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Home My WebLink AboutTR-6918Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0596C Date October 22, 2010 THIS CERTIFIES that the replacement of 108' of bulkhead using vinyl sheathing; removal of 13' i etty at western end of bulkhead; replacement of eastern section of existing groin with vinyl sheathing and low-profile no hiEher than 18" above grade on the down drift side 65' seaward of exposed landward end pile At 2180 Peter's Neck Rd., Orient Suffolk County Tax Map #32-1-6.1 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 4/4/08 pursuant to which Trustees Wetland Permit #6918 and Coastal Erosion Permit #6918C dated 6/18/08 Were issued and conforms to ali of the requirements and Conditions of the applicable provisions of law. The project for which this certificate is being issued is for The replacement of 108' of bulkhead using vinyl sheathing; removal of 13' jetty at western and of bulkhead; replacement of eastern section of existing groin with vinyl sheathing and low- profile no higher than 18" above grade on the down drift side 65' seaward of exposed landward end pile. The certificate is issued to SOPHIE LATHAM & PRISCILLA JAMIESON owners of the aforesaid property. rized S~gnatur~/ Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD May 19, 2010 Mr. George R. Latham 2180 Peter's Neck Rd. Orient, NY 11957 RE: SOPHIE LATHAM & PRISCILLA JAMIESON 2180 PETER'S NECK RD., ORIENT SCTM#32-1-6.1 Dear Mr. Latham: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wed., May 19, 2010: RESOLVED, that the Southold Town Board of Trustees grants a One-Year Extension to Wetland Permit #6918 and Coastal Erosion Permit #6918C, as issued on June 18, 2008. This is not an approval from any other agency. Sincerely, JMD:lms 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 1st day of construction ¼ constructed __ Project complete, compliance inspection. BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 6918 & 6918C DATE: JUNE 18~ 2008 ISSUED TO: SOPHIE LATHAM & PRISCILLA JAMIESON PROPERTY ADDRESS: 2180 PETER'S NECK RD, ORIENT SCTM#32-1-6.1 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 thc meeting held on June 18, 2008 in consideration of application fee in the sum of $500.00 paid by Sophie Latham & Priscilla 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 & Coastal Erosion Permit to replace western 200' of existing 381' bulkhead using vinyl sheathing; remaining eastern 181' section currently buried is permitted to be replaced when and if exposed; and existing 13' jetty at western end of bulkhead to be removed. Existing groin at eastern section to be replaced with a vinyl sheathing low-profile groin no higher than 18" above grade on the down drift side 65' seaward of exposed landward end pile, and all as depicted on the survey prepared by John T. Metzger last dated June 24, 2008, and stamped approved on July 18, 2008. 1N 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. 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 i179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD June 18,2008 Mr. George R. Latham 2180 Peter's Neck Rd. Orient, NY 11957 RE: SOPHIE LATHAM & PRISCILLA JAMIESON 2180 PETER'S NECK RD., ORIENT SCTM#32-1-6.1 Dear Mr. Latham: The Board of Town Trustees took the following action during its regular meeting held on Wed., June 18, 2008 regarding the above matter: WHEREAS, SOPHIE LATHAM & PRISCILLA JAMIESON applied to the Southold Town Trustees for a permit under the provisions of Chapter 275, the Wetland Ordinance, and Chapter 111, Coastal Erosion Hazard Areas, of the Southold Town Code, applications dated April 4, 2008, 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 June 18, 2008, 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 and Chapter 111 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 applications of SOPHIE LATHAM & PRISCILLA JAMIESON to replace western 200' of existing 381' bulkhead using vinyl sheathing; remaining eastern 181' section currently buried is permitted to be replaced when and if exposed; and existing 13' jetty at western end of bulkhead to be removed. Existing groin at eastem section to be replaced with a vinyl sheathing Iow-profile groin no higher than 18" above grade on the down drift side 65' seaward of exposed landward end pile, and all as depicted on the survey prepared by John T. Metzger last dated June 24, 2008, and stamped approved on July 18, 2008. 