HomeMy WebLinkAboutTR-7398AJill 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 OF TOWN TRUSTEES
TOWN OF SOUTHOLD
YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72
HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT
FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE
CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT.
INSPECTION SCHEDULE
Pre-construction, hay bale line
1st day of construction
½ constructed
Project complete, compliance inspection.
Jill M. Doherty, President
James F. King, Vice-President
Dave Bergen
Bob Ghoaio, 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.: 7398A
Date of Receipt of Application: August 31, 2010
Applicant: Mo Ahmadzadeh
SCTM#: 54-4-11
Project Location: 925 North Sea Dr., Southold
Date of Resoiutionllssuance: September 22, 2010
Date of Expiration: September 22, 2012
Reviewed by: Trustee Bob Ghosio
Project Description: To modify the existing plantings by adding native species.
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 on the
application received on 8/31/10 and survey stamped approved on 9/22/10.
Conditions: Final inspection.
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.
Boarfl ol TrL~/~.~ t:es i/
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 ~[~1/10 has been
reviewed by this Board at the regular meeting of ' C~[n~ I1) and your
application has been approved pending the complet'i6n of the following items checked
off below.
__ Revised Plans for proposed project
__ Pre-Construction Hay Bale Line inspection Fee ($50.00)
__ 1st Day of Construction ($50.00)
__ ¼ Constructed ($50.00)
t///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:
BY: Jill M. Doherty, President
Board of Trustees
Jill M. Dohe~ty, President
James F. King, Vice-President
Dave Bergen
Bob Ghosio, Jr.
Johll Bredemeyer
P.O. Box I ~79
Southold, NY 11971
Telephone (631) 765-1892
Fax (631) 765-6641
Date/Time:
Southold Town Board of Trustees
Field Inspection/VVorksession Report
Creative Environmental Design on behalf of MO AHMADZADEH requests an
Administrative Permit to modify the existing plantings by adding native
species. Located: 925 North Sea Dr., Southold. SCTM#54-4-11
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 ~Amendment
__Administrative__Emergency Pre-Submission __Violation
Info needed:
Modifications:
Conditions:
Present Were: __&King __J.Doherty __J. Bredemeyer __
B.Ghosio, D. Dzenkowski other
Form filled out in the field by ~
Mailed/Faxed to:
Date:
D. Bergen__
.......... C[ llJ~J COUNiY OF SUFFOLK $OglhOLD
SURVEY OF PROPERTY
A T SOUTHOLD
TO,tN OF SOUTHOLD
SUFFOLK COUNTY, N.Y.
1000-54-04-11
SCAL~: I~$0'
JUNE 5, 2008
JUNE 26, 2008 (revisions)
~ ~ I / I / "
~ : ~ I ~ ~/4 ~ AREA TO COASTAL ER~S~O~ HAZARD
, =,~ , I ~ 2zs, ~ I ~ LINE =4500
~ : ,,,, x, '
7~ ~ Board of Trustees
, .... ~" S59~4'00'W 100.00'
NORTH SEA DRIVE
PUBLIC W~ TER IN STREET
COASTAL EROSION HAZARD LINE FROM
COASTAL EROSION HAZARD MAP PHOTO ,,~ 56-566-8,
FLOOD ZONE FROM FIRM MAP NO. J610JC0154 G
MA Y 4, 1998
AREA=30,085 SO. FT.
ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION
OF SECTION 7209OF THE NEW YORK STATE EDUCATION LA P~
EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTIFICATIONS
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF
SAID MAP OR COP/ES BEAR THE IMPRESSED SEAL OF THE SURVEYOR
I/I,f"IOSE SIGNA FURE APPEARS HEREON.
ELEVA TIONS REFERENCED TO N. G. V.D.
~'~'~'~oz.---N.Y.S.L/C. NO. 496h
tS~-CONIC SUA~YORS. P.C.
(631) 765-5020 FAX (631) 765-17~7
P.O. BOX ~0~
1~0 TRAVELE~ S[~EET[
SOU~OLO, N. X 11971 08-142
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, Principal Planner
LWRP Coordinator
Date: September 16, 2010
Re: Proposed Wetland Permit for MO AHMADZADEH
SCTM# 1000-54-4-11
Creative Environmental Design on behalf of MO AHMADZADEH requests an Administrative Permit to
modify the existing plantings by adding native species. Located: 925 North Sea Dr., Southold.
SCTM#54-4-11
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
CONSISTENT with the denoted following Policy Standards and therefore is CONSISTENT with the
LWRP.
Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its
written determination regarding the consistency' of the proposed action.
