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Home My WebLink AboutTR-6847A . . 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 SOUTH OLD 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 L 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 Southdld, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 6847A Date of Receipt of Application: April 10, 2008 Applicant: Dennis & Rita Gallagher SCTM#: 87-3-40 Project Location: 3140 Minnehaha Boulevard, South old Date of Resolution/Issuance: April 16, 2008 Date of Expiration: April 16, 2010 Reviewed by: Board of Trustees Project Description: Abandon the existing septic system on the seaward side of the dwelling and install a new septic system further landward. 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 site plan prepared by Stanley F. Skrezec, and received on April 10, 2008. Special Conditions: None. Inspections: Final inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the South old Town Code, a Wetland Permit will be required. This is not a determination from any other agency. ro<~ 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: U-on(" {"Rl~ Go..ll~3h<"'f Please be advised that your application dated {-}-PO ~Ol dOO~ has been reviewed by this Board at the regular me~ of to'1 } t'o /<;).~ and your application has been approved pending the c'o pletion 6f 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) _/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: c:~ TOTAL FEES DUE: $ J () BY: James F. King, President Board of Trustees , 'I Ii .:./ I , i i I I I I , : <) , I 1 +-- ul~ f> "WS' 01> oil Iii I'>'j i I I I I ' t . ... . : c;tJlll() I i "~~rH"I~~~'1 ' " , ----L- ' ! I I I I }t\~ olhll I I I I i_I 4~hi I I I I , I i I - .1 i . I I , b\ . , ~! U . c, '~.' t- x t; . \ . C> I l~ <><< ~ L-, F . ,.~=-,-,. . ,. ~,","_, . ....-. '> ./"'f' / ~. 0'<1; ( ~ ~~'<I; ';0 _......",.".,,'--~"_.._,...-.-"< ," :~"; -If ~-~..--- 'c..... ,':> >~~:rr-" ~e r '. .. , '0> ."" '0 ~ .'}..~ "-" .; ,\:-u':; ~ :"..."'y.~ fe ~. ,': " .~ ~ i, I r ;t' r . '-',.. ,.',' ....-..,...;.... :'-.: .i::~ ;:' , . Q!' ~'i'f)I!.' i~ III lZ".~:j_,..,-'~~,}j)fjt$_~~:~~,.-r_:.., S 11 . ,'~~,r . ,,1::,' .,-,C',','_"" ._-.."""'.,..~-.-"..~^->~:.., .-....;'.::.:--'~"'.....'..::-'::-:"'"";.~ <""":'~' :"~:-:..,.:,<~:-.~"f,.'-?>7.~!.::_,;:i SURV~TgITE~RA~PaJiTY ) ,:i LAUGHING WATER ' :i:'~'f TOWN OF SOUTHQ~O . " Tf0jf~ SUFFOLK COUNTY, NEW YORK ,,":;;:1; .. , " .... - .. '.',. .. 'j,(,;~~ S.C. TAX NQ. 10?Q-~7-03r40;::~~ seAU: 1 =ZO , ".[3' SEPTEM,IIER 4, 1998 ,.?,! ,~., '~},i$~ .. ,>-,,:::;:~:ift! "~ ;/::~~0'~ , ~~,jI 't.'i!i A1lEA = 8,491.71 .... fl. rro TIE uNE) 6.195 OQ. CERTIFiED TO: fi;CPNIC ASSTR,t,CT mLE No. B(1-S~~6 A!!TOI!lAPEpKR~ SAVlIIGS AN\!> LOAN . D[NNf$ GAu.AGfI!:R . RrTA CALUGHER ' JosePhA, , Land sur' TlbII~ -SubdMaion8'....,.. SitlfPklnI-.-.-qo PHONE (51"6.)727-~ CI'f'J~l.DC'.lED'AT -+- , j ,""~ . f\\, I ' ,/ I' Ii ,/ 'I ~ Ii /&1/ Ii ~~ , . -- .----i;' I~/ .~.. if , , i ""' !lEC/( ,q ~~ I I, I' ---~. :.::::: -- . , " " ,/ 'I I, ~ I ~ 'r ~I + L "-"~~,,. + '- - G __,,,,,,,.,,,. E,_,..... ~,_.- ...."""'~~ [211 .....---- o -"~";'~ "...."",0. ,.~..."'''''' -"""-'~ "',...,,'w ..."""',m -"""'~ "......."..". *-...".,". -"',... '::{'" .,.