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 ~nspection. (See attached schedule.) Fees: $50.00 Very truly yours, James .K~ing ~"~ ,'~ President, Board of Trustees JFK/Ims 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 COASTAL EROSION MANAGEMENT PERMIT Permit#6918C Date: June 18, 2008 SCTM#32-1-6.1 Name of Applicant/Agent: Sophie Latham & Priscilla Jamieson Name of Permittee: Sophie Latham & Priscilla Jamieson Address of Permittee: 168 Central Ave., Greenport, NY Property Located: 2180 Peter's Neck Rd., Orient, NY DESCRIPTION OF ACTIVITY: To replace western 200' of existing 381' bulkhead using vinyl sheathing; remaining eastern 181' section currently buried is permitted to be replaced when and if exposed; and existing 13' jetty at western end of bulkhead to be removed. Existing groin at eastern section to be replaced with a vinyl sheathing Iow- profile groin no higher than 18" above grade on the down drift side 65' seaward of exposed landward end pile. SPECIAL CONDITIONS: None The Coastal Erosion Management Permit allows for the activities as indicated on the survey prepared by John T. Metzger !ast dated June24, 2008, and stamped approved on July 18, 2008. James F. King, President 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 Please be advised that your application dated /---//~/Oo~ has been reviewed by this Board at the regular meeting of 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) __ ½ Constructed ($50.00) '/'Final Inspection Fee ($50.00) __ Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: BY: James F. King, President Board of Trustees 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., May 14, 2008, the following recommendation was made: Moved by Jack McGreevy, seconded by Doug Hardy it was RESOLVED to NOT SUPPORT the Wetland Permit and Coastal Erosion Permit applications of SOPHIE LATHAM & PRISCILLA JAMIESON to rebuild the existing jetty and repair the existing bulkhead. Located: 2180 Peter's Neck Rd., Orient. SCTM#32-1-6.1 Inspected by: Jack McGreevy The CAC does Not Support the applications because they were incomplete. The CAC recommends additional information is submitted such as the type of materials being used, the length and design of the jetty, and a professional review of the effects of the groin. Vote of Council: Ayes: All Motion Carried James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ohosio, Jr. P.O. Box I 179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: SOPHIE LATHAM & PRISCILLA JAMIESON request a Wetland Permit & Coastal Erosion Permit to rebuild the existing jetty and repair the existing bulkhead. Located: 2180 Peter's Neck Rd., Orient. SCTM#32-1-6.1 Se of area to be impacted: B~ay altwater Wetland Freshwater Wetland Sound Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: __Chapt.275 Chapt. 111 other Type of Application: ,~Wetland ___~Coastal Erosion __Amendment Administrative__Emergency __Pre-Submission __Violation Info needed: ~ ,~ )' (~ (t t~/..~ ' '"~ , ' / ~~ - Uo~ifica~ions: ~ ~ ~ ~J (o- 7,'/~ Conditions: Present Were: :.D,ckerson D. Dzenkowski Mark Terry ~Sther Form filled out in the field by Mailed/Faxed to: Date: Environmental Technician Review- New York State Depa ent of Environmental Cons ation Division of Environmental Permits, Region One SUNY @ Stony Brook, 50 Circle Road, Stony Brook, NY 11790 - 3409 Phone: (631) 444-0365 · FAX: (631) 444-0360 Website: www. dec.state.ny.us NOTICE OF PERMIT REQUIRED Sophie Latham 2180 Peter's Neck Road Orient, NY 11957 May 9, 2008 Re: Jetty & Bulkhead ReconstructiorffRepair Dear Ms. Latham: The Department of Environmental Conservation (DEC) has become aware that you are proposing an activity near regulated tidal waters (tidal wetlands). Regulated activities proposed within 300 feet of tidal wetlands or directly in tidal waters require a Tidal Wetlands Act permit. Regulated activities include, but are not limited to: clearing, grading, filling, excavation, construction of structures, expansion of existing structures, installation of septic systems, constructing docks, installation of pilings, dredging, shoreline stabilization work, and the reconstruction of structures such as docks, decks, catwalks, sea walls and bulkheads. Therefore, your project requires a DEC permit in accordance with the Environmental Conservation Law(s) indicated below. [X] Article 25, Tidal Wetlands Act Our records indicate that no application for the proposed project has been received by DEC. Enclosed is an application package for your use. Please carefully read the checklist and be sure all specified information is included (see checklist) to avoid processing delays. Do not hesitate to contact me at 631-444-0374 if you have any questions. Sincerely, Deputy Permit Administrator CC; Southold'Town Trustees files OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cor. MoJn 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 To: Jim King, President Town of Southold Board of Trustees From: Scott Hilary, LWRP Coordinator Planner Date: May 7, 2008 ge~ Chapter 268: Waterfront Consistency Review Wetland Permit & Coastal Erosion Permit for SOPHIE LATHAM & PRISCILLA JAMIESON SCTM#32-1-6.1 SOPHIE LATHAM & PRISCILLA JAMIESON request a Wetland Permit & Coastal Erosion Permit to rebuild the existing jetty and repair the existing bulkhead. Located: 2180 Peter's Neck Rd., Orient. SCTM#32-1-6.1 The proposed action has been reviewed to Chapter 268, Waterfrom 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 pursnant to Chapter 286: Waterfront Consistency Review, Exempt/Minor Actions which are not subject to review. § 268-3. Definitions MINOR ACTIONS -- Include the following action, which are not subject to review under this chapter: B. 