HomeMy WebLinkAboutTuthill, Lawrence (3)Albert J. Krupski, President
James King, Vice-President
A~tie Fester
Ken Poliwoda
Peggy A. Dickerson
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only
Coastal Erosion Permit Application
~etland Permit Application ~"Major __
Waiver/Amendment~Cha~es
~,~Received Appli%~p~:~~
~'Received Fee:$ ~
___~ompleted Application
__Incomplete
__SEQRA Classification:
Type I Type II Unlisted
Coordination:(date
_~AC Referral Sent:~~_
._~Date of Inspection:
__Receipt of CAC Report:
Lead Agency Determination:
__~Teclmical Review:
~ffublic Heating Held: ~1
tl! .
Resolution:
Minor
Name of Applicant / O ~'t/' 6'0 ¢` "~c' 7Z'~; / /
Address ~.0.
Phone Number:( )
~:7/- t-/77-1~S
Suffolk County Tax Map Number: 1000- // 7" 0.5' - z// ~
eropertyLocation: ,oOe ~,o/~ ooj~ ~"1, ¢ ¢ [5 fillet., ,.ff o /'rf O/t~
ZS6 '
(provide LILCO Pole #, distance to cross streets, and location)
AGENT:
(If applicable)
Address:
Phone:
Land Area (in square feet):
Area Zoning:
Board of Trustees Application
GENERAL DATA
97,
Previous use of property:
Intended use of property:
Prior permits/approvals for site improvements:
Agency Date
~( No 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Has any permit/approval ever been revoked or suspended by a governmental agency?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 if necessary):
PROJECT iD NUMBER
~ART 1 - PROJECT INFORMATION
1.APPLICANT/SPONSOR
617.20
' APPENDIX O
STATE ENVIRONMENTAL QUALIT~ REVI~-,W
SHORT ENVIRONMENTAL ASSESSMENT FORM
for UNLISTED ACTIONS Only
( To be completed by Applicant or Project Sponsor)
2. PROJECT NAME
/:'/o
cou.
SEQR
3.PROJECT LOCATION;
Mun,oipa,ty ff'*" ' 'ff;ff(
4. PRECISE LO, CATION: Street Addess and Road ntersections, Prominent landmarks etc -or pro ida mad
5. IS PROPOSED ACTION: ~ New ~ Expansion ~ Modification/alteration
6. DESCRIBE PROJECT BRIEFLY:
7. AMOUNT OF LAND AFFECTED:
Initially O, OO'I acres Ultimately ' O. O O~ acres
8. WILL PROPOSED ACTION COMPLY WiTH EXISTING ZONING OR OTHER RESTRICTIONS?
~]Y~s [] No If no, describe bdefly:
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.)
[~Reside~tial E~]lndustrial [~Commercial [~Agriculture E~ Park / Forest / Open Space [~-"lOther (describe)
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
AGENCY (Federal, State or Local)
[~Yes 1~21No If yes, list agency name and permit / approval:
11. 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 ACTION W,LL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION?
E]Yes F-~No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant /Sponsor Name~y~ /j.~ ~,~ Date: V~O/Z/
Signature
V
If the action is a Costal Area, and you are a state agency,
complete the Coastal Assessment Form before proceeding with this assessment
PART I1 - IMPACT ASSESSMENT (To be completed by 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.
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.
[-'-]Yes ~'~No
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, ~f legible)
Cl. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal,
potential for erceion, drainage or flooding problems? Explain briefly:
C2. Aesthetic agncultuml archaeological, hlstonc, or other natural or cultural resources, or community or neighborhood character? Exp a n br erg
C3. Vegetafion or fauna, fish, shellfish or wildlife species, significent habitats, or thmatsned or endangered species? Explain briefly:
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 resoumes? Explain briefly:
1
C5. Growth, subsequent development, or mla~d activities likely to be induced by the proposed action? Explain briefly:
C6. Long term, short term, cumulative, or other effects not identified in C1 -C57 Explain briefly:
C7. Other impacts (includin~ changes in use of either (~uantit;/or ~pe of ener~;/? Explain bdefl¥!
