The URL can be used to link to this page

Home My WebLink AboutTR-6794A . . 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 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 151 day of construction Y, constructed ,/ Project complete, compliance inspection. . . 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.: 6794A Date of Receipt of Application: January 9, 2008 Applicant: Albert Moyse SCTM#: 31-18-5 Project Location: 120 Rabbit Lane, East Marion Date of Res\>lution/lssuance: January 23, 2008 Date of Expjration: January 23,2010 Reviewed by: Trustee Bob Ghosio Project Description: To raise the dwelling and replace foundation posts and lower building back onto new post/girder arrangement. Remove/replace existing deck surrounding building landward of the Coastal Erosion Hazard line, as necessary, to facilitate work. 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 plans prepared by J.H. Rich Jr. last dated December 16, 2007. Conditions: Gutters and drywells are installed in accordance with Chapter 236- Stormwater Management, of the Town Code. 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 Per~it will be required. This is not a determination from any other agency. Jame~, f::si~ Board of Trustees . . 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: {])J..J.v, 1- '-111 01 . II ~ I Please be advised that your application dated / / '1/08' has been reviewed by this Board at the regular meeting of I / iJ.~ In f and your application has been approved pending the completion of the following items checked off below. Revised Plans for proposed project Pre-Construction Hay Bale Line Inspection Fee ($50.00) 1st Day of Construction ($50.00) y" 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: $ ,9}, ()l) BY: James F. King, President Board of Trustees c. . 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: 1/);).-/0"6 Applicant: fJ/L-r- ACj5-'- Agent: a .w. {:<'<-t. Location and SCTM#: Description of Activity: Type of area to be impacted: ~altwater Wetland Freshwater Wetland Sound ~ay Distance of proposed work to edge of above: Part o,fTown Code proposed wetk falls under: ,/ Chapt.275 ~Chapt. 111 other Type of Application: _ Wetland _Coastal Erosion _Amendment ~dministrative _Emergency _Pre-Submission _Violation Info needed: Modifications: Ifif d.r7~ d dm,;:~ Conditions: tJp/Z.. '5 ~+& ( 0, I K.<,J, Is dv-UcJcr s~ <r~/IIL(.? Present Were: _J.King _J.Doherty _P.Dickerson _D. Bergen ~~sio, Jr _H. Cusack _D. Dzenkowski _Mark Terry _other Form filled out in the field by: MailedIFaxed to: Date: Environmental Technician Review: . . ,,>-. aZ", ....l . , <=00 -0_ :.E'C I .0"'- "''''''''' 0::"'" _0 aUla N"'O -~- - :.w.. ,I ':. ~I I: I iilPI 'E P , ~; ; . g , 1111 j'i' III I :l'Sl ill ! nPi dnH Hi'j 111II1 ,,,., I i i i i il i!;I, I . i . , I ~ ~ ~ jilll !!l[l iilll "I' , i1ff:f ~: rill1fii ~U;! hii~ ~;~; ~ ~ ~~.u m U~;r: ~a~; .' " ~ ~;a("') .of =,\,0 !~~ ~~ ~-< ~~;~ ~~ ,.. l/> I~~ :~.~ ..~ - s'51 i)EJ - tkO, 0 :. ~ ~ ", 0 . 0 c." v'" ~~s . i . ~ o c o o ,,,,,,,I__ I ! I'~ 6>.". + , ~~-= -r' <:) w p . James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen John Holzapfel BOARD OF TOWN TRUSTEES TOWN OF SOUTH OLD r . Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 Office Use Only _Coastal Erosion Permit Application Wetland Permit Application X Administrative Permit / _ Amendment/Transfer/Extension -./ flteceived Application: :::!::Received Fee:$ _Completed Application _Incomplete _SEQRA Classification: Type I_Type II_UnIisted_ _ Coordination:( date sent) .......J:WRP Consistency Assessment Form I J, 110 & CAe Referral Sent: ' /Date ofInspection:~ _Receipt of CAC Report: _Lead Agency Determination:_ Technical Review: ~blic Hearing He~ _Resolution: \6),IH ~ I VI!: ~ l\ru JAN - 9 2008 l\1}) Soulbhokl TOWI Board of Trustees Name of Applicant f) I-.J1F2.r rftO<iS~ Address /~ T:2 "'.Ii.) S.., N.c>J tJ:j."b/L ~AtK ,,/tS .