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HomeMy WebLinkAboutTR-7250 0 ( 5° _e4CAEEr r `} Michael J. Domino, President ��OF S0(/rTown Hall Annex John M. Bredemeyer III,Vice-President �� l0 54375 Route 25 P.O. Box 11 Glenn Goldsmith 1�[ Southold, New York 11971 A. Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams O Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD ",!�F� Z APPLICATION FOR A TRANSFER OF A WETLAND PERMIT W►'G,dra"-) n y//ol ev/8" DATE q OWNER_S k DhGi h 1 C. Lau 0 U 01 I L PHONE MAILING ADDRESS i I1'L to I I I 'Yl Iyaj twI 11S '(o AGENT <,-k Ve, L040U O IS PHONE q I1 8 '12-3 ADDRESS I I 7LL i L2 at Lu Xq I ( yq (.o PROPERTY LOCATION S�u r l d Vl-f W "I l r l OUtj W l6 I TAX MAP NO. I, L� — 1 —.2'�•co I/We S-0hGn t Ltl1'Jud b request a Transfer of Permit# 111'W40m. 00 Y10 812 /i l-C, 4 AD 'f)h1 r1,d �OldovdrL ) UL-PhOn t I 44Dun( i �r art V� Atg cdau-' FY- /00 c tUg_ ftU41 kjt�_ Signed y. vu �aJ Board Of Southold Town Trustees q, " SOUTHOLD, NEW YORK b DATE: .Januaxy 31 9.997 r PERMIT NO. 4696. ISSUED TO ... Angelo,Padoven„ , �. Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1893; and Chapter 404 of the Laws of the State of New York 1952; and the Southold Town Ordinance en ' titled "REGULATING AND THE PLACING OF OBSTRUCTIONS ., IN AND ON TOWN WATERS AND PUBLIC LANDS and the 'r REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;" and in accordance with the GF' Resolution of The Board adopted at a meeting held on 0� b 150.00• aid b r 19 9.7...., and in consideration of the sum of $... P y T, o Mr.•,P.adovan.,,. -T Permit rSexviaes on , y bel�al� of :..... -. and u ' c o t N. Y. s bje t f the ! Terms and Conditions listed on the reverse side hereof, to of Southold Town Trustees authorizes and permits folloanwdg. construct a concrete retaining wall totalling seaward side of retaining Wall construct a rock revetment on sl y v� all in accordance with the detailed specifications as presented in z the originating application. , IN WITNESS WHEREOF, The said Board of Trustees Mere i l:, I x by causes its Corporate Seal to be affixed, and these presents to < be subscribed by a majority of the said Board as of this date. ',1,,; / t 5 v`�[ ��Q�• ® Trustees... ............ ;'lir; �} �.-- = mss^- �•%"�'" " �WA 10 6 tl C5'i P,Qo��s AW 6WIA PFJ W p QTR � P"P- 4 C wp #66 KELLY LAGOUDIS 1-21210 3 012 71 TULIP LN. WILLISTON PARK,NY 11596-1014 DATE_�[/�1VG•` ��,��g PAY TO THE f` 1 1�1 �I u�.� v�d ORDER Of� //7 (J 'Vu/ l� ���JJJ_�J/J I $2b 6 �p6 � /l/V V / �U mGV"l.0 w �.�/�.vi� t�6 DOLLARS ,aQ s.��«N.. CHASEC JPMorgan Chase Bank,N.A. www.Ch MEMO 1:0 2 L0000 2 0: 7 LO 7 *oard of Trustees Applica n AFFIDAVIT � BEING DULY SWORN DEP6S1kS AND AFFI S THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS) 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 BOARD OF 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, INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION,' , INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signature o o y Owner Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF r-Yhfi a 20j—L— Notary ublic ALEX THOMAIDIS Notary Public, Srato of New York No. 02TH6140840 Qsu�lified in Queens Comet J� Commission ExPires February 13�20..._� f FILE NOTES DATE & INITIALS: "�d' ' emyw chtL F-go* 6fix'` y®1� LUVPEKJA►r�- IF rfc5 iP.�N� c, W,4:S ON '91)4 Y•ll"l8- A6j�-A/D/q-. 7�0 /+rrR yr-s/ OJT-IH*r J- MV AEQC-57W A r- Hid 0/2- 0) dwA �a qp& oup, Mow. -I-' 7xo thim Hs- couto � e, UP Tiu. r14#p-4L&�- of /#5fono ' 7� �km,fk ag- N�' �r�s7l4e�0 S IT 14—pAt i I2 5-0G cars fP-. �(,p EF��t z SuPPu�p that_ wwr- A- eoly 4-0 ffclm ftftcr tlt- PR460 ffC-- AhO C"W G/A#-W -P TX1W � icT BUJ thM 79 PFA5e E 41A-tL- Ale -iW,+T �- A(60 TO -FR& MF WV* ` 7V Pa w c t k5 Chi-, fit- P" 7&,v- Ay U-NAtt— APP4535. DIP NO-1 Jill M. Doherty, President James F. ICing, 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 # 0608C Date: November 12, 2010 THIS CERTIFIES that the connection of gutters to leaders to dr~vells on the seaward side deck roof and house roof; removal of debris and stored wood on bank; removal