! I
D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL
E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If ~,es explain:
PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency)
INSTRUCTIONS: F~reachadversee~ectidenti~edab~ve'detarminewhetheritissubstantia~~targe~imp~rtant~r~therwises[gni~cant~ 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
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 FULI
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 actio~
WILL NOT result in any significant adverse environmental impacts AND provide, on attac~hments as necessary, the masons supporting thi
determination.
Name of Lead Agency
Date
Title of Responsible Officer
print or Type Name of Responsible Officer in Lead Agency
Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer)
PROOF OF MAILING OF NOTICE
ATTACH CERTIFIED MAIL RECEIPTS
Name:
Id, Il, to'
Address:
STATE OF NEW YORK
COUNTY OF SUFFOLK
, being duly sworn, deposes and says that off the
~ day of ~u ~ ~,~s./ ,20 o¥, 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
Sworn toJ~efore me this ( ~
Day of /JOJ [aJ ~nc ,20 ~)
Not~LP_~blic
MELANIE OOROSKI
NOTARY PUBLIC.State of New
No. 01D04634870
Qualified in Suffolk County ,.~ . .._
Commission F..~ires September ~0,.,z-o~J
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 MY PROPERTY TO INSP.]~CT THE
PREMISES 1N CONJUNCTION WITH REVIEW OF THIS~.
~ Signature -
SWORN TO BEFORE ME THIS
DAYOF ,20o¢
Notary Publ~Ld
MELANIE DOROSKI
NOTARY PUSUC, State of N~v Ymk
No. 01D04~34870
Qualified in Suffolk County
Albert J, Krupski, President
James King, Vice-President
Artie Fester
Ken Poliwoda
Peggy A. Dickerson
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631i 765-1892
Fax (631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
BOARD OF TRUSTEES: TOWN OF SOUTHOLD
In the Matter of the Application of
COUNTY OF SUFFOLK)
STATE OF NEW YORK)
AFFIDAVIT OF POSTING
, residing at iZt6~
being duly sworn, depose and say:
That on the ff day of ~'to°[ , 200~, I personally posted the property kno,~wn.a~
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 eigl~ days prior t9 the date of the public
hearing. Date of hearing noted thereon to be held ~
Dated:
Sworn to before me this I ~'~
day of~u~a~00~-/
lq;tary Public
MELANIE DOROSI~
NOTARY PUBLIC, State of New ~
No. 01D04634870
Oualified in Suffolk County
Commission Expires Septen~g 30, 7,,o
EIJT~BE'I~U A. NEV~LL~
TOWN CLERK
REGISTRAR OF V~TAL STATISTICS
~GE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southol&own.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
APPLICATION FOR PUBLIC ACCESS TO RECORDS
INSTRUCTIONS: Please complete Section I~ of this form and give to Town Clerk"s
Office (agency Freedom of Information Officer). One copy will be returned to you
in response to your request, or as an interim response.
SECTION .I.
TO:
(Department or Officer, if known, that has the information you are requ~esting.) '
RECORD YOU WISH TO INSPECT: (Describe the record sought. If possible, supply
date, file title, tax map number, and any other pertinent information.)
Mailing Address (if different from above):
Telepho.e .umber:
Date:
[ ] APPROVED
[ ] APPROVED WITH DELAY* _
Elizabeth A. Neville
Freedom of Information Officer
[ ] DENIED*
AUg 1 8 2004.
~uuiboitbla~ Clerk
* I[dela~ er ~ see rever~e side for explanation.
,JUL 2 U 2004
b
..... 1 L ........ J
AUG-16-2004 1~:8~ FROM:WICKHAM & 8RESSLER $~1 298 8565
T0:6317651~66
P~002~00~
LAW 0 FFIC ~'G
WICKHAM, BRESSLER. GORDON & GEASA,
13015 MAIN ROAD, p,O. BOX
MATTITUCK, LOt',lO ISLAND
wwblaw@nol,cc~m
August 16, 2004
Atto: Albert Krupski
Souflaold Town Trustees
Southold Town Hall/Feather Hill
Main Road
Southold, New York 11971
Re: Schulteis Application
kU6 173)04
Board of Trustees
Dear Mr. Krupski:
We are the attorneys for Gerard and Carolyn Schultbeis and are writing you in
response to your letter of August 57 2004. Imagine our surprise upon review of the
content of your letter in light of recent events. Specifically, we note the following:
1. The Trustees have consistently refused to go forward on applications from
Lawrence TuthilI for the current requested project. In this regard, kindly refer
to correspondence from then presidents Frank A. Kujawski and John
Bredemeyer. There is no basis to depart from this stance.