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 (CELIA) law where structures may not be replaced, rehabilitated or reconstructed without a permit. 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 ~'~oastal Erosion Permit Application ./Wetland Permit Application ~" Amendment/Transfer/Extension ./q?~eceived Application: ~l~ecmved Fee:$ %~ ~} L/'Completed Appli~a'tion Incomplete SEQRA Classification: Type I Type II Unlisted Coordination:(date sent)_ · ~LWRP Consistency Assessment Form ~7AC Referral Sent: ~ I q I~ ~t · . ~ite of Inspection: .'"~,"1.14]0 Receipt of CAC Report: Lead Agency Determination:__ Technical Review: Hearing Held: Resolution: Office Use Only Administrative Permit Phone Number:( ) ¢3l- 4g?-O Suffolk Co~ty Tax Map Nmber: 1000- g~- ['~,~¢ ~rov)de LILCO Pole ~, dist~ce ross streets, ~d location) AGENT: ~e.~ ~, L~ (If applicable) ~ O Phone: ~ Board of Trustees Appl~ion Land Area (in square feet):. ga'ea Zoning: c~..eSi ~D'xdt.k c Previous use of property: Intended use of property: GENERAL DATA Covenants and Restrictions: If "Yes", please provide copy. Prior permits/approvals for site improvements: Agency Yes t//No Date ///No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspende, d by a governmental agency? I//No Yes If yes, provide explanation: Board of Trustees Appli ~ion WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose ofthe proposed operations: '~ ~'~OQt[c[ Area of wetlands on lot: square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? b~ No Yes If yes, how much material will be excavated? How much material will be filled? Depth of which material will be removed or deposited: Proposed slope throughout the area o f operations: Manner in which material will be removed or deposited: ~q-Bq cubic yards 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): Board of Trustees Appl~ Ition COASTAL EROSION APPLICATION DATA Are wetlands present within 100 feet of the proposed activity? No %/' Yes Does the project involve excavation or filling? u//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) I PROJECT ID NUMBER PART 1 - PROJECT INFORMATION 1. APPLICANT / SPONSOR 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 3.pR'IOJECT LOCATION:~,~,[~>,O~..~.~ ~..~.'P"~ , 4.~PRECISE~[~LOCATION:~~Street Addess~and~o~,~ ~. ~R°ad Intersections,~o~in ent landmaAs,~etc - or ~. ~Dro/de map 5.1S PROPOSED ACTION: ~ New ~Expansion ~Modiflcation/alteration _ 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WiTH EXISTING ZONING OR OTHER RESTRICTIONS? ~Yes [] No If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) r-]Residential r--~lndustrial [~Commercial ~-]Agriculture [~]Park/Forest/OpenSpece ~'~'er (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNplNG, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENC . (Federal, State or Local ~1 ~ "~ ~es ~ No If yes, list agency name and permit / 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? g~Yes E~o If list name and permit / approval: yes, agency 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? E~Yes r-]No I CERTIFY THAT THE INFORMATION PROVIDED ~ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor N~.ame '~4~J~.. ~ //-~/()~-. ~'~,t~.t[.~, I~. Date: .i/~/..~.~ Signature ~'~1)~)[ ~ (~.. ' ~:f ~.~ [4 J "~ ~ ~ / ""{"~ 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 completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.47 If yes, coordinate the review process and use the FULL EAF. [""-]Yes [~]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. r~Yes r-]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: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: 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: C5. Growth, eubsequent development, or related activities likely to be induced by the proposed action? Explain briefly: C6. Long term, short term, cumulafiYe, or other effects not identified in C1 -¢5? Explain hdefiy: I 1 C7. Other impacts (including changes in use of either c~uanti~ or t}/pe of energy'? Ex~lain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? (If yes, explain bdefly: PART III - 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 adequatety addressed. If question d of part ii was checked yes, the determination of significance must evaluate the potential impact of the 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 FULl EAF and/or prepare a positive declaration. Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed actiol 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 Title of Responsible Officer Signature of Preparer (If different from responsible officer) Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES~ TOWN OF SOUTHOLD In the matter of applicant: YOU ARE HEREBY GiVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: That the project which is subject to Environmental Review under Chapters 32, 37, and/or 97 of the Town Code is open to public comment on: . 