HomeMy WebLinkAboutAroniadis, Nick-WithdrawnEN- CONSULTANTS, INC.
ENVIRONMENTAL SERVICES
June 30, 1998
1329 North Sea Road
Southampton, New York 11968
516-283-6360
Fax: 516-283-6136
E-mail: encon @ peconic.net
L.[QWN OF SoU.__THO L[
Matthew R. Penski
New York State Department of
Environmental Conservation
Division of Environmental Permits
SUNY, Building 40
Stony Brook, NY 11790-2356
RE: NICK ARONIADIS #1-4738-01126/00003
Dear Mr. Penski:
Please be advised that at this time, Mr. Aroniadis wishes us to withdraw his application
without prejudice. By copy of this letter, we are advising the Department of the Army and
Southold Trustees of the same.
Respectfully yours, ~
Robert E. Herrmarm
Coastal Management Specialist
REH:In
Cc: Sophie Ettinger #98-08010-L2
A1 Krupski, Southold Trustees
]'_OWN OF SOUTHOI D
John C Miller
611 Westfleld Ave.
Westfield, NJ 07090
July 23, 1998
Albert J. Krupski, President
Board of Town Trustees
Town of Southold
53095 Main Road
Southold, NY 11971
Dear Mr. Krupski:
This letter concerns the application for proposed pilings and boat lift in Long Island Sound offthe
residential property of Mr. Nickolas Aroniadis at 1090 Latham Lane, Orient in the Land's
End development.
As owners of the lot adjacent to Mr Aroniadis' we have reviewed the application and request denial for
the following reasons:
1. Potential hazards of damage and injury to adjoining propeffies due to history of heavy inflows of surf,
and waterborne debris, including large tree trunks (often more than 80' in length and over 2' in diameter)
during storms. These would break up boat lift.
2. Damag'mg environmental changes to surrounding beaches and shore line due to potential alteration of
the existing natural tidal water patterns which would be threatened by the introduction of the pilings and
boat lift structure, and the resultant erosion.
3. There is no need for a private boat lift in this residential area -- there is a substantial marina with boat
crane in the immediate area, less than a third of a mile from the applicant's home.
4. The negative result of introducing a new, foreign structure and suspended boat 80 to 120' offshore will
severly damage the present pristine natural scenic value of the area.
5. The proposed boat lift and suspended boat would cause injury to the existing natural water and shore
views of all other Land's End waterfront property owners, specifically Lots 1, 2, 3, 4, and 5. In addition,
the scenic views of most other Land's End owners who have built homes with special 2nd story living
rooms to obtain the area's exceptional water views of the Sound.
Please feel free to contact me (908)317-0747
Land's End Property Owners Assn.
PO Box 57, Orient, NY 11957
Albert J. Krupski, President
Board of Town Trustees
Town of Southold
53095 Main Road
Southold, NY 11971
Dear Mr. Krupski:
June 23, 1998
I'OWN 01: SOUIHO[D,
This letter concerns the application for proposed pilings and
boat lift in Long Island Sound off the residential property of
Mr. Nickolas Aroniadis at 1090 Latham Lane, Orient in the Land's
End development. Hearing is scheduled for June 24.
We have reviewed the application and request denial for the
following reasons~
1. Potential hazards of damage and injury to adjoining properties
due to history of heavy inflows of surf, and waterborne debris,
including large tree trunks (often more than 80' in length and
over 2' in diameter) during storms. These would break up boat lift.
2. Damaging environmental changes to surrounding beaches and shore
line due to potential alteration of the existing natural tidal
water patterns which would be threatened by the introduction of
'the pilings and boat lift structure, and the resultant erosion.
3. There is no need for a private boat lift in this residential
area -- there is a substantial marina with boat crane in the immed-
iate area, less than a third of a mile from the applicant's home.
4. The negative result of introducing a new, foreign structure
and suspended boat 80 to 120' offshore will severly damage the
present pristine natural scenic value of the area.
5. The proposed boat lift and suspended boat would cause injury
to the existing natural water and shore views of all other Land's
End waterfront property owners, specifically Lots 1, 2, 3, 4, and 5.