~..;'." ~ " ""'-------"----- ' " _~'H"~~:~:~ ::':;;'" ~,';';,.... NOTICE ....T[""""',"-T..'T:l~'O;""" :~:ErJ::~;~2 ':~:" CO''''TY OF SUFFOLK CD (i) UI. T ServIce Aqency RealPrGpertYfll~~Yll!Ol . . Can""c"":~[""",_ .. -'" SOUTHOLD SECTION NO &.. 087 12.1 '''.,,~; :,~~. ",fII::'IOl 1000 PROPERTYI.lH' . ~ OFFICE WCATION: l~all Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold, NY MAIUNG ADDRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631 765-1938 Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM COORDINATOR TOWN OF SOUTH OLD MEMORANDUM ~ ~ A~R ~ 61 2:~ ~ ~ To: James King, President Town of South old Board of Trustey Mark Terry, Principal Planner ~ L WRP Coordinator Southhold Town Board of Trustees From: Date: April 16, 2008 Re: Request for Wetland Permit for DENNIS & RITA GALLAGHER SCTM# 87-3-40 Stanley Skrezec on behalf of DENNIS & RITA GALLAGHER requests an Administrative Permit to abandon the existing septic system on the seaward side of the dwelling and install a new septic system further landward. Located: 3140 Minnehaha Blvd., Southold. SCTM#87-3-40 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 CONSISTENT with the below Policy Standards and therefore is CONSISTENT with the LWRP. Pursuant to Chapter 268 the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. " . . James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob linusio, 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 Office Use Only _Coastal Erosion Permit Application _Weiland Permit Application ,/' Administrative Permit Amendmentffransfer/Extension ../Received Application:~ ~eceived Fee:$ SO / _Completed Application _Incomplete _SEQRA Classification: Type I~Type II~Unlisted_ _ Coordination:( date sent) _ L WRP Consistency Assessment Form CAC Referral Sent: ~Date ofInspection:~~l~ _Receipt of CAC Report: _Lead Agency Determination:_ Technical Review: ~blic HearingHe~ _Resolution: "1 I~. . APR 0 2008 . ..-3 l JJ,J e.-1I V Name of Applicant '" ,1 ' I {...Ie /JjV, > ... l2:!, ::I::1'\: Address ~ l 't 0 , ~fJNe..-h.A- h..... G-LLA-) ~..u- eLVi) :)ov~LO, 'V,y, , \l'11 \ Phone Number:~ 30 7S7-'?JOC,{ 03 -l.{-o Suffolk County Tax Map Number: 1000 - f$ 1 - Property Location: kAu '\lu'"" lv~) ) \ L'L to Po/,...f' y;i: I (provide LILCO Pole #, distance to cross streets, and location) AGENT: S~ley t': (If applicable) 5b G..v \.,..L ~lM.\b. ~ 3.c::..ve'2.Q c....... Address: CX~t/r- IN . Y, ll1. 'i If Phone: 19 31 -4-/7 -l~ L 1- ~oard of Trustees APPlica~n GENERAL DATA Land Area (in square feet): f; ~'71 l ( I Area Zoning: tL C":--..;- 0 12:J~ +> II L Previous use of property: f4-> ~.i O~J-II\ L Intended use of property: rCe&iflen.g j. I Covenants and Restrictions:_ Y es If "Yes", please provide copy. X No Prior permits/approvals for site improvements: Agency Date Be""", ~ <s>...f' \:Il...v<;. k e .s 01v~w --60 prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? ~No_ Yes If yes, provide explanation: Project Description (use attachments ifnecessary): A ~[)on. ""f'fl-.L.. ~y:"J..e...... (>j,0~ to tu~~ ~$,.~(,\ ~oN... ~ ~ f'N~ k~ @0<;:s;;:;k-,/e 4ItBoard of Trustees APPliCillfn WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ~e A. ~~'L \.A..J ~ . '::,Y'l:.~ c ~Ac.'-l-.