) (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action: Present land use: Present zoning classification: If an application for the proposed action has been filed with the Town of Southold agency, the following o a ions l pro d2¥ (a) Name of applicant: (b) Mailing address: b dUT, , I l z o (c) Telephone number: Area Code ( (d) Application n~ber, iffy: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes [--] 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 Southold 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 III - Policies; Page 2 for evaluation criteria. --]Yes [] No ~-~Not Applicable / Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of thc Town of Southold. See LWRP Section III ' Policies Pages 3 through 6 for evaluation criteria ~] Yes ~ No ~Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III - Policies Pages 6 through 7 for evaluation criteria Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LwRP Section III - Policies Pages 8 through 16 for evaluation criteria ~/Yes F-] No ~ Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III - Policies Pages 16 through 21 for evaluation criteria ~/Yes ~ No ~Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore thc 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 througJ~32 for evaluation criteria. Yes No Not Ap ble '~ 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 [--'~Not 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. PUBLIC COAST POLICIES 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 III - Policies; Pages 38 through 46 for evaluation criteria. [] NoT otApplicahle Attach additional sheets if necessary WORKING COAST POLICIE~ 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~l~ Not Applicable A~ach additional sheets if necessary 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 ~/NNot Applicable At~ach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III - Policies; Pages 62 through 65 for evalu/ation criteria. [] Yes ~ No~l-~ Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III- Policies; Pages 65 through 68 for evaluation criteria. [] Yes ~-~ No ~/NNot Applicable PREPARED BY TITLE DATE Board of Trustees Application County of Suffolk State of New York '1:3 a-cO- % . ,* ,' BEING Dray 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 ~3~[gW OF THIS APPLICATION. SWORN TO BEFORE ME THIS /~ DAYOF ,J_~?O-iVtCt~ ,20~ ~ I~otary Public LAUREN U. STANDISH Notary Pul~lc, S~te of N~w York No. 01S16164008 ,, O.ual~fied_in Suffolk County ~,ommlssion Lxpires April 9,20/[ APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics orohibits conflicts of interest on the Dart of town officers and emnlovees. The nuroose of this form is to orovidc in forinatiun which can alert the town of nossiblc conflicts of interest and allow it to take whatever action is necessary to avoid same. (Last nam~ flint flame, oafddle 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 (lf "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? "Relatiunship" 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% &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 Southold Title or position of that person Describe the relationship between yourself (the applicant/agentJrepresantative) 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): __fi,) the owner of greater than 5% of the shares of the corporate stock of the applic0nt (when the applicant is a corporation); B) the legal or beneficial owber of any interest in a non-corporate entity (when the applicant is not a corporation); __.C) an officer, director, parmcr, or employee of the applicant; or __.D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS 1 Submitted this ~day of ~- 200,~- Signature /7~.~-~ ../~-~dd ~ ..~-~-~.' ' PrintNa~'/ ~~ ~.