In addition, the scenic views of most other Land's End owners who
have built homes with special 2nd story living rooms to obtain the
area's exceptional water views of the Sound.
Please feel free to contact me,
(516)323-1352.
or Vice-President Charlie Murrin,
Sincerely yours,
William ~.-Bo!cl_h~rt, President
Board of Trustees
Town of Southold
53095 Main Road
Southold, NY 11971
Ruth Boylhart
1370 Latham Lane
Orient, NY 11957
6-22-98
Dear Board of Trustees:
As I will be unable to attend the Hearing regarding the applic-
ation of Mr. N. Aroniadis of Latham Lane, Orient, for a boat
Lift to be installed on his residential property I send this
letter.
I live one lot away from the property in question, on the water-
front, in the Land's End community and have owned my home for 16
years plus. Consequentially I am well aware that the beach is
fragile and must be protected.
Awhile back Mr. Aroniadis received a permit to install a long,
wide steel ramp on his property to facilitate launching his 28
foot boat from his property. This ramp extends across his lawn,
down the bluff and quite a way onto the beach.
Now this neighbor is requesting yet another permit to erect a
boat Lift in the same area. All other properties in this community
are residential only, and no other owner has extended construction
onto the beach.
The adjacent lots to his property, numbers 5 and 7, are both still
unbuilt -- so these owners may not yet be aware of the noise and
visual encroachment threatened by the boat lift,and on property values.
Land's End is a quiet, cooperative neighborhood and we would like
to keep it that way without introducing special privileges not to
be found in a strictly residential community.
Mr. Aroniadis must be aware that about 1/3 of a mile from his home
is a fully equipped marina--surely able to handle his boating needs.
So it is hardly necessary that he install a Lift, nor is it necessary
to park his large boat on the beach.for the summer months.
Thank you for your consideration.
Sincerely yours,
(Mrs.)Ruth Boylhart
EN- CONSULTANTS, INC.
1329 North Sea Road
Southampton, New York 11968
516-283-6360
Fax: 516-283-6136
E-maih encon @ peconic.net
ENVIRONMENTALSERVICES
June 19, 1998
Town of Southold
Board of Trustees
Post Office Box 1179
Southold, New York 11971
Atm.: Jill Doherty
TOWN OF SOUTHOLDi
Nick Aroniadis
1090 Latham Lane, Orient
SCTM #1000-15-9-1.6
Dear Ms. Doherty:
In response to our telephone discussion of Juno 17, 1998 regarding the above referenced, enclosed are:
Three (3) Coastal Erosion Application Data forms, and
Application fee of $50.00.
Should any additional information be required, please do not hesitate to contact our office.
Sincerely,
Robert E. Hemmmn
Coastal Management Specialist
/khs
COASTAL EROSION APPLICATION DATA
Purposes of proposed activity: Private boat dockage.
Are
X No Yes
Does the project involve excavation or filling?
X No Yes
If Yes, how much material will be excavated? n/a
How much material will be filled? n/a
Manner
wetlands present within 75 feet of the proposed activity?
(cubic yards)
(cubic yards)
in which material will be removed or deposited:
n/a
Describe the nature and extent of the enviroranental impacts
reasonably anticipated resulting from implementation of the
project as proposed. (Use attachments if necessary)
The project consists only of the installation of (8) pilings
and will not have any adverse effects on Town waters. There
are no vegetated wetlands on the property.
Bo~ ~ of Trustees Application
COASTAL EROSION APPLICATION DATA
Purposes of proposed activity:
X
Does
X
Are wetlands present within 75 feet of the proposed activity?
No Yes
the project involve excavation or filling?
No Yes
If Yes, how much material will be excavated?
How much material will be filled? n/a
n/a (cubic yards)
(cubic yards)
Manner in which material will be removed or deposited:
n/a
Describe the nature and extent of the environmental impacts
reasonably anticipated resulting from implementation of the
project as proposed. (Use attachments if necessary)
The project consists only of the installation of (8) pilings
and will not have any adverse effects on Town waters. There
are no vegetated wetlands on the property.
