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Home My WebLink AboutTR-7339AJill 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 Permit No.: 7339A Date of Receipt of Application: June 23, 2010 Applicant: Sandra Fellman SCTM#: 123-4-13 Project Location: 2850 Deep Hole Drive, Mattituck Date of Resolution/Issuance: July 21, 2010 Date of Expiration: July 21, 2012 Reviewed by: Board of Trustees Project Description: Maintenance permit to hand-cut Common Reed (Phragmites australis) to a height not less than 12" on an as needed basis. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated in the application received on June 23, 2010. § 275-5 Permit procedures. (i) Cutting of common reed (Phragrnites australis) to within 12 inches of the soil surface landward of the wetland boundary. This does not include mowing to ground level. Special Conditions: Do not disturb native vegetation dudng the hand cutting of Common Reed (Phragmites australis), including but not limited to; Eastern Red Cedar (Juniperus virginiana), Northern Bayberry (Myrica pensylvanica), Marsh Elder (Iva frutescens), and Groundsel Bush (Baccharis halimfolia). Inspections: Final inspection due after initial phragmite trimming. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. Jill I~1')Doherty, President~/ Boah~ of Trustees JMD/eac J APPROVED BY BOARD OF TRUSTEE~ TOWN OF SOUTHOLD DATE. AiWA = 26.200 ~a.. ft. to tie lt~ne JUN 2 3 2010 Sou/hhoJd Town Board of Trustees SURVEY OF PROPERTY A T MA TTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK 1000-123-04- 13 SCALE: 1'=40' SEPT 8, 1999 [leFt;lied to: ANv AL~EF,;~OAz OR ADDITION FC THiS SdRVE~ IS A VtOLAT~Ot~ 0T SECT/Ot~ ?209 OF THE NEW YORK ~TAT[ EDUCATION LA~ ExCEP~ ~E PER SECTION 720g-SUBDIFtSIQ~ 2 ALL CERTIFICATIONS ~ERE~ A~:: V~t ~ FOR THIS MAP AND COPIES r~EREOF ONL ,' ~ SA~D ~A~ CR ~: '~S BEAR TNE iMPRESSED SEAL OF T~ SurvEYOR W~QSE S~G~ .~ T~ APPEARS HEREON Sondro L Feiim, or 7099-2264 ?230 TRAVELER STt?EE~' SOUT~OLD, N 'a ~197~ t~O 496~ J 9-$0 Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OFTOWNTRUSTEES TOWN OFSOUTHOLD 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 ~ constructed __ Project complete, compliance inspection. 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 (631 ) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Please be advised that your application dated ~,-t~ ~.. ,~O./r~ has been reviewed by this Board at the regular meeting of '~,,)1~, o,o/. o~0/O and your application has been approved pending the completiOh of {he 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) __ ¼ Constructed ($50.00) ~ Final Inspection Fee ($50.00) __ Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southotd Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE:$.~L~----~°~ BY: Jill M. Doherty, President Board of Trustees Jill M. Dohe~xy, President James F, Kmg, Vice-President Dave Beqgen Bob Ghosio, Jr. John Bredemeyer P.O. Box 1179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631 ) 765-6641 Southold Town Board of Trustees Field Inspection/VVorksession Report Date/Time: SANDRA FELLMAN requests an Administrative Permit to trim the phragmites to a height not less than 12" on an as needed basis. Located: 2850 Deep Hole Dr., Mattituck. SCTM#123-4-13 TY[~ 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 T~Y~Ad of Application: Wetland __Coastal Erosion __Amendment ministrative__Emergency Pre-Submission __Violation Info needed: Modifications: Conditions: Present Were: __,,.,,,ng~ __ . erty__ . edemeyer rge B.Ghosio, __ D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold, NY 11971 MAILING ADDRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631 765-1938 Fax: 631 765-3136 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Jill Doherty, President Town of Southold Board of Trustees From: Mark Terry, Date: July 19, 2010 Principal Planner LWRP Coordinator Re: Proposed Wetland Permit for SANDRA FELLMAN SCTM#123-4-13 SANDRA FELLMAN requests an Administrative Permit to trim the phragmites to a height not less than 12" on an as needed basis. Located: 2850 Deep Hole Dr., Mattituck. SCTM#123-4-13 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is EXEMPT from LWRP review pursuant to: § 268-3. Definitions. MINOR ACTIONS item "FF" which states: FF. Cutting phragmites to greater than 12 inches and vegetative restoration, provided that native wetland vegetative species are not affected or disturbed in any manner; Cc: Lori Hulse, Assistant Town Attorney James F. IZ~ng, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob ~nosio, 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 Applicatio~ Wetland Permit Application ~' Administrative Permit R ~Amendmenffl'r ann ferfE>it ensi°n eceived Application: eccived Fee:$ ~ ~ f ' ~Completed Application tD ~Incomplete __SEQRA Classification: Type I Type II Unlisted__ Coordination:(date sent) ..-'LWRP Consistency Assessment Form CAC Referral Sent: ~/Date of Inspection: Q ! i q Receipt of CAC Report: Lead Agency Determination: Technical Review: ,.Pablic Hearing Held: r')~-. _.z~l [ lO ' Resolution: JUN 2 3 2Si0 $0uthh01d Town Beard of Trustees tV¥c_ Suffo~ Co~ty T~ M. Number: 1000- 1 ~3 - % -- ~5 ~rovide LILCO Pole ~, dist~ce to cross s~eets, ~d location) AGENT: (If applicable) Address: Phone: of Trustees Applicati~ GENERAL DATA LmndArea(insquarefeeO: ~'~.~..0(~ %.'~- Area Zoning: ~ jdmCt ¢~ Previous use of property: Intended use of property: Covenants and Restrictions: Yes x)<, No If "Yes", please provide copy. 