\ ,"^-" '->r')V'A~ ~ '" l"'-*- -tv I' \'k ~ ihv '1. ~ Area of wetlands on lot: D o squarefeet -Bul ,?k~ .0 lo't"' Percent coverage oflot: % Closest distance between nearest existing structure and upland edge of wetlands: ~r feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? No )( Yes rfyes, how much material will be excavated? (; 0 cubic yards How much material will be filled? (O-:-If; ?w~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: ~<: ~JA"'" +- ~rtrv~ u~tatement of the effect, if any, on the wetllll1ds and tida!waters oftl1e town thatl!laxres~lt IJ)' reason of such proposed operations (use attachments if appropriate): , . PROJECT 10 NUMBER 617.20 . APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only (To be completed by Applicant or Project Sponsor) 2. PROJECT NAME SEQR PART 1 . PROJECT INFORMATION 1. APPLICANT I SPONSOR QJ'" LOCATION: Municipality County S~~\I.L 4. PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks ete _ or provide map ?, 1 ~O l-1..ie.J~e~~. ~l) ( ~)~\ ~f\.~S, So,-,~\~ 1"-' -Y. I\? 71 5. IS PROPOSED ACTION: 0 New o Expansion ~OdifiCatiOn I alteration 6. DESCRIBE PROJECT BRIEFLY: A~ ~~ .2.c..~~c>vL. &.ef~c. ~/:"~ ~. Le' kuw-. ~L~U.,^,~ \~~~<LL l\-~ r""4'~l'o.~) ...w..~\'\ Nl.W Sy~~ 1lor<,O. ~ fb-oJ, ~ ,-/Q\/r.',tH ~ ~/r('~~s cf~ ~rPorlY ~. 7. AMOUNT OF LAND AFFECT EO: Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? DYes 0 No If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY Residential D Industrial 0 Commercial OF PROJECT? (Choose as many as apply.) DAgricu,ture 0 Park I Forest I Open Space o Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) DYes 0 No If yes, list agency name and permit I approval: -11:UOES- DYes Am'ASPt:L.:1 Ur I HI:: A<.;IIUN HAVI::. A CURHI::.NILY VALID PERMIT OR D No If yes, list agency name and permit I approval: APPROVAL? 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT I APPROVAL REQUIRE MODIFICATION? Ges 0 No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant I Sponsor Name Signature ~ Date: 1ao>'e, If the 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 com Dieted bv Lead Agency) 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 0 No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? II No, a negative declaration may be superseded by another involved agency. DYes 0 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, rtential for .e~sion, drainage or flooding problems? Explain briefly: ... . :1 C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: I. .....1 C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: I .... 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: II C5. !'owth. subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: .1 C6. Long term, short term, cumulative, or other effects not identified in C1~C5? Explain briefly: l I C7. Other impacts (including ch~~~~s in use of eith~r_q~antitv ()rtyp~ of ~nergy? Explain briefly: I l D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEAl? (If yes, explain briefly: DYes 0 No I E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? DYes DNo L I Ilyes eX~lainj PART 11I- 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 (i.e. 