4
Albert J. Krupski, President
James King, Vice-President
Henry Smith
Arkie Foster
Ken Poliwoda
Town Hall
53095 Main Road
P.O. Box 1179
Southold, New York 11971
Telephone (516) 765-1882
Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
BOARD OF TRUSTEES: TOWN OF SOUTHOLD
In the Matter of the Application
of
__ _~_ _~_~_ _~___~:_~_~_ _~ _~A_ ~% .............
COUNTY OF SUFFOLK)
STATE OF NEW YORK)
AFFIDAVIT OF POSTING
,,c.
, '~90 IdftDTLi ec~
I ~ , residing at ] ............... ~9.
SOUTHAMPTON, N.Y. 119~
being duly sworn, depose and say: 516-283-6360
That on the ]~ay of 3~, 199% I personally posted the
property known as /~O ~ ~
by placing the Board 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 seven days prior to the date of t~
public hearing. (date of hearing noted thereon to be held~
Dated:
Sworn to befqre me this
~ ~day of~<~C~ 199
~-ot<a ~ y Public
~ Commiss~n N.. ~1~1
c~
EN- CONSULTANTS, INC.
1329 North Sea Road
Southampton, New York 11968
516-283-6360
Fax: 516-283-6136
E-mail: encon@peconic.net
ENVIRONMENTAL SERVICES
June 12, 1998
Town o£ Sonthold
Board of Trustees
Post Office Box 1179
Southold, New York 11971
Attn.: Jill Doherty
Nick Aromadis
1090 Latham Lane, Orient
SCTM ~1000-t5-9-1.6
Dear Ms. Doherty:
In regard to the above referenced property, enclosed are the following for the Board of Trustees review:
3.
4.
5.
6.
7.
Three O) Wetland Permit Applications,
( including Notice and Proof of Mailing to adjacent owners).
Three O) Short Environmental Assessment Forms.
Three O) copies of authorization & disclosure forms.
Three O) work plans.
Three (3) copies of survey.
One (1) set of site photographs.
Application fee of $150.00.
I trust this information shall allow you to process our request for a Wetlands Permit. Should any
additional information be required, please do not hesitate to contact our office.
Coastal Management Specialist
/kbs
NICK ARONIADIS
l~igure 1, lxaolting north~tst over long Island ~ound at site of proposed boat lift.
Figure Z Looking southwest toward upland propertyfrom shorelln~
FROM : ENCONSULTRNTS, INC.
PHONE NO. : 516~836136
EN- CONSULTANTS, INC.
ENVIRONMENTAL SERVICES
Jun. 03 1998 05:27PM P1
1329 Nor',h Sea Road
Scothampto~, New Yon~ 11~
51
F~: 51~2~1~
E-m~l:
Ju~e 4, 1998
Mrs. lill Doherty
Board of Trustees
Town of Southold
53095 Main Road
Southold, NY 11971
FAX M'F.~O RE: NICK ARONIADIS. ORIENT
TOWN OF SOUTHOLD
Dear lill:
This morning you should receive via FedEx a wetland application for Joseph and loan Chisholm
Unfortunately, however, we were unable to include our wetland application for Nick Aroniadis,
because we have not yet received a copy of his survey or his si~ned authorization forms. He has
assured us that we will receive these next week, as he is in a rash to.obtain his permits. Thus,
would you kindly publish the following project d __e~,'ption, as I will submit the ap_,plication by
the end of next week, in plenty of time for the Board s filed in~pectious on the 1
PROJECT,DESCRIFrlON: Install (S) 10" diameter pilings (4 pairs of dolphin piles) to
support 16' x 20' boat Iht approximately 120' seaward of ~xisti~ rock revetment.
Applicant: Nick Aroniadis
Loc~on: 1090 Lathem Lane, Orient (Long Lsland Sound)
SCTIV[: 1000-15-9-1.6
Please let me know if this is a problem and if not, thanks as always.