of the sand that was placed along the north side of Lot 24.1 and re-deposited on the bank to re-fill the excavated area on the bank; restore the area with native sea grasses; existing stairs to beach and wood retaining wall At 22615 Soundview Avenue, Southold, New York Suffolk County Tax Map # 135-1-23, 24.1 & 25.1 Conforms to the applications for a Trustees Permit heretofore filed in this office Dated 1/28/10 pursuant to which Trustees Wetland Permit #7250 Dated 2/24/10 and Coastal Erosion Permit #7250C Dated 2/24/10 and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the connection of gutters to leaders to ~ells on the seaward side deck roof and house roof; removal of debris and stored wood on bank; removal of the sand that was placed along the north side of Lot 24.1 and re-deposited on the bank to re-fill the excavated area on the bank; restore the area with native sea grasses; existing stairs to beach and wood retaining wall The certificate is issued to MARIO ABATE & JOSEPHINE PADOVAN owner of the aforesaid property. 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 $OUTHOLD DATE OF INSPECTION: t~Ch. 275 v'o Ch. 111 INSPECTION SCHEDULE __ Pre-construction, hay bale line/silt boom/silt curtain 1 st day of construction constructed Project complete, compliance inspection. INSPECTED BY: COMMENTS: CERTIFICATE OF COMPLIANCE: Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hall, 53095 Main Rd. P.O. Box I 179 Southold, NY 11971 Telephone (63 l) 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, hey--bekHifle-- ,~tt~ ~t,--/t t/' t~c~ t.t~]/I~'~, d~/.~:~-rr.r_ 6/¥/~ __ 1st day of construction ¼ constructed v/' Project complete, compliance inspection. BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 7250&7250C DATE: FEBRUARY 24~ 2010 ISSUED TO: MARLO ABBATE & JOSEPHINE PADOVAN PROPERTY ADDRESS: 22615 SOUNDVIEW AVE., SOUTHOLD SCTM#135-1-23~24.1&25.1 AUTHO~RIZATION 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 February 24. 2010 in consideration of application fee in the sum of $1.000.00 uaid b~ Padovan 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 connect the roof gutters and leaders from the seaward side d6~:k roof and the house roof to a drywell; remove the debris and wood stored the bank, in the area excavated; remove the sand placed along the north side and redeposit on the bank to re-fill the excavated area on the bank; restore the area with sea grasses planted within six (6) months from the date of this permit; and stairs to the beach and existing wood retaining wall, and as depicted off the reVised on January 28, 2010 and stamped approved on February 24, 2010. IN WITNESS WHEREOF, the said Board of Trustees hereby causes its Corporate Seal w be affixed, and these presents to be subscribed by a majority of the said Board as of this date. TERMS AND CONDITIONS The Permittee, Marion Abbate & Josephine Padovan, residing at 22615 Soundview Ave., Southold, NY, as part of the consideration for the issuance of the Permit does understand and prescribe to the following: That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will, at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold. That this Permit is valid for a period of six (6) months, which is considered to be the estimated time required to complete the work involved. That this Permit should be retained indef'~itely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that authorization was originally obtained. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application maybe cause for revocation of this Permit by resolution of the said Board. That there will be no unreasonable interference with navigation tis a result of the work herein authorized. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation, the said Permittee will be required, upon due notice, to remove or alter this work project herein stated without expenses to the Town of Southold. That thc said Board will be notified by the Permittee of the completion of the work authorized. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit, 'which may be subject to revoke upon failure to obtain same. 