//010 Phone Number:( )0"/'" - r4/ - o4.g.3 Suffolk County Tax Map Number: 1000 -J / - /,f' - .5" Property Location: /,2 0 7~ (jiB,! 1A"I1€. r AoS-r . ';e> #:0"/ a ! do I ~.,;, ~.e,D 0 - --;j!, (provide LILCO Pole #, distance to cross streets, and 10 AGENT: (;. JJ. ;}001/ (If applicable) Address: 1cJ..6'GJ;-fr. --:6El.Y-J.A-,.J At/';: H//I2'o--/ N.c}- ---: f.f?r1Z1 P,J III. \;~ r. ~ty \\\\\() &(.L,tk~ r! (S /1971 . Phone: 7(;,6' -..g"jt,,y ~rd of Trustees APPlicati~ GENERAL DATA .l:f' Land Area (in square feet): ' I~ f To Area Zoning: Previous use of property: 6':<..HffE,l 2e6r:z,,,,JC/f Intended use ofproperty: bA}(i2" Covenants and Restrictions: Yes If "Yes", please provide copy. ...........- No Prior permits/approvals for site improvements: Agency NiJA/L Date ...........- No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a~rnmental agency? No Yes If yes, provide explanation: N.Il. Project Description (use attachments ifnecessary): -Zl'f€ ;jJ<.J<,I,I.. ",.,,/!,-; ---...----::> -- -/ -', / &? rc;)/-flJ" J-On,.../Z)AT70"'/ rosr t:::d~~ecflc,J-r f Lo..Ui!.. '2..-1.Lj)"J<l dfllc.J<. c;.ln:;> N~"; ~<;-r/ (f/I2'pEIL 47212f/,./(f~H e,,)1 4;1-(0,/,[' %1",,4t'k.ef E~/STM./ ~ P.;'Ck &R..120~Jv,J1-"iJIULb/lJ(j,l A.5 ,../;E'c.r.sS,4-~Q;r;e, h4Cfl-l'fI/i' ;/.,d~ "'rd of Trustees APPlicati~ WETLANDITRUSTEE LANDS APPLICATION DATA / Purpose of the proposed operations: 'A2rMI<z' /'::;;d-"/P/i7lo.J --;:?'sr6 Iii4T d4-v~ 7:;>;:-rtEJ2.oA7Ei> Area of wetlands on lot: D square feet Percent coverage oflol: o % Closest distance between RilareBt"{;xisting structure and upland edge of wetlands: ::t- ~~ feet Closest distance between nearest proposed structure and upland edge of wetlands: Ai. A feet . Does the project involve excavation or filling? ,/ No Yes If yes, how much material will be excavated? 1-/. II . cubic yards How much material will be filled? r/. II cubic yards Depth of which material will be removed or deposited: II: II feet Proposed slope throughout the area of operations: ;I. /}. Manner in which material will be removed or deposited: ''\J, 1/ . ,.)0 t-flJltfl2l1l- ID~ I2moveil D;2 /J.!-fJo.srnhJ ;:'Wr.<W0ITt"-. 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): ,..)0 F';Pt:C-, ~~ l7',JcJ W/I'/"'A~,/)<; 1Ifrd of Trustees APPlicati~ AUTHORIZATION (where the applicant is not the owner) ... I, /J1-BD2r ,.{~.s? (print owne f property) residing at 1..2 J::'Zk/I,v Sr (mailing address) rkiJ .J~fl>1!: ~i2.<L 1"/.6. I/OJo do hereby authorize f;EdiJ.(1tl: J.! /./oef/ (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. ~,Jf~e) . 8 PART 1 . PROJECT INFORMATION Ie 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM / for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) . I PROJECT 10 NUMBER SEQR .s~ I~o Z,q.t3'i3fT ..(,A-,Je:. 2. PROJECT NAME G~f(WI!.-;Z.. Municipality ,.. 1=. County ersections, Prominent /.1-1~ Fo.t-k.. 7~;- oAD;;de maD /,flo 'i21t#33,r/..IIIV~ E4.S-;- >lJil2lo,J N d 5. IS PROPOSED ACTION: 0 New o Expansion ~Odification I alteration 6. DESCRIBE PROJECT BRIEFLY: -:7 ('G. tJ IS .€.2.u... 71),./ t/ I,;;, IZt f'"u~e,;: JJc.,..,F III (:>114 r~ i> I-~ Ai]> * r",,,J -P<>~.,.-..s. 1.",.Je',{.;)kfl-l>f.JC!. ;;JileK o,Jro rI.cw7e>S-r/tJfl2:Ja 4f2i2f1,JC4/-!".Jt. /<''/-lol / 7Z,t'A.t+err- t ~/S7"JC; P.JclL S~i1Ko''--.IJ>j4('7 -:i1t.fJ.-/"- 'j) f~/ lJ.s ,.!.rc,z-S.5'AI{OJ ,-; rAC'~I(:j,/"f ~otUl. 7. AMOUNT OF LAND AFFECTED: Initially:f I acres Ultimately acres 8.~ROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER ~Yes D No If no, describe briefly: ", ~ RESTRICTIONS? ---- 4:2> 9. WHAT IS PRESENT LAND USE IN VICINITY ~Sidential Dlndustrial DcommerCia' OF PROJECT? (Choose as many as apply.) DAgriculture 0 Park I forest I Open Space DOther (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, ~y (Federal, State or Local) ~Yes D No If yes, list agency name and permit I approval: NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL 6Dt.lLnJtJ~ -;;;,.1 N %//...';) j.J~ ])'::f>"/ 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? DYes [3*6" If yes, list agency name and permit I approval: 12. AS A ~~ OF [)yes ~No I CERTIFY PROPOSED ACTION WILL EXISTING PERMIT I APPROVAL REQUIRE MODIFICATION? THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant Date: Signature Ifthe 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 eomDleted bv Lead Aoenev) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF. DYes [t;I No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative declaration may be superseded by another involved agency. DYes r7I 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: I I j~ A.D {lllZ.5~ / C. ,-=';:If,C-rS C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: I rJ () (J,1) UIlsL. ;f'';E€.c:rS I C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: I ;J () tI 'PIt ,zs,! ~;:F&CP' I C4. A community"s existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly: I No {J,7){eiLSL f'FE.€.crS I C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: I rlQ A 7:> (LI26,l E..E r-5<:. ,s I C6. Long tenn, short term, cumulative, or other effects not identified in C1.C5? Explain briefly: - I NO /It>als.t Ei~F#5:,rs I C7. Other impacts (including chanQes in use of either quantity or tvoe of energy? Exolain brietlv: I AI., 41> (4,t)6,l; ~- S I D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? (If yes, explain briefly: I DYes ~o I E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If ves explain: DYes &0 I I PART 111- DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (Le. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked yes, the determination of significance must evaluate the potential impactofthe 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 andlor prepare a positive declaration. Check this box jf 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 thi determination. Name of Lead Agency Date Print Of Type Name of ResponSible Officer In Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer) Town of South old . . LWRP CONSISTENCY ASSESSMENT FORM ./ A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of South old 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. 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 L WRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, !istin!! both supportin!! and non- supportin!! facts. If an action cannot be certified as consistent with the L WRP policy standards and conditions, it shall not be undertaken. A copy of the L WRP 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# {ceo -JI - Iff -,5 PROJECTNAME &'><J1'ilL J2e.sI DL'/cL. - AI-;3;oZ',tlr t-ftj-s..r The Application has been submitted to (check appropriate response): Town Board D PlanningBoardD Building Dept. D Board of Trustees W 1. Category of Town of South old agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital construction, planning activity, agency regulation, land transaction) D D (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: ~. Nature and extent of action: -;?AIU2'-Fdl.lt; ~ HC/I-/4-rE ~rJ.--iJ:tAT/O,) 7asr ?ldv..IIC~"7-f&Jr:,-;;}.q-,- I//U fA! A J>~-r~d.I{).4tlT,El) (b,.,JtJ/770d. 72rHIJf/~/7?EjJ~AcF E'JL-.ISl7.Jf; , S:O,J.-IlJJ:xufbJ.Jq kcA U; ,:ACI/../tJT/$ ;./&Il.It.. . . r !/A.