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? X No__ Yes If yes, provide explanation: Project Description (use attachments if necessary): 12_'I of Trustees Applicati WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operatio, ns: ,~ t/L0,.c~ [Y'I ~-~<..~ , Area ofwetlands on lot: :n., quare Percent coverage oflot:~f~O feet Closest distance between nearest existing structure and upland edge of wetlands: ] ~D feet Closest distance between nearest proposed structure and upland edge of wetlands: .~/~_ feet Does the project involve excavation or fil!ing? ~r No Yes If yes, how much material will be excavated? How much material will be filled? cubic yards cubic yards Depth of which material will be removed or deposited: Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: feet Statement of the ?_ff_ec[~ ~if any, 0_n the wetl~ds and..tidal_ wa_ters_ of Ih? town tha_t ~ay resu!t__b_y reason of such proposed operations (use attachments if appropriate): PROJECT ID NUMBER PART 1 - PROJECT INFORMATION 3.PROJECT LOCATION: Municipality 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 4. PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc -or ~rovide map 5. IS PROPOSED ACTION: ~ New r--] Expansion r~Modificafion / alteration SEQR 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY VVITH EXISTING ZONING OR OTHER RESTRICTIONS? r'"~Yes ,~ NO If no, describebdefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) [~Re$idential [~]lndustdal E~]Commercial e~]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) E~Yes ~No If yes, list agency name and permit / approval: 11. uul::5 ANY A:SPECI UP [~HE A~JIION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [~Yes ,[~No If yes, list agency name and permit / approval: i12. AS A ~ULT OF PROPOSED ACTION WILL EXmSmINe PERMIT/ APPROVAL REQUIRE UODIFICATION? I es I CERTIFY THAT THE INFOR~,T~O/I~ ~iROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE 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, ccordinata the review process and use the FULL EAF. F-1 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. [-']Yes r-]No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) Cl. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattam, solid waste production or disposal, poten6al for erosion, drainage or flooding problems? Explain bdefly: C2. Aesthetic, agricultural, archaeological, historic, or other ~l;t~a~ or cultural re;~;; or c0~uni~j ~)7 neigh~cod ch-a~cl~r? Explain bdefly: C3. Vegetation or tauna, tish, shellfish or wildlife species, significant habitats, or throateced or endangered spacies? ~xplain 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 nalural resources? Explain briefly: C5. Growth, subsequent development, or mlatad activities likely to be induced by the proposed action? E×plaia br~fly: C6. Long term, short term, cumulative~ or other effec~ not identified in C14957 fixplain briefly: CT. Other impacts (including changes in use of either ~uanti~ or t~e ofener~¥? Explain briefly: D. VVlLL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICA ENVIRONMENTAL AREA ICEA? Ill yes, explain briefly: r~Yes [~No E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If }'es explain: ~lYes [~]No PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: F~reachadversee~ectidenI[~edab~ve~determinewhetheritissubstantia~~~arge~imp~rtant~r~therwisesigni~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 rei~erence supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified a~d adequately addressed. If question d of part ii was checked Check this box if you have identified one or more potenUally large or significant adverse impacts which MAY occur. Then proceed directly to the FULl EAF and/or prepare a positive declaration. WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessa~, the reasons supporting thi., determ~ation. Name of Lead Agency Date lint or Type Name of ~sponsible Officer in Lead Agency Title of Responsible Officer Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCA~ON: S.C.TJ4. ~. THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A s~Uon L~ (~=K I W,=U BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. scOpE OFWORK - PROPOSED CONSTRUt;YlON ITI~I # / WORKASSESSMENT I Yes No a. What is the Total Area of the Project ParceLs? (Include Total Area of all Pameis located within I~ _..-.. I Will this Project Retain Ail Storm-Water Run-Off Ihe Scope of Work for Proposed Construction)~ Generated by a Two (2') Inch Rainfall on Site? b. What is the Total Ama of Land Ctaaflng (S.F. IAc,~) (This item will include all run-off craated by site ~.,/./_.~ ~ cleadng and/or construction acitvi§ee as well as all constructionand/°r GroUndactivlty?Disturbance for Ihe proposed[~/F/"'~'~. / ~) ImpendousSite ImprovementSsurfaces.)and the permanent creation of Drainage Structures Indicating Size & Location? This ~.~EC/~ Item shall include all Proposed Grade Changes and ~-,~-~ .-~-~ ~r~O IC~.) Slopes contmtiing Surface Water Ffow. and sediment control practices that will be used to i.~,(.~.~[~y%0~,,._~~. ~__.~/~,~../~__) ~.-~ control slte eroslon and storrn water discharges. This item must be maintained throughout the Entire ~ ~ _-, Construction Pedod. '-"'1- I'~"~ 4 ExcavationWill this ProJectwhereRequirethere isany Land Filling, Grading or ~.~...~ i.~_...~ a change to the Natural _ Existing Grade Involving more than 200 Cubic YardsI--I of Matedal within any Parcel? 