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 February 24, 2010 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Patricia C. Moore, Esq. 51020 Main Rd. Southold, NY 11971 RE: MARLO ABBATE & JOSEPHINE PADOVAN 22615 SOUNDVIEW AVE., SOUTHOLD SCTM#135-1-23, 24.1 &25.1 Dear Ms. Moore: The Board of Town Trustees took the following action during its regular meeting held on Wed., February 24, 2010 regarding the above matter: WHEREAS, Patdcia C. Moore, Esq. on behalf of MARLO ABBATE & JOSEPHINE PADOVAN applied to the Southold Town Trustees for a permit under the previsions of Chapter 275 of the Southold Town Code, the Wetland Ordinance, and Chapter 111 Coastal Erosion Management, applications dated September 30, 2009 and revised on January 28, 2010, and, WHEREAS, said applications were referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, the LWRP Coordinator issued a recommendation that the applications be found Consistent with the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Headng was held .by the Town Trustees with respect to said application on February 24, 2010, 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, and, 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, and, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees has found the applications to be Consistent with the Local Waterfront Revitalization Program, and, BE IT FUTHER RESOLVED, that the Board of Trustees APPROVES the applications of MARLO ABBATE & JOSEPHINE PADOVAN to connect the roof gutters and leaders from the seaward side deck roof and the house roof to a drywell; remove the debds and wood stored on the bank, in the area excavated; remove the sand placed along the north side of Lot 24.1 by hand and redeposit on the bank to re-fill the excavated area on the bank; restore the area with native sea grasses planted within six (6) months from the date of this permit; and allow for the as-built stairs to the beach and existing wood retaining wall, and as depicted on the revised plans received on January 28, 2010 and stamped approved on February 24, 2010. Permit to complete the project will expire six (6) months from the date of the permit. Inspections are required at a fee of $50.00 per inspection. (See attached schedule.) Fees: $100.00 Very truly yours, Jill .~J[Doherty, ~resi~d t Board of Trustees JMD/Ims Jill M. Doherty, President James F. King, Vice-Preaident 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 COASTAL EROSION MANAGEMENT PERMIT Permit #7250C Date: February 24, 2010 SCTM#135-1-23,24.1 &25.1 Name of Applicant/Agent: Patricia C. Moore, Esq. Name of Permittee: Marlo Abbate & Josephine Padovan Address of Permittee: 22615 Soundview Ave., Southold Property Located: 22615 Soundview Ave., Southold DESCRIPTION OF ACTIVITY: To connect the roof gutters and leaders from the seaward side deck roof and the house roof to a drywall; remove the debds and wood stored on the bank, in the area excavated; remove the sand placed along the north side of Lot 24.1 by hand and redeposit on the bank to re-fill the excavated area on the bank; restore the area with native sea grasses planted within six (6) months from the date of this permit; and allow for the as-built stairs to the beach and existing wood retaining wall. CONDITIONS: Permit to complete the project will expire six (6) months from the date of the permit. INSPECTIONS: Pre-construction inspection and final inspection. The Coastal Erosion Management Permit allows for the activities as indicated on the revised pla~s..r, ec~edu~n ~n~j~, 28, 2010 and stamped approved on February 24, 2010. JiliA4. Doherty, Preside?