(2(tJ"j rI.g. Location of action: 1.20 -;Zrll3.an- L1+^,'~ Site acreage: .! t! .Aazp: Present land use: ~J-fiUt. lZ'iI!6,OE-Jc.iE- Present zoning classification: '7- Jv 2. 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: ,J.4. , d. /1 (b) Mailing address: (c) Telephone number: Area Code () J.A. (d) Application number, if any: / A Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes D No ff 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 L WRP Section III - Policies; Page 2 for evaluation criteria. DYes D No ~NotApplicable ,v_ ;::-~"'JtC.-r~M A"'~ .., -;;'Us,,- c..ff~Hf9"IlI-rS Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See L WRP Section III - Policies Pages 3 through 6 for evaluation criteria DYes D No ~otAPPlicable -r;i;;: ;alE. -;r3 d:/.J l? 1.5 ~ II J~rtJLIl:_ .lr1V'bfD,(l .4ilC,4l..I"O~ICA-L- 1Z6XZa1lc~<; J)h~r...II1.3J.)j -~ J":J./S "77"';EcT Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See L WRP Section III - Policies Pages 6 through 7 for evaluation criteria DYes D No [9'Not Applicable l. kit../- "'or "'I""Fle., y'1.SU.fI... ttu.,q.j,'(5 A#J"ll il 6~#1C- te4~f!J"""US I 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 DYes D No Gf"NotAPPlicable ,..ID (zJ:FIC.e., ,nl 5rAZILC,..T"o.C..Jl#5 AN:/> nrATU-ltIf.L. 'iGJE:60<A.Le,;s ,:::p -4( h D.:D 1".1(; ; E~&S. / d"/ 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 DYes D ,No ~otAPPlicable b!.LJ-J,.. ("lA-IIi&. ^,,, F/:!,./&e, DAl LI~rJ"1l.. Q<(.ALI rc,( ~11....s.....jPP"c) ,JOl .JC ......../~/...:J; () Attach additional sheets if necessary 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. D D ~ Yes No Not APlable . M~L- 4-ttl'J! N 4> €;:- t: ($c, D,.! -<;"'~L't. GD~T""'L.- t=",.d $ JJu.'b. L,K~ /I.~/r"'7... . , a'CD4"~.s.,....L.~S ,';c.l.""~"'<; .J .IJ" "r.I.A"/1JS , 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. DYes D No~otAPplicable ~o E~F;ccl 0..1 AliJ &.c."'~/7d Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See L WRP Section III - Policies; Pages 34 through 38 for evaluation criteria. DYes D No [2(Not Applicable .J,,-,- ~~ tI<D ir:~~~I-r-.f>"; ~!v'/~HS'A/I nc~ S..L./:II LJ"'-rr '1/A;6_ __0.....$ ~ __ _*,.k-_~ 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 L WRP Section 111- Policies; Pages 38 through 46 for evaluation criteria. DYeD No ~ot Applicable "/D 7u.4t1-4e.... L'#A/r>S ,,J V4DLII#JJ . Attach additional sheets if necessary . WORKING COAST POLICIAt . Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See L WRP Section 111- Policies; Pages 47 through 56 for evaluation criteria. DYes D NOg-Not Applicable .z:r F'J!"c.,- ~ J".--~... J).!:.P.E,.jJ) L,J., t-e-C;'" ( Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See L WRP Section III - Policies; Pages 57 through 62 for evaluation criteria. DYes D No ~ot Applicable d:>.~~:'-- iI.1:=Fg;c."Aolf ?IJ"-r <D~ tr"C.f.l.CI SCS-'-,e',,) Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See L WRP Section III - Policies; Pages 62 through 65 for evaluation criteria. DYes D No ~ot Applicable ";OAq.2./a."'-L."~1f'- I.-Adb:f ,,j ./ICIII/Jr(f' 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. DYes D No ~~~t~APp,~iAc)ac.b~......~.... ~(1", "^'__ ~~- ,,;L ~rt!.2";f-$iL E"N'tr..i4tf Ne.~bS elZ.. (2.1_9C,,1..Il.c../L S PREPARED BY OECI2 G$- J../ j( CC-# TITLE A~~, DATE I tl? /"8'" 4Itoard of Trustees APPlicat~ ./ County of Suffolk State of New Yark G~D(2C,e-.J /;~~/4~~-i, 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 illS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN 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 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 TillS APPLICATION. ,~ 19nature SWORN TO BEFORE ME TillS 0 9 , DAYOF ..II"),./' ,20Effr CONSTANCE SZVMCZAK NaIary Public, State 01 New YOIIl No.Q1 SZ812S618 QuallWiII SUfloIIt CounlY_ ComIr'il'-lI ixlII*AId '1._ ~ard of TrusteesAPPlicat~ AUTHORIZATION (where the applicant is not the owner) ... I, HI-Be:a.r J!