2. Gerard Schultheis has a right to maintain his dock as pen~itted by reason of
both riparian rights and ownership of the land underwater. The Board is well
aware of this since four copies of his deed are in the Board's file. Since you
have apparently not inspected the fi]e, another copy of the deed is enclosed.
3. As previously discussed at length with the Town Attorney, the purported
recission of December, 1993 is null and void. This was recognized when the
criminal prosecution was dismissed. Your continued insistence that the
Board's actions were appropriate constitutes inter alia a constitutional
deprivation, which will be addressed in the appropriate lbrum. The Board is
on notice that its continuing acts attempting to deprive our client of his rights
are without legal jurisdiction.
4. Your request for a copy of our client's DEC pen:nit is~ at best, curious. Three
copies ofsarne are in the Board's files. Moreover, in 2003 another copy was
provided to the 'gown Attorney. However, against the possibility that you are
unable to find same (or simply wish to create additional work) a copy is
enclosed,
AUG-1G-200~ 1~:22 FROM:WICKHgM & BRESSLER 631 2~ ~565 T0:~1765i~ P.003~00~
5. yotu' statement that you are asking "once again" for evidence of ownership of
underwater land and implying that you do not have s~une ~s untm. As above,
your file contains four copies of the deed.
6. It is evident f~om the Board's current stance that it has determined, for re~sons
at this point, known only to itself, to improperly and unconstitutionally benefit
Larry Tuthill at the expense of our clients. We assure you that we will not
permit this action to go unchallenged.
7. If a notice of violation or a summons is issued in this matter or if our clients
· ' e v~olated, all those involved, both in a representative and
rights contmu to be ·
individual capacity, will be held responsible. We trust that this will not be
necessary.
$. Finally, we r~ote that successive inspections of the Board's file reveal that
certain documents not previously present have subsequently appeared. We
take very seraously the Board's obl]gauon to mmntmn w,th integrity its files.
The absence of date stamping and u~explained appearances ca, ts grave doubt
on this obllgation.
Please be guided accordingly.
EJB~lb
ejb/~hclbdt~
Very truly yours
Eric~
AUG-16-8004 13:E2 FROM:WICEHAM & 8RESSLER 6~1 898 8565 T0:6~17651~66 P.001x003
Law Offices
WICKHAM, BRESSLER, GORDON & GEASA, P.C.
13015 Mai~. Road, P.O. Box 142-~
Mattituck, New York 11952
631-298-fl353
Telefax no. 631-298-8565
Thio transmission contains information confidential and/or Lo/~.lly privJlcg~. It. is intcnded for use 0nly by thc pcrSo~
to wh~m I~: is directed. If'you have recelvcd this telecopy in ~rror, pleaso notl~ ~ by teiephonc immediately so that we
cai3 ~.rnmge for the rc;tum al°thc documcnt~ to us at no cost to you. Ir'you do not receive all ofth~ p~tges indicatcd,
please call a~ ~oon es posslble e.t the numbcr above.
Co~.ntnents:
This is page one of__, ~
AUG-17-2004 I0:4~ FROM:WICKHAM & 8RESSLER
~T
6231 ~9@ 8565 T0:6317651366
10333 ~C509 .......