~t Board of Trustees JMD:lms Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hall, 53095 Main Rd. P.O. Box I 179 Southnld, NY 11971 Telephone (631 ) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Please be advised that your application dated ~/~OJO '~ has been reviewed by this Board at the regular meeting of c,l/~ qJ/O and your application has been approved pending the completion of the following items checked off below. Revised Plans for proposed project Pre-Construction Hay-B-a~--L-ine Inspection Fee ($50.00) __ 1st Day of Construction ($50.00) __ ¼ 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: Jill M. Doherty, President Board of Trustees James Eckert, Chairman Lauren Standish, Secretary Town Hall, 53095 Main Rd. P.O. Box I 179 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., October 14, 2009, the following recommendation was made: Moved by Peter Young, seconded by James Eckert, it was RESOLVED to NOT SUPPORT the Wetland Permit and Coastal Erosion Permit applications of MARLO ABBATE & JOSEPHINE PADOVAN to restore the sand excavated from the bluff and to restore the bank along the edge to the original configuration/breadth. Located: 22615 Soundview Ave., Southold. SCTM#135-1-23,24.1 &25.1 Inspected by: Peter Young, James Eckert The CAC does Not Support the applications because of insufficient information and detailed restoration plans should be submitted. Vote of Council: Ayes: All Motion Carried James F King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. P.O Box 1179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: J/-.Q '~ ,~ ? MARLO ABBATE & JOSEPHINE PADOVAN request a Wetland Permit & Coastal Erosion Permit to restore the sand excavated from the bluff and to restore the bank along the edge to the original configuration/breadth. Located: 22615 Soundview Ave., Southold. SCTM#135-1-23,24.1&25.1 ~aa~eera tV~e~ae~ pactedF"reshwater Wetland /Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work fails under: __Chapt.275 __Chapt. 111 other Type of Application: tland __Coastal Erosion ~Ad ministrative__Emergency Pre-Submission __ __Amend ment Violation Info needed: f Modifications: Present Were: _~.King /~/J.Doherty ~J~.Dickerson __ D. Dzenkowski other Bergen__ B.Ghosio, Form filled out in the field by Mailed/Faxed to: Date: James F. King. President Jill M. Doher~y, Vice-?resident Peggy A. Dickerson Dave Bergen Bob Ghosio~ .Ir. P.O. Box 1 [79 Southold. NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/VVorksession Report Inspect the property of JOSEPHINE PADAVAN (MARLO ABBATE) to discuss a re-vegetation/remediation plan as a result of the Summons dated 7/23/09 issued to Mario Abbate. Located: 22615 Soundview Ave., Southold. SCTM#92-1-2.1 Type of area to be impacted: __Saltwater Wetland Freshwater Wetland ~"'Sound Bay 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 _Am/c~rdment __Administrative__Emergency --Pre-Submission --~'~"Violation Info needed: Present Were: c"'J~.King f"'"O.~i)herty Cl~.Dickerson U"~.Bergen B.Ghosio, D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: Town of Southold 'A' 41 E~4 Suffolk County, NY The People of the State of New York vs. Suffolk County, NY The People of the State of New York vs. PATRICIA C. MOORE~TORNEY 51020 Main Road Southold, NY 11971 (631) 765-4330 email: pcmoorel @optonline.net AT LAW _M~ EMO LETTER ~DATE ¢~Please reply ~r~ No reply necessary PATRICIA C. MOORE Attorney at Law 51020 Main Road Southold, New York 11971 Tel: (631) 765-4330 Fax: (631) 765-4643 January 27, 2010 Southold Town Trustees Southold Town Hall Main Road P.O.Box 1179 Southold, NY 11971 (By Hand) Re: Josephine Padovan and Mario Abbate 1000-135-1-23,24.1 & 25.1 Dear President Dougherty and Board: In accordance with your request at the meeting the following notations were added to the plans prepared by Angel Chorno, Architect and the application is amended to include the following: The roof gutters and leaders from the seaward side deck roof and the house roof will be connected to a drywell located as shown, by hand, on the 7-26-07~lans and revised January 27, 2010, prepared by Angel Chorno,~ of Chorno Associates, Architects. The debris and wood sto~ed on the bank, in the area excavated, will be removed from the bank. The sand placed along the north side of Lot 24.1 will be removed by hand and redeposited on the bank to re-fill the excavated area on the bank. The owner/applicant will advise the trustees prior to commencement of the work, and will advise the Trustees when the work will be performed. I have advised my client that