Sincefel~
Coastal Management Specialist
Albert J. Krupski. President
~ohn Holzapfel, Vice President
Jim King
Martin H. Gm-tell
Peter Wenczel
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall
53095 Main Road
P.O. Box 1179
Southold, New York 11971
Telephone (516) 765 - 1892
Fax (516) 765-1823
Office Use Only
Permit Application
Grandfather Permit Application
/~___Waiver/Amendment/Changes
Received Application:
~-Received Fee:$/50_
~-~ompleted Application~_~j~_
L~-Incomplete
SEQRA Classification:
Type I Type II Unlisted
Coordination:(date sent)
CAC Referral Sent: ~-~--~
Date of Inspection:
Receipt of CAC Report:
Lead Agency Determination:
Technical Review:
__Public Hearing Held:
__Resolution:
JUN I T 199
TOWN OF SOUTHOLD
Name of Applicant
Address
Nick Aroniadis
c/o NPA Systems, Inc.
761 Coates Avenue, Holbrook,
NY 11741
Phone Number:Ol6 ) 467-2500
Suffolk County Tax Map Number: 1000 15-9-1.6
Property Location: 1090 Latham Lane, Orient
(provide LILCO Pole #, distance to cross streets, and location)
AGENT: En-Consultants, Inc.
(If applicable)
1329 North Sea Road
Address: Southampton, New York 11968
Phone: 516-283-6360
FAX%: 516-283-6136
Board of Trustees Application
Land Area (in square
Area Zoning:
GENERAL DATA
feet): 43,921
R-40
Previous use of property:
intended use of property:
residential
no change
Prior permits/approvals for
Agency
DEC #1-4738-01126
Trustees #4476
site improvements:
Date
5/17/95; amendment 5/28/96
6/29/9~ amendment - 8/01/96
__ No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspended by a
governmental agency?
x No Yes
If yes, provide explanation:
Project Description (use attachments if necessary):
Install {8) 10" diameter pilings to support 16' x 20' boat lift.
Pilings will be arranged as (4) pairs of dolphin pilings.
~oard of Trustees ApplicatiOn
WETLAND/TRUSTkU~ LANDS A~PLICATION DATA
Purpose of the proposed operations: private boat dockaqe
Area of wetlands on lot: 0 .square feet
Percent coverage of lot: 0 %
Closest distance between nearest existing structure and upland
edge of wetlands: n/a feet
Closest distance between nearest proposed structure and upland
edge of wetlands: n/a feet
Does the project involve excavation or filling?
~ No Yes
If yes, how much material will be
How much material will be filled?
excavated? n/a cubic yards
cubic yards
n/a
Depth of which material will be removed or deposited:
feet
Proposed slope throughout the area of operations:
Manner
n/a
in which material will be removed or deposited: n/a
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):
The project consists only of the installation of (8) pilings
and will not have any adverse effects on Town waters. There
are no vegetated wetlands on the property.
14-16-4 (2187)--Text 12
PROJECT I.D. NUMBER I 61 7.21
I
Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART I--PROJECT INFORMATION (To be completed by Applicant or Project sponsor)
SEQR
1 . APPLICANT/SPONSOR ~I~CK .M~ONIA~IS BY I 2. PROJECT NAME
EN-CONSULTANTS, INC.
I
3. PROJECT LOCATION:
Municipality SOUTHOLD County SUFFOLK
4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map)
1090 LATHAM LANE, ORIENT, NY - SCTM ~1 000-.].5-9-1 . 6
5. IS PROPOSED ACTION:
[] New [] Expa.sion [] Modlfi~ation/a ,eration
6. DESCRIBE PROJECT BRIEFLY:
iNSTALL (8) 10" DIAMETER PILINGS TO SUPPORT 16' X 20' BOAT LIFT. PILINGS WILL BE ARILAN'GED AS (4) PAIRS
:)F DOLPHIN PILINGS.
7. AMOUNT OF LAND AFFECTED:
Initially 43,921 S.F. acres Ultimately 43,921 S.F. acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
[]Yes [] No If No, describe briefly
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
[] Residential [] Industrial [] Commercial [] Agricultu~'e [] Park/Fo,est/Open apace [] Other
Describe:
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL,
STATE OR LOCAL)?