[ jUN 0 ~, Lq~7
P. 002/006
AUG-17-2004 10:4] FROM:WICEHAM & BRESSLER
631 298 856S T0:6~17651366
of Ney York, ~ou~d~d ~nd deS~T~?d ~*~
l'and o~ ~omas ~1, said ~lac bei~ ~rch
~' 10" V~C ~.~9 feeC CO land of La~ence
3) North 87' 27' 50" ~sc ~90.32 feet co ocd~
Harbor;
[eec ~o the ~o~nc o[
First Stceecl l~ ~ln8 ch~e In a ~s~ecly dt~cCion aI~S
meflclo~e~ c~ c~C0es is fo~l~$: 1) Boz~ 60 52' 10" bec 73.28 teac ~o
~ ~th the ~h~, easiest a~ xiShc of way ~o use,
zepair o~ r~e aa ex~sc~6 P~ li~ ~ ~ll point, vp~ the land
Of ~r~ K, ~chill; decease, for t~ prisa of yc~idins d~astic
P.00~/006
AUG-l?-2004 10:45 FROM:WICKHAM & 8RESSLER
651 298 8565 T0:6517651566
P.004/006
the ~t ~ ~ du~y ezetu~ed ~1~ d~ t~ dxy ~d ymr 6ut i1~.~
AUG-l?-2004 10:44 FROM:WICKHAM & 8RESSLER
898 8565
T0:6~17651~66
P.005/006
AUG-l?-8004 10:45 FROM:WICEHAM & BRESSLER 651 288 8565 T0:6317651566 P.006x006
" ,SHEET/o~
t~ '
AUG-17-2004 10:43 FROM:WICEHAM ~ BRESSLER 631 298 8565 TO:6G17651366 P.OOlx006
Law Offices
WICKI-IAM, BRESSLER, GORDON & GE/iSA, p. C2.
],3015 Mai~t Road, P.O. Box 1424,
Mattituek, New York 11952
6:31-298-8353
Telefax no. 631-298-8565
'This tmnamiSsiOn contains inform~tior~ confidential. ~Wor legaI)y privilegcd, it is inmndc4 for u~ only by tho pcmon
to whom it is di~t~, liYou h~v= ~iv~ this tele~py in crmc' pic~se n°tify us by tel~h°ne imm~i~ety s° ~hat we
~n a~ge for thc ree~m of the docum~ to us at no eo~I to you, If you do not r~ivc all of the p~s indited,
From:
Re: __
This is page one of (_ ~7
Sauthokl Tow i
Board of T~ustees . i
ECEIYE
AUG 1 7 2O04
road
'4
Field Inspection 8/10/04
Telephone
(631) 765-1892
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
CONSERVATION ADVISORY COUNCIL
TOWN OF SOUTHOLD
At the meeting of the Southold Town Conservation Advisory Council held Tuesday,
August 10, 2004, the following recommendation was made:
Moved by Jack McGreevy, seconded by William Cook, it was
RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH
A CONDITION of the Wetland Permit application of LAWRENCE TUTHILL to construct
a 6'X 40' floating dock, 2.5'X 10' ramp and catwalk. Located: Schoolhouse Creek, New
Suffolk. SCTM#117-5-47
The CAC recommends Approval of the application with the Condition the docking facility
complies with the present legal limits. The CAC also recommends a 10' non-turf buffer
landward of the bulkhead.
Vote.of Council: Ayes: All
Motion Carried
CUTCHOGUE
HARBOR
46,4
SUFFOLK
TAX MAP
COUNTY
PAGE 117
5
22
Albert J. Krupski, President
James King, Vice-President
Artie Foster
Ken Poliwoda
Peggy A, Dickerson
Town Hall ..
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only
__Coastal Erosion Permit Application
__Wetland Perrndt Application Major
__Waiver/Amendment/Changes
Received Application:
Received Fee:$
Completed Application
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:
Minor
Name of Applicant
Address /~. 0.
Phone Number:(
Suffolk County Tax Map Number: 1000- //
Property Location: ~"c ~,o/~ 0t~Y~ ~"k
5'71- ~77-/~d' z
(provide LILCO Pole #, distance to cross streets, and location)
AGENT:
(If applicable)
Address:
Phone:
Land Area (in square feet):
Area Zoning:.
Board of Trustees Application
GENERAL DATA
$7, o0(
Previous use of property:
Intended use of property:
Prior permits/approvals for site improvements:
Agency Date
~ No 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 if necessary):.