the Trustees have offered to make a "progress" inspection during the corse of the work to confirm that the restoration is being performed as expected. (The client believes the work may take a few hours to remove the sand). After the sand is removed, the area will be restored with native sea grasses (either seed or plants). Grasses will be planted within 6 months of issuance of the permit. The as built stairs to the beach and existing wood retaining wall are included in this permit. Thank you for your courtesies. Very truly yours, Patricia C. Moore Office Use Only __Coastal Erosion Permit Application __Wetland Permit Application Administrative Permit AmendmentZrrans fer/Extension __Received Application: __Received Fee:$ __Completed Application __Incomplete SEQRA Classification: Type l Type Il Unlisted Coordination: date sent) __LWRP Consistency Assessment Form CAC Referral Sent: Date of Inspection: __Receipt of CAC Report: Lead Agency Determination:__ __Technical Review: __Public Hearing Held: Resolution: Name of Applicant Address /0/- 7_ Suffolk County Tax Map Number: Property Location: (provide L1LCO Pole/4, distance to cross streets, and location) AGENT: (If applicable) Address: liP?~ Pho.e: 733':- q3~o Board of Trustees Application Land Area (in square feet): Area Zoning: Previous use of property: Intended use of property: GENERAL DATA , q3 4-'c. ~, ,/5-~ . Covenants and Restrictions: Yes If"Yes", please provide copy. Prior permits/approvals for site improvements: Agency No 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): ~, ~ J ' Description of Project: The roof gutters and leaders from the seaward side deck roof and the house roof will be connected to a drywell located as shown, by hand, on the 7-26-07 plans and revised January 27, 2010, prepared by Angel Chorno, of Chorno Associates, Architects. The debris and wood stored on the bank, in the area excavated, will be removed from the bank. 3 o The sand placed along the north side of Lot 24.1 will be removed by hand and redeposited on the bank to re-fill the excavated area on the bank. The owner/applicant will advise the trustees prior to commencement of the work, and will advise the Trustees when the work will be performed. After the sand is removed, the area will be restored with native sea grasses (either seed or plants). Grasses will be planted within 6 months of issuance of the permit. 5 o The as built stairs to the beach and existing wood retaining wall are included in this permit. of Trustees Appi±cat~-{ WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ~rea of wetlands on ~ot: S~ F~ ~'/5'~¥are feet Percent coverage o£1ot: <~ ~ % Closest distance between nearest existing structure and upland edge of wetlands: '-~ .D~/3 feet Closest distance between nearest proposed structure and upland edge of wetlands: ~//g-- feet d'.¢,~/~.~o~a-~ ~r~ee~ Does the project involve excavation or filling? No g/ Yes If yes, how much material will be excavated? ~L/!~"¢ ~cubic yards *F How much material will be filled? ~ ¢~', ~ cubic yards 4~ Depth ofwMch matefiM will be remov~ or d~osit~: ~ ~ feet Pmpos~slope~ou~outthe~eaofoperatio~: ~ ~ M~ M wMch material will be rmoved or d~osited: S~tem~nt of ~c ~ffect, if ~y, on ~ wetl~ds ~d ~dal waters og ~ to~ ~at may reset by ~ ~ o c~ ~. r~on of such P~pos~d op~tions (ase a~nts if appropriate): ~7~~ ~ / of Trustees App~icatJ- COASTAL EROSION APPLICATION DATA Purposes of proposed activity: ,~~~~ ~~.' Are wetlands present within 1 O0 feet of the proposed activity? No ~'/ Yes Does the project involve excavation or filling? No /~ Yes If Yes, how much material will be excavated.~ L~'~ ~(eubie yards) How much material will be filled? ~ C~..