[] Yes [] No If yes, list agency(s) and permit/approvals
DEC, cee & DOS
1 I. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
[]Yes [] No If yes, list agency name and permit/approval
12. AS A RESULT OF PROPOSED AC33ON WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION?
[]Y- [].o
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Signature: /N.~-~ v ~-- ~
If the action is in the Coastal Area, and you are a state agency, complete the
Coastal Assessment Form before proceeding with this assessment
OVER
LONGISLAND SOUND
1. Purpose: P~iv~te bo~t dockege
2. I~tum: ALW
3. Timbe~ piles to be CCA-treoted
4. Piles to be arranged in (4) p~irs
of dolphin pilings to support
[6' x 20' bo~t lift
5. Site: [090 Lm~om L~ne, Orient;
5CTM #1000-15-9-1.6 EH-CONSULTANTS INC.
6. Adjacent Owners: 1329 NORTH SEA RD.
[ - Miller SOUTHAMPTON, N.Y. 1]968
2 - N~onis 516-283-6360
On,-
PROPOSED PILINGS/BOAT
LIFT FOR NICK ARONIADIS
ON LONG ISLAND SOUND,
ORIENT, SUFFOLK CO., NY
SHEET I OF I 6/9/98
NOTICE TO .~]DJACENT PROPERTY OWNER
BOA_RD OF ~RUSTEES, TOWN OF SOUTHOLD
In the matter of Nick Aroniadis
SCTM~1000- 15-9-1.6
YOU ARE HEREBY GIVEN NOTICE:
!. That it is the intention of the undersigned to request a
Permit from the Board of Trustees to: Install (8) 10" diameter
pilings to support 16' x 20' boat lift. Pilings will be arranged
as (4) pairs of dolphin pilinqs.
2. That the property which is the subject Environmental Review
is located adjacent to your property and is described as
follows: 1090 Latham Lane, Orient
3. That the property which is subject to Environmental Review
under Chapters 32,37,or 97 of the Town Code is open to public
comment. You may contact the Trustees Office at 765-1892 or in
writing.
The above referenced proposal is under review of the Board of
Trustees of the Town of Southold and dose not reference any
other adjacent that might have to review same proposal.
OWNERS NAME: Nick Aroniadis
MAILING ADDRESS: c/o NPA Systems, Inc.
761 Coates Avenue, HolbrooK, NY 11741
PHONE ~: 516-467-~b0u
Enc.: Copy of sketch or plan showing proposal for you~
convenience.
christine &
j. Miller
AddreSS:
580 Thames Street, Suite 208
Newport, RI 02840
Thomas Manis
47 vanderlyn Drive
Manhasset, NY 11030
STATE OF NEW yORK
CoUnTY OF SUFFOLK En-ConsultantS, Inc.
doing business
~ at 1329 North Sea Road,
Robert E. Herrmann .,
~ntb~mpton. NY ., bein~ duly s~orn, deposes and says
that on the 12th day o~ June ,19 98., deponent mailed
a true copy o~ t~e Notica~Set ~orth in the Board o~ Trustees
Application, directed to each of the above named persons at the
addresses set opposite there respective names; that the
addresses set opposite the names o~ said persons are the address
Town of $outhold; t~at
· Southampton , that said Notices
States post Office. at
were mailed to each
mail.
Robert-"E. Her~nn
Sworn to before me t~hi~so8!2th
da~ of June , =~ ~
7d of Trustees Applicati
Councy of Suffolk
State of New York
~EING DULY SWOP~N
DEPOSES AND AFwIRMs THAT HE/SHE IS Tn~ APPLICANT FOR THE ABOVE
DESCRIBED PERMIT(S) AND THAT ALL STAT~mIENTs CONTAINED ~IN ARE
TRUE TO ~ BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL
WORK WILL BE DONE IN THE MANNER SET FORTH IN T~IS APPLICATION
A~rD AS MAY BE APPROVED BY u'~,: SOU~£~OLD TOWN BOARD OF TRUSTEEs.
THE APPLICANT AGREEs TO HOLD ~ TOWN OF SOUTHOLD AND ~ TOWN
TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS
~RISING UIq~ER OR BY VIRTUE OF SAID PERMIT(s), IF GRARTklD. IN
COMPLETING THIS APPLICATION, I HE~Y AUTHORIZE THE TRUSTEES
THEIR AGENT(S) OR P~EPHESENTATIVES{~), TO ENT~ '
TO INSPECT T~E PRF/~ISES IN CONJUNui£ON WITH K
APPLICATION.