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 )'9S, tRe determiAation ofsigniflS3RG&-fRUSl-evoll:late the poteA-tia~iffli*let.ef-#1e proposed satioR en the onyireF\R ,€:f1tal charaeter-isties-ofthe€CA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FUll EAF andlor prepare a positive declaration. Check'fhls-bo>dfyou-haviid'ErtermTned;-hased-on-flie -in-formation and analysis -above arid-any supporting documentiitioll, tlla-tille-proposed actlo- 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 Pnnt or 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) " , . Board of . Trustees Application ," County of Suffolk State of New York ~~ ~ ~~..,~c.. BEING DULY SWORN DEPOSES 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 TillS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENT ATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF TillS APPLICATION. CQ. Q ~~ :1gnature SWORN TO BEFORE ME TillS /o'f-. DAY OF QjJJb..J ,20~ ~J.U.M <fiJ. ~ HiA' N tary Public N ta LAPuURbE"N M, STANDISH o ry c, State of New York No.OlST61640OS Com Q~al!fied in ,Suffolk County miSSion Expires April 9, 204 . . ~d of ~,APPll.ca;tion ' , 'I'- AII".I......IV'tg~OK (where the appUcant is not. the owner) , L lrll 'r DENltH5 GfJLLi'lG-tfEl. ~esid' nq at-YJ 'f~ IAlAlEIfIllVl &"vp, i ' (print owner of property) ng addresll , ' . I <' ' , ' ; UOIffHd/..P. j1/EW ~tfl( Illt7( do hereby autbori'ZlJ 3m-HiE! F:S<.REr'Z;.B1. :- ,. . . . J (Agent) 1 i J i ' fouthold Board. of ~own TrUBtees on ll'IY beha.H. ; ! to appJ.y for permit(s) from the , I I I, I I I ! ! , , , i' r ~. ; J , I .." I I I i , 1 , . . ,_._ .'M._ NO __.... 'M ... _..~ __ .. ..... .._.,. M.._.._.____. " . 8 : . . APPLICANT/AGENTIREPRESEN1'ATIVE TRANSACTIONAL DISCLOSURE FORM The Town of South old's Code of Ethics orohibits conflicts of interest on the Dart arroW" officers and emolovees. The Durnose of this form is to orovide information which can alert the town of oossible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: <;S'"[l.r-I ~ ~, ~C-.,o,... (Last name, first n e,.qtiddle initial, unless yo"u are applying in the name of someone else or other entity, such as a company. Ifso, indicate the ather 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 v Do you personally (or through your company, spouse, sibling, parent, Of child) have a relationship with any officer or employee of the Town of South old? "Relationship" includes by blood, rQarriage, 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% 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 South old Title or position afthat person Describe the relationship between yourself(the applicantJagentJrepresentative) 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, ot child is (check all that apply); ~A) the owner of greater than 5% of the shares of the corporate stock of the applic~nt (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 Form TS 1 S~bmitted tb~aY of ~~ 2003: Stgnatunr ~v. ~ Print Name F..,.. .... Town 6f Southold . . 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 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. 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 deta~l. Iistine; bot~ sUllllortine; aod 000- sUllllortioe; facts. If an action cannot be certified as consistent with the L WRP policy standards and conditions, it shall not be undertaken. /'-<l 1 r>'l'C \r r \ , \~ LUI..~ 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# g 1- - C~ - l..\~ PROJECTNAME ~~~ ~~"^> ~ '~1"'~ The Application has been submitted to (check appropriate response): Town Board D Planning Board D Building Dept. D Board of Trustees ~ I. 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) D D (b) Financial assistance (e.g. grant, loan, subsidy) (c) D Permit, approval, license, certification: Nature and extent of action: . ~Dco.J I ~{-11 ~...... ~ ~\ u-. ~ ~ 1)1"' ~ -\:t- ~'S.hl ~~, ~\,~ ~cA.