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 does not reference any other agency that might have to review same proposal. OWNERS NAME: MAILING ADDRESS: PHONE#: Enc: Copy of sketch or plan showing proposal for your convenience. Board of Trustees Ap~cation County of Suffolk State of New York ~(G. L~_.t d-~ ' 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 HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH 1N 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 REVIEW OF THIS APPLICATION. ISignature SWORN TO BEFORE ME THIS 6] ~ DAY OF O~_) ,20 0¢ N'~-a~y Public APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics nmhibits conflicts of interest on the ear[ oftewn officem and emt~lovees. The oumose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. (L~t no}ne, first name, gaiddle 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 (If"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? "Relationship" includes by blood, tearriage, or business interest. "Business interest'~ means a business, including a partnership, in which the town officer or employee has even a partial ownership of(o[ employment by) a corporation in which the town officer or employee owns more than 5% &the shares. YES NO k~/ · ~ 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/agent/representative) 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 ~hild is (check all that apply): ___A) the owner of greater than 5% of the shams of the corporate stock of the applic0nt (when the applicant is a corporation); __.13) the legal or beneficial owner of any interest in a non-corporate entity (when the applicant is not a corporation); ___C) an officer, director, partnei', or employee of the applicant; or __.D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS 1 S u bmitted this,~?~_day of . ~l~r; { 200t~ Signature '~'~P[ ~t/- r~tJ'~zl~-.- Print Name I - ' 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 ,,lrea. 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 supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold ' s 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 scm#/DOC> - - / - &./ The Application has been submitted to (check appropriate response): Town Board [] Planning Board [] Building Dept. ~ Board of Trustees Category of Town of S outhold 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) Pem~it, approval, license, certification: Location of action: Site acreage: Present land use: Present zoning classification: If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Nme of applicant: (c) Telephone number: Area Code ( ) (d) Application number, if any:_ Will on be directly undertaken, require funding, or approval by a state or federal agency? Yes ~'~ I No[--] Ifyes, which state or federalagency? 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. Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III -Polie/ies Pages 3 through 6 for evaluation criteria ~ Yes ~ NoI--'/f--~ 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 [-~ Yes [] No ~Not Applicable 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 [] ~ ~{;~v~pl~ ~/tx ~f~s~Of}. 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 7] Yes [] No 7 ot ot^pplicahle 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. Yes No ~cable 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 ~ot Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. ~ee LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria. ~ Yes ~-] No [~NNot Applicable 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. N~ot Ap'p ~] Y es~ No licable Attach additional sheets if necessary WORKING COAST PO~CIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III - Policies; Pages 47 through 56 for evaluation criteria. ~-~ Yes [] No ~/~ot Applicable 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 LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. [] Yes ~ No ~Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southoid. See LWRP Section III - Policies; Pages 62 through 65 for evaluation criteria. ~ Yes [] No ~Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III - Policies; P~s 65 through 68 for evaluation criteria. Yes No [~ Not Applicable N APPROVED BY BOARD OF 1RLL~,, TOWN OF SOIJTHOLD SURVEY OF PROPERTY A T ORIENT TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. 1000-82-01-6.1 SCALE: 1~-40' JANUARY 25, 2008 COASTAL EROSION HAZARD AREA MAP PHOTO 4~ 49-628-83 AREA= 78,022 SQ. FT. TO TIE LINES k 765-1797 P. 0 BOX 909 ~2~0 TRAVELER STREET s~ur~o~, ~.x .~z 08-10£ N SURVEY OF PROPERTY AT ORIENT TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. 1000-$2-0I-6.1 SCALE: 1'~40' JANUARY 25, 2008 COASTAL EROSION HAZARD AREA PHOTO ~ 49-628-83 MAP APR - 4 2008 AREA= 79,022 SQ. FT. TO TIE LINES (651) 765 5020, P.O BOX 909 1220 TR,qVEL£R STREET SOUTHOLD, N.K 11971 08-102