PROJECT ID NUMBER
PART 1 - PROJECT INFORMATION
1.APPLICANT/SPONSOR
617.20
APPENDIX G
STATE ENVIRONMENTAL QUALITY REVIEW
SHORT ENVIRONMENTAL ASSESSMENT FORM
for UNLISTED ACTIONS Only
( To be completed by Applicant or Project Sponsor)
2. PROJECT NAME
cou.ty ,5+ f £° I
SEQR
3.PROJECT LOCATION:
4. PRECISE LOCATION: Street Addess and Road intersections. Prominent landm r~s otc -or Dm ide mad
5. IS PROPOSED ACTION: ~ New ~ Expansion ~ Modification / alteration
6. DESCRIBE PROJECT BRIEFLY:
7. AMOUNT OF LAND AFFECTED:
Initially O. OO'I acres Ultimately · ~. O ~7'~ acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS?
~Yes [] No [f no, describe briefly:
g. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.)
~lResidential []Industrial []Commercial E~Agriculture [~] Park / Forest / Open Space [~--~Other (describe)
10. DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
AGENCY (Federal. State or Local)
'--]Yes I~-lNo If yes. list agency name and permit / approval:
11. 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 ACTION WILL EXISTING PERMIT/ APPROVAL REQU,RE MODIF,CATION?
~Yes [~No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant /Sponsor Name~ ~m ~i~¢~ Date:
Signature ~ ~ /,//jo .,
If the action is a Costal Area, and you are a state agency,
complete the Coastal Assessment Form before proceeding with this assessment
7
1.1A
12.1
CUTCHOGUE
HARBOR
Cree~
46,4 ,
SUFFOLK
TAX MAP
COUNTY
PAGE 117
32
$2.3
5
3.5~c3
',50')
22
, 2!.
Albert J. Krupski, President
James King, Vice-President
Artie Foster
Ken Poliwoda
Peggy A. Dickerson
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only
__Coastal Erosion Penuit Application
__Wetland perrmt Application Major
__Waiver/Amendment/Changes
__Received Application:
__Received Fee:$
__Completed Application
__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:
Minor
Name of Applicant 2 ~ ~ P ~0 C e
Address /9. Q /.~ / ~ 2.
ffZ/- ~77-1~J' ~
Phone Number:(
Suffolk County Tax Map Number: 1000- /I
Property Location: ,5'c ~/~ oo~e ff'~.
,f
(provide LILCO Pole #, distance to cross streets, and location)
AGENT:
(If applicable)
Address:
Phone:
Land Area (in square feet):
Area Zoning:
Board of Trustees A~plication
GENERAL DATA
Previous use of property:.
Intended use of property:.
Prior permits/approvals for site improvements:
Agency Date
~ No 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 if necessary)
PROJECT ID NUMBER
PART 1 - PROJECT INFORMATION
1.APPLICANT/SPONSOR
617.20
' APPENDIX O
STATE ENVIRONMENTAL QUALITY REVI~.W
SHORT ENVIRONMENTAL ASSESSMENT FORM
for UNLISTED ACTIONS Only
( To be completed by Applicant or Project Sponsor)
2. PROJECT NAME
cou.ly
SEQR
3.PROJECT LOCATION:
Municipatity W*~'~
4. PRECISE LO,CATION: Street Addess and Road intersections, Prominent landm rks otc - or ore ide mad
5. IS PROPOSED ACTION: [] New [] Expansion r---IM°dificati°n/alterati°n
6. DESCRIBE PROJECT BRIEFLY:
e/ Ne" 4' '40' - 'loa¥ 2 %',/o'
7. AMOUNT OF LAND AFFECTED:
Initially a. a o'l acres UI6mately · O. O a~/ acres
6. WiLL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS?
~Yes [] No If no, describe bdefly:
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.)
---1Residential []Industrial r--ICommercial [~]Agriculture r~Park/Farest/OpenSpaca [~----'lOther(dascdbe)
10. DOES ACTION INVOLVE a PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
AGENCY (Federal, State or Local)
i'~Yes [] No If yes, list agency name and permit / approval:
11, 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 ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION?
[~¢es [--'"'~ No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Appticant /SponsorName~ w~m ~/.tt~}~ Date:
Signature
If the action is a Costal Area, and you are a state agency,
complete the Coastal Assessment Form before proceeding with this assessment
._ ScTI~
2
( l..-~sv~ f~"%)
51.1
1.1A
t2.1
46.4
CU7'CHOGUE
HARBOR
SUFFOLK COUNTY
TAX MAP PAGE 117
$2.$
22
b
DODO