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Home My WebLink About1000-31.-14-11Town of~Southold A. INSTRUCTIONS LWRP CONSISTENCY ASSESSMENT FORM 1. All applicants for permits* including Town of gouthold agencies, shall complete this CCAF for proposed actions that are subject to t;ae Town of Southold Waterfi'ont Consistency Review Law. This assessment is intended to supplement other infcrma':ion used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building ?ermits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in ~ ' oe{ tmn C, the: preparer of this form should review the exempt minor action list, policies and explar ations of each po [icy contained in the Town of Southold Local Waterfront Revitalization Program. A propos~t a_ction will be evaluated as to its significa, a beneficial and adverse effects upon ~e coastal area (whi..ch includes all of Southold 3. If any question in Section C on this form is answered ">'es" or "no", then the proposed action will affect the achievement of the LWRP policy manchu'ds and conditions contained in the consistency review law. Thus, each answer mast be explaiaed in detail, lisfine bolla suooortin~ and non ~. If an action cannot Ic~ certified ~s consistent with the LWRP policy standards and conditions, it shall not bc undertaken~ A copy of the LWRP is available in ~he following places: online at the Town of Southold's website (southoldtown.northfork.net), the Bom'd of Trustees Office, the Planning Department all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPO ,ED ACT[ON I q t/ ~.~ppneauon nas oeen suom~tted to (check ap~roi/fiate response):~ TownBoard [-~ Planning Board C~ Building Dept. ~ ],oardofTrustees 1. Category of Town of Southold agency action (check appropriale response): (a) Action undertaken directly by Town agency (e.g. capit~l construction, planning activity, agency regulation, land transaction) (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certificatior~: Site acreage:_ · I ~, Present land use: "~g ~o(~ Present zoning classification: ~-- k~o If an application for the proposed action has been filed with the Town of Southold agency, the Ih/lowing information shall be provided: (a) Name ofapplicant'~tqrt/ ]~.'~'iE..,~-~-I t----" ~> - t (c) Telephone number: Area Code (d) Application number, if any:_ Will the action be directly undertaken, require funding, or app:oval by a state or federal agency? Yes [~ No ~ If yes, which state or federal agency?_.../~] \] '-~_. C. Evaluate the project to the following policies by analyzing bow 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 Somh01d 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 HI - Policies; Page 2 for evaluation criteria. [] Yes ~-] No ~/Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological r{~sources of the Town of Southold. See LWRP Section III -7~ies Pages 3 through 6 ~ar evaluation eri£eria [] Yes ~ No M Not Applicable Ar, ach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic reseurces throughout the Town of Southold. See LWRP Section III - Policies Pages 6 through 7 for evaluation criteria ~-] Yes ~'] No ~----~'NotApplicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, an~l natural resources from flooding and erosion. See LWRP Section III - Policies Pages 8 through 16 for ev~duation criteria Attach additional sheets if necessary Policy 5. Protect and improve water quality artd supply in the Town of Southold. See LWRP Section Ill - Policies Pages 16 through 21 for evaluation cr~itcria ~-] Yes ~ No F--~No, Appli~_~b~ 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 wetland,,t. See LWRP Section III - Policies; Pages 22 through 32 ~ eval~ criteria, Y. es No Not Applicable At{ach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies Pages 32 through 34 for evaluation criteria. ~ Yes [] No ~/Not Applicable Attach additional sheets ifnecessa%, Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III -- Policies; P~tges 34 through 38 for evaluation criteria. PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III -. Policies; Pages 38 through 46 for evaluation criteria. ~N [] Yes~] No ot Applicable Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations~e~,LWRP Section III - Policies; Pages 47 through 56 for evaluation criteria. [] Yes [-~ No [ ~1' Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic EstuT? and Tow~ers. See. LWRP Section III- Policies; Pages 57 through 62 for evaluation criteria. [] ~ ~s ['~ No I vi Not Apphcabl~ Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III - Policies; Pages 62 through 65 for~tion criteria. [-]Yes [] NoI-Z-JNotAppllcable MO ~_)~r'Jc_~,j.t-'~CtEt:::L(' /~rtF)d~ At~ach additional sheets if necessary Policy 13. Section III - Policies; pages 65 t. hrough 68 for evaluation criteria. [] Yes ~-] No ~Not npphcabl~.. Promote appropriate use and dewdopment of energy and mineral resources. See LWRP Board of Trustees Application County of Suffolk State of New York DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO M~PROPERTY TO INSPECT THE PREMI SE S IN CONJUNCTION WITH,~.~./.~./0-~APPLICAT ION Notary ~Public APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics nrohibits conflicts of interest on the oart of town officem and emnlovees. The l)uruose of this form is to nrovide information which can aler~ the town of oossible conflicts of interest and allow it to take whatever action is necessary to avoid same. (Last name, first n~ne, middl6 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 Of"Other", name the activity.) Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee oftbe Town of Southold? "Relationship" includes by blood, marriage, or business interest. "Business interest" means a business, including a partnership, in whicl] the town officer or employee has even a partial ownemhip of (or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. YES NO / If you ans~ered "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 child is {check all that apply): __.A) the owner of greater than 5% of thc shams of the corporate stock of the applic:~nt (when the applicant is a corporation); __.B) the legal or beneficial owner 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 l~dr~ By McPonold ~eGsclence ~/10/Cr7 / / / / / / / / / Main Road (SR 25) ,t 2O El~v. ~.2 j El~v. 7.1 ) 1" ~.I' ¢ Orlen'r Harbor Firm Zone AE (El 9) (Panel 04) / / I / 55anlfcy Notes 1. There Is no public well or sewage sy~'em within 15C~D'. 1000 ~ol .~c Tank De.tall ~xale 1/4"= 1' Mir1. 4 ]Dim. Approvad DEC 2 1 2007 5HALLOW SYSTEM LEACHIN~ POOL DETAIL DrAMOND INCHES OF FREE 10,6' DPuNNING AGGREGATE DRAIN TI~ (EL VARIES) .T.f__AN r' H 0 R DIAMOND® WA-~L .~Im lion E~ed on ~urvey by Kerme'~n M. Wm/cl~k DaSd 1130107 ~- SCALE 1" = 20' DWO NAME: Site Plan DWG NO PAGE I OF I