Signa' ur~
SWOR/~ TO BEFORE ME THiS DAY OF ~/~
,JAY G. SOUCIE
No. 4947878
C Qualified in Suffolk Coun~ 61 ~
ommiselofl r=~flms Fetwuary 27. 19_1. ~
¥ Pubi-c
· ONTO MY PROPERTY
,VIEW OF THIS
~rd of Trustees ApPlicat~
AUTHORIZATION
(where the applicant is not'the owner)
~C~ ~_~3~ residing at ~O~o ~~
{print owner of property) ' {mailing address)
Southold Bi
(Owner
( Agent )
to apply for permit(s) from the
~rd of Town Trustees on my behalf.
s I~gnature )
PROOF OF MAILING OF NOTICE
ATTACH CERTIFIED MAIL RECEIPTS
Name: Address:
Christine & J. Miller
580 Thames Street, Suite 208
Newport, RI 02840
Thomas Manis
47 Vanderlyn Drive
Manhasset, NY 11030
STATE OF NEW YORK
COUNTY OF SUFFOLK
Robert E. Herrmann doing business En-Consultants, Inc.
, ~~ at 1329 North Sea Road,
Sol~hmmpton. NY , being duly sworn, deposes and says
that on the 12th day of June ,19 98 , deponent mailed
a true copy of the Notice set forth in the Board of Trustees
Application, directed to each of the above named persons at the
addresses set opposite there respective names; that the
addresses set opposite the names of said persons are the address
of said persons as shown on the current assessment roll of the
Town of Sou=hold; that said No~ices were mailed at the United
States Post O~fice at Southampton , that said Notices
were mailed to each of said persons by
mail.
Robert~E. Her~ann
Sworn to before me this 12th
day of June ,19 98
Z 119 591 940
US Postal Service
Receipt for Certified Mail
No Insurance Coverage Provided.
Do not use for Intemational Mail (See reverse
St et & Number
P Office, State, & ZI~ Code
~?~" '~.c~ £
Z 119 591 939
US Posta~ Service
Receipt for Certified Mail
No Insurance Coverage Provided.
Do not use for international Mail (See reverse
Street & N mber
Post Office, Slate, & ZIP Code
Postage $ . ,~,~
TOTAL Potage & F~s $ ~. ~ ~
P~tma~ or Date
APPLICANT
TRANSACTIONAL DISCLOSURR FORH
Tile Town of Southold's Code of Ethics prohibits conflicts of
interest on tile part of town officers and employees. Tile
purpose of this form is to provide information which cai,
alert the town of possible conflicts of interest and
it to take whatever action is necessary to avoid same.
YOUR
(Last name, first name, middle initial, unlees
you are applying in the name of someone else or
other entity, such as a company. If sa, indicste
the other person's or company's name.)
NATURE OF APPLICATIONs (Check all that apply.)
Tax grievance
Variance
Change of zone'
Approval Of plat
E~emption from p~a,t o~ official map
other
(If "Other," name] t~e activity.)
!
employee of tit8 Town of Sou~hold7 'Rgiutionship* include,
inter,st' m~ans a busin~ss, inuludin~ a partnership, in
o~nerehip of (or employment by) a corporation In which
the town officer or employee o~n. mot9 than 5~ og the
NO
If you answered 'yES,#complete the balance of this form and
,late and sign where indicated.
r~ame of person employed by the Town of Southold
Title or position of that person
Describe the relationship between yourself (the applicant)
and the town officer or employee. Either check the
appropriate line A) through D) and/or de~cribe in the space
provided.
The town officer or employee or his or her spouse, sibling,
parent, or child is (check all that apply)l
A) the owner of greater than 5% of the shares of the
corporate stock of bite applicant (when the applicant
is a corporabion)l
__.B) the legal or beneficial owner of any interest is a
noncorporate'entity (when the applicant is not a
corporatton)~
C) an officer, director, partner, or employee of the
applicenbl or
__D) tile actual applicant.
DESCRIPTION OF RELATIONSIIIP