~c,J1: (print owner property) residing at 1..2 I2"Jt,,/ ;:;, (mailing address) J i!,) ,J~ DI! -;:),}. It. N c!J /1 () Jo do hereby authorize (Agent) ~E.oI29E. ;J J! oc.f/ to apply for permit(s) from the Southold Board of Town Trustees on my behalf. 8 . . APPLICANT/AGENTIREPRESENTATIVE 0' TRANSACTIONAL DISCLOSURE FORM The Town ofSoutbold's Code of Ethics nrohibits conflicts of interest on the Dart of town officers and emolovees. The DUroose of this fonn is to orovide information which can alert the town ofoossible conflicts of interest and allow it to take whatever action is necessarY to avoid same. YOUR NAME: (Last name, first nam iddle initial. unless you are applying in the name of someone else or other entity, such as a company. Ifsa, indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Variance Change of Zone Approval of plat Exemption from plat or official map Other (If "Other", name the activity.) Building Trustee Coastal Erosion Mooring Planning ./ ,/ Do you personally (or through your company, spouse, sibling, paren~ or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage. or bus'iness 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 ~n officer or employee owns more than 5% of the shares. YES _ NO /' If you answered "YES", complete the balance of this fonn and date and sign where indicated. Name of person employed by the Town of Southold (.. .1' ~I".!N 1 +- 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) andlor describe in the space provided. The town officer or employee or his or her spouse, sibling, paren~ or child is (check all that apply): _A) the owner of greater than 5% of the shares of the corporate stock of the applic~t (when the applicant is a corporation); _B) the legal or beneficial own~r of any interest in a non-corporate entity (when the applicant is not a corporation); _C) an officer, director, partner, or employee of the applicant; or _D) the actual applicant. DESCRIPTION OF RELATIONSHIP ~~:n:;~:~ay;q~ PrmtName - z::: d 200 l? Form TS I . . Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD OTHER POSSIBLE AGENCIES YOU MIGHT HAVE TO APPLY TO N.Y.S. Dept. of Environmental Conservation (DEC) SUNY, Bldg. 40 Stony Brook, NY 11790-2356 (631) 444-0355 Mon., Wed., Fri., 8:00 AM-3:00 PM Suffolk County Dept. of Health Services County Center Riverhead, NY 11901 852-2100 U.S. Army Corp. of Engineers New York District 26 Federal Plaza New York, NY 10278 212-264-3912 N.Y.S. Dept. of State Coastal Management 162 Washington Ave. Albany, NY 12231 518-474-6000 } . . .58-1 NOTICE OF PUBLIC HEARING .68-1 Chapter 68 NOTICE OF PUBI,IC HEARING 158-1. Providing notice or publio hearings. [HISTORY, Adopted by the Town Bo....d of the Town of SouthoJd 12.27.1995 as L.t.. NQ. 25-1995. Amend.:uents noted where applicable.) .68-1. Providing not/ce of public hearings. 'Whenever the Code calls for a public hearing, this section shall apply. Upon determining that an application is complete, the board or commission reviewing the same shall fix a time and place for a public hearing thereon. The hoard or commissi,on reviewing an application shall provide for the giving of notice: A. By causing a notice giving the time, dat.e, place and nature of the hearing to be published' in the official newspaper within the period prescribed by law. a. By requiring the applicant to erect the sign provided by the town, which shall be prominently displayed on the premises racing each public or private street which the property involved in the application abuts, giving notice of the application, the nature of the approval sought thereby and the- time and place of the public hearing thereon. The sign shall be set back not mOTe. than ten (10) feet from the property line. The sign shall be displayed for a period of not tess than seven (7) days immediately preceding the date of the public hearing. The applicant or his/her agent shall file an affidavit that s!he has complied with this provision. C. By requiring the applicant to send notice to the owners of record of every property which abuts and every property which is across from any public or private'street .