5 Will this Application Require Land Disturbing Activities r""i Encompassing an Area in Excess of Five Thousand (5,000 S.F.) Square Feet of Ground Surface?~ -- 6 Is there a Natural Water Course Running through the ~ site? Is this Project within ~e Trastaes jurisdiction General DEC SWPPP Requlmmento: or within One Hundred (100') feet of a Wetland or Submission ofa SWPPP is required for all Const~ction activities invoking s~ Beach? disturbances of one (1) or mom acres; including disturbances of less than one acm t~at 7Will there be Site preparation on Existing Grade Slopes r"---,i are pad of a larger common pisn that wi~ u~trmato~y dbtu(o one or more acres of land; which Exceed Fift.e, en (15) foet of Vertical PJse to I ioc~d~g Consto~ofbn activities Invo~ng sol disturbances of toss than one (1) acre where One Hundred (100 ) of Hodzontal Distance? L~J the DEC has dofen'Nned that a SPDES permit is required ~or store1 water dlssharges. SWPPP'~ Shall meet the Mtnlmum Requirements c4the SPDES General Permit 8 Will Driveways, Paddng Areas or other Impervious I'---1 for Storm Water Discharges ffmlt Construction activity. Permit No. GP-0-10-00t,) Surfaces be Sloped to Direct Storm-Water Run-Off t. The SWPPP shell he prepared prior to the submittal of the NOI. The NOt shell be into and/or in the direction of a Town right-of-way? STATE OF NEW YORK, ~,\ f'f COUNTY OF ...~.~.~..~...I. ................ SS And that he/she is the .................................. CD ~ /I ~_~ y~ ......... '('o~;~ ~ ~ ~;?/,~;~i~ c~x:~ ~:; ~'~ i ................................................................ Owner and/or representative of the Owner or Owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this applicallon are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed herewith. ~wom to before me this; /'~ ~.x" ~ VICKJ TOTH / Notary Public: ..~.. ~ .......... ~ .............................. J~lary.,-~.ic,,~a~of. New Yorl~-~ ~ Qv::..~9.0)JO6190696,..,.:..;.;g:;,,?.:;,;,_.. "~ - FORM - 06/10 [iv res July 28, 2~1_~~ ~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 1N 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 WITH REVIEW OF THIS APPLICATION. ~ ~ - Signature SWORN TO BEFORE ME THIS c~),_~ DAY OF ~.~-~- ~ -,,~ ,20/O Notary Public VIOKI TOTH ofary Public.Stete of New York No. OZTO6Zg0696 Qpal~ied in Suffolk County ~omm~ssiun Expires July 28, 2D / Oara of Trustee-~ applicatO AUTHORIZATION (where the applicant is not the owner) (print owner of property) residing at (mailing address) do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (Owner's signature) APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE~ FORM The Town of Southold's Code of Ethics nmhibits conflicts ofinterast on the lyart of town Officers and emolovces. The nuroose of this form is to nrovide information which can alert th~ town of oossible cenflicls of interest and allow it to take whatever action Ms ¥OURN E: t' (Last name,, first name, ~niddl'e initial, unless yOU are applying in the name of someone el~e or other entity, such as a company. If so, indieat~ 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, marriage, or b~iness interest. "Business interesf' means a business, including a partnership, in which the town officer or employee has even a partial ownership of (or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. YES NO N~ If you answered "YES", complete the balance of thls form and date and sign where indicated. Name of person employed by the Town of Southold Title Or position &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 the shares of the corporate stock of the applicant (when the applicant is a corporation); __.B) the legal or beneficial own~ of any interest in a non-corporate entity (when thc applicant is not a corporation); __.C) an officer, director, par~nei', or employee of the applicant; Or __.D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS 1 · ,., Submitt Othi d yof\l Signatur~ 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 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- suooortin~ 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 SCTM#- The Application has been submitted to (check appropriate response): TownBoard ~ Planning Board [] Building Dept. [-~ BoardofTrnstees/~_ 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 action: . 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: (b) Mailing address: ,~_(~ ~~]~/~ (c) Telephone number: Area Code ( )~ q,~_.~ (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. Yes ~-] 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 [] 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 [-~ 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 [] No ~-~ Not Applicable 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 Yes ~ No [~Not Applicable 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. WORKING COAST POLICIE~ 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 Peconic Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. Yes Nol 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; Pages 65 through 68 for evaluation criteria. Yes [] No [] Not Applicable TITLE Yes No /~ot Apl~ble 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 [~ Not 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 ~] 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. [] Ves~ No [~ Not Applicable Attach additional sheets if necessary