~, ~- (cubic yards) Manner in which material will be removed or deposited: ,~., ./~./~L Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) Board of Trustees Application County of Suffolk State of New York it~-~;~ J,/17/'~c'"-0-t-4-~ r~.,,./BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE~'A~"I$1~ICANT 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 INSPECT THE PREMISES 1N CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature SWORN TO BEFORE ME THIS ~'~ DAYOF 3/~:~],~ ,20 /~) 01/13/2010 10:25 F&Z 631 705 ¢643 U1/12/20.10 17:a5 FAX 851 ? MOORE LAW OFFICES Trustees [~002 ~PH. 12 2~10 l~;:34Pt, I P1 Southoki ToWn. Board of Trustees Town Hall 530~5'Main Road. p.o.B=i t179 ' 8outh~id, NY 11971. Josephine padovan 101-20 67 Drive .. Forest Hilts NY 11375 RE:' $CTM: 1000-125-1 23, 24.1 & 25.1 Sit or Madam: · . .,.. ~. ,,.i,ad ,~.,, m~ .~o~.., .,~,.~,;,,,;,,~Z~'.~'.'~~ ,..o ,,.., ou{' ~haif tnd ~ execute tny and all d~u,,,- -. . Thank you. Very trbly yogin, ~PADOVAN James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only ~'~Coastal Erosion Permit Application ~etland Permit Application Amendment/Transfer/Extension ~"Rece~vved Application:~ ~,.~l~eceived Fee:$J~~[~__ _0~ ~ompleted Appfidafion~X:~ __Incomplete __SEQRA Classification: Type I Type II Unlisted Coordmation:(date sent) ~I~WRP Consistency Assessment Form IC~ ~'~AC Referral Sent: l C~ ,~- ~-~Date of Inspection: ~.~(~'!r~ __Receipt of CAC Report: __Lead Agency Determination:__ Technical Review: ~,Ptlb'Iic Hearing Held: _t ~0 !,~1~ O~ Resolution: Name of Applicant Address Administrative Permit Suffolk County Tax Map Number: 1000 - } ~-I-o~ o~q,I Property Location: ~//5 <:>O0/')fi'/~/"/]~';'~6} (proviffe LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: Phone:(~? [~ fia~ of Trustees Applicat~' Land Area (in square feet): GENERAL DATA Area Zoning: b0 C-'TL~oClx_K Previous use ofproperty: /~ .5-/(r~/~T~&~'~ ~ ~~/~ ~tended use ofprope~y: ~ ~/~fi~~ ~ ~/~ Covenants and Restrictions: Yes If "Yes", please provide copy. Prior permits/approvals for site improvements: Agency V/No Date __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? No 3/'Yes If yes, provide explanation: /5/e0 too d'-'~-- /4-/-,g,~- o~ ~- $//~/ Project Description (use attachments if necessary): ~-'~7~:~i~/~*- / of Trustees Applicat' WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ?er¢~t¢overageoflot: < ~ % Closest distance between nearest existing structure and upland edge of wetlands: "' .D~/~ feet Closest distance between nearest proposed structure and upland edge of wetlands: ~/W- feet ('/~o ,~'.~op~ w*-~ ~za~z.e.~.~ Does the project involve excavation or filling? No / Yes If yes, how much material will be excavated? ~'¥ ~'~ ~cubic yards How much material will be filled? ~ ffSe ~' cubic yards 4~ Depth of which material will be removed or deposited: '~' o}- feet Proposed slope throughout the area of operations: '~ Manner in which material will be removed or deposited: Stat~ent of ~e effect, if ~y, on ~e wetl~ds ~d tidal waters of the to~ that may result re.on of such proposed operations (use a~ac~ents if appropriate): )ard of Trustees Applicat:' COASTAL EROSION APPLICATION DATA Purposes of proposed activity: Are wetlands present within 100 feet of the proposed activity? No J/ Yes Does the project involve excavation or filling? No ~' Yes If Yes, how much material will be excavated.~' L~J, ~(cubic yards) How much material will be filled? '-" ~--ff', ~- (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) PROJECT ID NUMBER PART t - 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 / Coun U/ ZK SEQR 3.PROJECT LOCATIOI~.~ L// /~ ~ /~Z'/l b ~/ Municipaltiy 4. PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks eta -or provide mad 5. IS PROPOSED ACTION: [~ New [] Expansion ~l~odificatio. /alteration 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WILL..PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? I 'lYes [~ No If no, describe bdefly: Re' WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many asapply.) sidential []Industrial []Commercial [~Agriculture ~ Park / Forest / Open Space r-]other(describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) ~ NO If yes, list agency name and permit / approval: 11. DO ANY ASPECT OF THE ACTION HAVE a CURRENTLY VALID PERMIT OR APPROVAL? ~es ~r~lo if yes. list agency name and permit / approval: i 12. a RESULT Of PROPOSED ACTION WILL EXISTING PEBMIT/ APPROVAL REQUI.RE MODIFICATION? I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Ap ' Date: 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 FAF. r-lYes []Ne B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative deotaralJoe may be superseded by another involved agency. I--lYes [.o C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surtace or groundwater quality or quantity, dolse levels, e~tstthg traffic pettem, solid waste ixeduc0on or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or cemmuntiy or neighborhood charaoter? Explain briefly: C3. Vegetation or fauna, fish. shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefiy: C4. A cemmun~'s existing plan* or go~ls as otficial~ sdopt~l, or & change In u~ or intensit~ o! u~ o~ land ~ otber natural r~oor~s? E~plain br~: I C~. Growth, subooqceot development, or rotsted e~ties ~. Lon~ term, shod terra, cumuleti~, or ctber o~::~ not ideotlfi~l th C1~§? fi.~ain tid~fiy: I C?. Other impsot~ Iim:tudin~ chanties in u~ o~ either ~usnt~ or ~ o[ ene~l~ E~lein bo~fi¥: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA ICEAI? (If),es, explain brier}/: i--lYes '1.oI E. IS THERE, OR IS THERE LIKELY TO BEI CONTROVERSY RELATED T© POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If ~/es explain: PART Ill - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, ledge, 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) geogmphio scope; and (t~ magnitude. If necessa~, add attachments or referenc~ supporting materials. Ensure that exptsnations contain suffic~nt detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was chedxed yes, the determination of significance must evaluate the potential impact of the proposed action on the envimnrnentel characteristics of the CEA. Check this box if you have identified one or more potentially large or slgnifisant adverse Impacts which MAY occur. Then proceed directly to the FULL FAF and/or prepare a positive deolaration. Chec~ this box ff you have determined, based on the information and analysis above and any supposing docurnenfation, that the proposed acrid WILL NOT result in any significant adveme envtronrnanfal impacts AND provide, on attachments as nacessapj, the reasons supporting thl determination. Board of Trustees .Name of Lead Age)~-y Jill PHrd or Type N~/e of Responsible Officer in Le~,ll~ Agency Signature of Responsible Officer in Lead Agency Date President Tifie of Responsible Officer Signature of Preparer (If different from responsible officer) PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Narfie: Address: STATE OF NEW YORK COUNTY OF ~K O~z?~ , being duly sworn, deposes ~d says ~at on th~ ~ day of ~ ~ ,20 o~, d~onent mailed a ~e copy of ~e Notice set fo~. xn ~e Bo~d of T~stees Application, d~ected to each of ~e above n~ed pe~ons at the ad~esses set opposite ~ere respective n~es; ~at ~e ad~esses set opposite ~e n~es ofs~d perso~ ~e ~e ad.ess ofs~d p~sons ~ sho~ on ~e c~ent ~sessment mil of ~e To~ of Southold; ~at s~d Notices were m~led at the U~ted States Post Office at ~t ]~16~ , ~at s~d Notices were m~led to each of said persons by (certified) (registered) mail. Swom to berate me this Day of OC~ , 20o_?_~ Notary Public MOHAMED $, RAHMAN Notary Public, State of New York No. 01RA6041406 Qualified in Queens County Commission Expires May 8, ~2 James F. King, Prcsident Jill M. Dohcrty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall, 53095 Main Rd. P.O. Box I 179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of MARIO ABBATE/JOSEPItINE PADOVAN COUNTY OF S~I--EK) STATE OF NEW YORK) AFFIDAVIT OF POSTING , residing at/dba /0/-o10 ~) being duly sworn, depose and say: That on the a) day of t9 '(24~ ,200~, I personally posted the property known as 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 eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wed.