~ .68-1 SOUTHOLD CODB .68-1 from the property included in the application. Such notice shall be made by certified mail, return receipt requested, posted at least seven en dllys prior to th~ da,te of the initial public hearing on the application and addressed to the owners at the addrelJse$ listed for them on the local assessment roll. The appli~t or agent shall file an affidavit that alba has complied with this provision. Survey of Property Prepared for: Suzanne Moyse Surveyed: August 2007 SCT# 1000-31-18-5 Situate: East Marion Town: Southold Suffolk County, NY Referenc.e Deed L1ber 12136 Page 334 Area = 0.21 ac.res to c.vrrent H~M l' =30' JA ;\; 2 9 20CB "U1al1tno~lzed oltvotlOf'1 or C1ddlllon to 0 $urvey ~o~:~~~~';f;n~~~~~'?o~~,~~~\.&~f't~ 0 New York; Slote EckI(.otlon Lo.... "Qr1ly c.oplei!o From the orlglnol 01 tnl& !\UI'"v"y mo-k.ed ~:~I':'~~~~;'~~r~~o5~V~~~& ~'T~~"&' "GertlflGotlOt'l& Ir\dlc.oted hereD<1 ~1<3"lfy that thl,; ~~t: r:;"t'~':t~(.; ~('~~~:h", t~~~~d by the New yO'\: stole ""&OOollon of ~O'''''''''lonol Land ""..veyori!o_ Sold C.""IIIIG-otIOf'!> &hall rvn ""Iy to the per&O" lor ....r.om the &u..-vey 1& preplXed and on hi", t::>eholf to the lllle (,O"I"\PDr1'j qovemme"- tol og"r><:.\j 0"0 Il!O"dlrlq In"tllut1on i!"ted ""reon, ono to [he o"",lo/'"e& Of tFle ''''1(.II''g "",,[Itullo... GertIIIGO- 1.lon!> 0'" 'lOt Iro.'Meroble to odnll1onol In&lIt"I'''''", N w-t--E S \ \ \ \0 't- ~ 1,. _/\9,~ \ \~ _ !;I\:1> ~ _/1-0 ~ ls- \?-,,:>!>' ., \ -::;:::~- ~, ~/~;~~ ?~" ~~/ \, ~~ ,~~ r/ ~- '\ /~4> 0 " r:r- - ~ \, ....0' ~ '\_ 0'l>- <Q'l>- ,.., -", v<\ \9<,,: ' ~ , ~o" ~ ,;;o~ i;q; .(pV (i'~ ~" yl ? '<I' ~O" // .~.{X ""~/ 1"" .;/ ROBERT H. FOX NYS PLS# 50197 PO BOX # 366 AQUEBOGUE NY 11931 631-722-3390 a.12bI200' q,OI,:;'BAM C'\Sl,M\mo.j!>elp~o Survey of Property Prepared for: Suzanne Moyse Surveyed: August 2007 SCT# 100Q-31-18-5 Situate: East Marion Town: Southold Suffolk County, NY Reference Deed L1ber 12136 Page 334 Area = 0.21 acres to current HJAlM N w+e s f5)~~~~\YJ~~ ln1 JAN - 9 2008 IldJ '60 , --rl~ ,,6 , ........:?1' ,:,~<;J \0 ,/ ~ \9,\ ~ . ~~ ". ~ 't;. " \ ~ ~ ls- l' = 30' -.:;.-:';;::::-:l.. r /.0" ~ a ?, ---=-==- ~ j~~ /.>? ,7 \. ~ ~c9.y:7 ':'\ ""~./ ~ -c' /:7~ 'S. ,7", ,'" //:tt."J '(. ~~"S' ^ 0 '/qr- . ,- .. '(.0'-\ \. 0'b- ~'b- ~ . """,\ 'l,' ~ . APPROVED [, r.\ ~\ i! ---, I ! BOARD OF TRlL) , TOWN OF soun:c DATE~?~/t7 e ~~b "l..01outhorlZecl olte.--otlOt'l or ddltlC&"tO 0 'Wrve~ .J' '_', mop ~crl~ 0 Il<;.en_d Ion" S<Jf"""lIOr'~ ~eol I~ 0 .~.______ _ \ YlQlatlon of ~ealon 120G1. "'1b-dlvlf,l"" 2. of tke Ne... York state Educ.atlon La..... "Only c.oples From the original of this ~V~ marked ::~,~~'~hO~~~r~~~Q~~~~St~i~dk!l"" 'Gl!Wtlflc.ot~ It'ldk..oted hereon "IglIF~ thot th~ sur"",:! ..os pre~ed In oc.c.or00lX.6 ...1t!'1 the ex. ~~" ~ ~~rk ~~e ~;"'~~o~7e~o?:~~' Lor'Id ~"'''yors, Sold c.ertlflc.otlom. ~hall "m onl,:! to the perr.on for "hom the ~","ve,:! I~ prepareCl i~ICl o;~~ ~~:~~lnth~~I~II~t:;,':t'~~d ~~:~~~~ to the o~~lgnee~ of t~ lenCling In~tit"t1on. Gerllflc.o- tlon~ ore not tr~ferOble to Oddltlonol In~tltutlon., '\ \ ROBERT H, FOX NYS PLS# 50197 PO BOX # 366 AQUEBOGUE NY 11931 631.722-3390 Q/2f:;,12001 Q,OI.53AM ,-'.'''-' M\m"'.~o"~~