\~ ~~. 20<~ \Nd\~\)s;. ~,..~+ ~\\. ,... 1J<u.N ~~-\: ~'t~ -M::.~~""f'~{y ~twA..~ ...,\,\o..J. Location of action: ~"~1 Site acreage: . 31,-\0 ~U~J\ '. ~v~. AC. Y'&- Present land use: Q.. <2::::.1 ~ Irl-.. Present zoning classification: Qp~ D~~M-. 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: f4~.... ~~> ~,'wv- 1 (b) Mailing address: '"3 \ ~ C:> I.\.N.",-,,,, ~ ~ '^ I'l- ~W ~ I ~...><tt. clc:D . , kJ .If. \~"11 I (c) Telephone number: Area Code ~~ .., ~ 7 - '3.oC] I (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes D No rxr 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 'gJ Not Applicable . ~~~:: "-' ~~ ~~ ~'f~~ ~~~'t ~ ~\-\~. ~ N~ (!HJ./t \ 1'1-I'1 ~ f.w-~..., s. J\-\~ Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of South old. See L WRP Section III - Policies Pages 3 through 6 for evaluation criteria DYes D No cK1 Not Applicable ~~~lj t~~~-:~~;?~~~ ~~~5. A-'\\....u-J 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 -.k. Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See L WRP Section III - Policies Pages 8 through 16 for evaluation criteria DYes D No IZJ Not Applicable ~~-.~~~ ~f#t'''''' ~~ ' ~ ~\ \~+;- . ~L~<rZ:T- GlcI'a.R. A'c:S Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of South old. See LWRP Section III - Policies Pages 16 through 21 for evaluation criteria DYes 0 No I2SINot Applicable ~ l'fn ~oJ",..1..&\A'" \-:~ u:""'1. \'V~ I ~ Jl~ ~ ~,,<a-I....<:>f........J-~ ~&o..O<i\.-. *~~~~~...:~~ 't.:: ~;"~:.i~::.":'-"'> 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 L WRP Section III - Policies; Pages 22 through 32 for evaluation criteria. D D D . ~~~~~~~;"~ ~~('-t;.. ~~ 0 ;; ll;. ..~.trS\l~.'~ . Yes' No 2<.:- 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. DYes D No La Not Applicable l~-- ~~ ~~~~~;U~<-I"" --':1:::::\ ~ "' ~~t~ ~ \ Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of South old from solid waste and hazardous substances and wastes. See LWRP Section III - Policies; Pages 34 through 38 for evaluatioll criteria. ~ Yes D No D Not Applicable ~ ~= ~",,<-e-, "';" ddl~ =fe' 't ~ IN . \ ~':J. f..~ As. 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. DYeD No c13..Not Applicable -~z!!~~~~~d~~ti: t'1oJc....le~ ~~ Attach additional sheets if necessary WORKING" COAST potCIES . Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent Ilses in suitable locations. See LWRP Section 111- Policies; Pages 47 through 56 for evaluation criteria. DYes 0 No 181 Not Applicable , ~r ~~'~ ~_'~L~~~~~N C . ~'-v ',:: w~:J~~ r:~':.e '. N2.AN f'r;~:' 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 0 No ~ Not Applicable ;~~^":~,*-~\~~~~fr~~;~~~')- 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 0 No ~ Not Applicable ~ '~~~ ~YS~~"'~'-~ tQKA~~~~ ~';*u'~ :(~ys 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. o Yes 0 No ~ Not Applicable ~ f~~' ~ ~s.~ ~\,"~U'k ~~ ~:. ~~~ t ' mv.:-: :-: ~~ \l:'.~ ~r ~4..",.. (b PREPAREDBY ~~ 'f": ~ TITLE 'S-j~~~~DATE#1(. 60 ~ ~lx ~9~ I I ! I I I I I I I I I I I I I I I I I I I I I r-'--'" - I I i I I I I I I I i i I I I I I I I cD = o "" - ;/ ; I If If " I I I I I i I I I I I I I . L = ~ 6. \ I I __ n_ I i-1 I I I I' I n I)J i : I I I I I 0:: ~ ::" i IS' I . ~: ~; , I I I . ! I I I i\~O I ~I (J.\ \IJ < -- --I .--...-, -- - ~--- l>