~ October 21~ 2009 on or about 6:00 PM. Dated: Sworn to b~,fo, re_ me this day of ~0~200~ Notary l~ul~t~i i .':~. w York Corem ss~[~ ~-'~ Coum~ uxO ros May 8, 2002 MOHAMED $. RAHMAN ~lotary puulic, State o[ New York No. 01RA6041406 Qualified in Queens County Commission Expires M~y 8,~2 OBoard of Trustees Applica~on County of ~S~ State of New York '~7~}/~2~/~) /~ '~7"~-- BEING DULY SWOKN 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 I-HS/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 INSPECT THE PREMISES IN CONJUNCTION W~.TH REVIEW OF THIS APPLICATION. Signature SWORN TO BEFORE ME THIS DAY OF ~ ~' ,20~ Notary Public MOHAMED S. RAHMAN Notary Public, State ol New YorR No. 01RA6041406 ified in Queens County Qua . , B a~2o~o Commission Expires May , APPLICANT/AGENTfREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics orohibits conflicts &interest on the r, art of town officers and employees. Thc DUmOSe of ~his 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. '-" ~ (Last name, tk~r hame,~odlc initial~ unicas ~l~e applying in the name of someone else or other entity, such as a company. If so, indicate ~he 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 (lf"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 o£ Southold? "Relationship" includes by blood, marriage, 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 Vo of the shares. YES NO ~ lfyou answered "YES", complete the balance of this form and date and sign where indicated. Name of person em'ployed by the Town of South_old Title or position of that person Describe the relationship between yourself(the applicant/agent/reprasentative) 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 o?ner 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 owner of any interest in a non-corporate entity (when the applicant is not a corporation); __C) an officer, director, pm'me?, or employee of the applicant; or __D) the actual applicant. DESCRIPTION Of RELATIONSHIP Form TS I Signature . Print Name 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 Area. 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 i~s 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- suooortine facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not bc 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 / The Application has been submitted to (check appropriate response): Town Board ~ Planning Board ~ Building Dept. [] Board of Trustees ~ 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) (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of actiort; - _ , 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) Name of applicant: 00) Mailing address: (c) Telephone number: Area Code ()~t/~) O~(a -c~3~-~¢ (d) Application number, if any: Will the action be directly undertaken, require funding, or approval 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 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. [~es ~ No [] Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III - Policies Pages 3 through 6 for evaluation criteria Yes I I No [-~ 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 ~--3~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 I'Yes No NotApplicahle 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 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 Not A~l[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. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria. Yes [] No V-~Not 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. [] Ye~ No [~/Not Applicable Attach additional sheets if necessary WORKING COAST POLICi~ 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 ~/Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peeonie 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 Southold. 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; Pages 65 through 68 for evaluation criteria. [] Yes Po -4/ ot Applicable AUTHORIZATION (where the applicant is not the owner) ~0~;~ ~~ residing at (print owner of property) (mailing address) do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. .// (~ffer ~ signature) 8 ,~&'~r / - '~7o 010 I - MAP OF ,PFZO-PB[~T.~ SUI'2..VEYED VIeI/V ,,% N S E JAN 1 2 2010 Young & Young NOTS5 ARDA = ID,,D'74 5(~. ~UW. VtS¥O~'5 d.E~TIFIC, ATION ANCELO PADOVAN $ou~hold, Toi,~n oF .~ouLholcl SuFFolk. C, oun~, Neon York. C, ounJ:~ T,:ax ~¢1~ IOOO 1~5 OI 2~ DIs~dct I000 s~u~. 1~5 s~o=~ OI Lo~ 24 I I~XICTIN~ ~ONDITION.~ MAP