Cc: Lori Hulse, Assistant Town Attorney
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 (63 I) 765-1892
Fax (63 I) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only
_._Coastal Erosion Permit Application/
___Wetland Permit Application I/Administrative Permit
Amendment/Tran~ fer/Ex,tension
~.R~ ece~ved Application:~
~_P,:eceived Fee:$
.~Jompleted AppliCation
__Incomplete
__SEQRA Classification:
Type I Type II Unlisted
Coordination:(date sent)
~ Consistency Assessment Form q [ ~.-\~,O
~--CAC Referral Sent:~[[
~te of Inspection: _
~Receipt of CAC Report:
__Lead Agency Determination:
__Technical Review:
~./'Public Hearing Held:
__Resolution:
/60/,5
Phone Number:( )
Suffolk County Tax Map Number: 1000- ~c/_ O~j ~ t[
Property Location: 7Z~' ~f) C¢~,-- <~lgGc_ ' ~'~)C; d~
(provide LILCO Potle #, distance to cross streets, and location)
(If applicable)
Address: B~[{JD ~,.~ ~2~q-.
Phone:
,, BOd Of Trustees Applicatlon0
GENERAL DATA
Land Area (in square feet): ~;~(~) ~
Area Zoning: ~,
Previous use of property:.
Intended use of property:.
Covenants and Restrictions:
If "Yes", please provide copy.
Yes /No
Does this project require a variance from the Zoning Board of Appeals __
If "Yes", please provide copy of decision.
Prior pemfits/approvals for site improvements:
Agency Date
Yes ~
' ~No prior permits/approvals for site improvements.
Has any permiffapproval ever been revoked or suspend~l~by a governmental agency?
Yes
If yes, provide explanation:
Project DescriPtion (use attachments if necessary):
~d of Trustees Applicatio0
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations:
Area of wetlands on lot: o square feet
Percent coverage of lot: C~ %
Closest distance between nearest existing structure and upland
edge of wetlands: ]~-o feet
Closest distance between nearest proposed structure and upland
edge of wetlands: /~-~D feet
Does the project involve excavation or filling? ~No Yes
If yes, how much material will be excavated?
How much material will be filled?
Depth of which material will be removed or deposited:
Proposed slope throughout the area of operations:
Manner in which material will be removed or deposited:
cubic yards
cubic yards
feet
Statement of the effect, if any, on the wetlands and tidal waters of the town that max result _b~
"mason' of-sudi'pr~pos~d' b~erafi~ns"(us~a~h~en~s {i~'~pp{0~i-at~Si
PROJECT ID NUMBER
PART 1 - PROJECT INFORMATION
1. APPLICANT I SPONSOR
I ~ 'r~--n,~'~ ~J~/,
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. PR~;T NAME
SEQR
3~'~)'~ ECT L(~CATION:' Coun[y
[ Munic/patity _~),,r'~ ~%(~ J \ ~-~'k-'vI , .
PRECISE LOCATION: Street Addes§ and Road Intersec§ons, Prominent landmarks etc -or provide mad
IS PROPOSEO ACTION: [] New
DESCRIBE PROJECT BRIEFLY:
]Expansion ~el1~ification / alteration
7 AMOUNT OF LAND AFFECTED: O~
Initially · O? acres UIflmately ~ acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS?
~Yes [] No If no, describe briefly:
IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.)
dential [~ Industrial [~] Commercial [~]Agriculture [~] Park / Forest / Open Space
10.'DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDING,
AGENCY (Fed_.~ State or Local)
]Yes ~,~1-No If yes. list agency name and permit / approval:
[~Other (descdbe)
NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
13. U[JE~5 ANY~Y A~,~A'FECt [Jl" IHE ACIION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? []Yes [~No If yes, list agency name and permit / approval:
12. AS A RESr~JJz~ OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION?
J~Yes L..~ No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Signature (~/--~~~ Date: (~
V
~tlon 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 ff yes, coordinale the review ixocess aad use the FULL EAF'
I-1 - 171No
B. V~LL ACTION RECEIVE COORDINATED REVIEVV AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative
dedaraben may be su~ by ano{h~ immlved agency.
C. COULD ACTION RESULT IN ANY N:)VERSE EFFECTS ASSOCIATED ~ THE FO(LOWING: (Answer~ may be handvai~ten, If legible) Cl. E~ a~' qual~, surlece or groundwaler quarry or quanllty, ~tse le~le, e~ beflic patlem, s~ld waste ixad~ or ~'
o
C5. Growth, subsequent de,,e;,~i.~nt, o~ related active, s likely to be induced by Ibe proposed action? F~?~n briefly:
C7. Other ~,T,l~..~.{including Gw,~ in use of either ¢luan~ or t)~pe of eaor~l~ F-J(plaln txlel~.
O. ~N~LL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL
I
E. IS THERE, OR IS THERE UKELY TO BEI CONTROVERSy RELATED TO'pOTENTIAL ADVERSE ENVIRONMENTAL IMPACTS?
PART III - Dc g I=KMINA~'ION OF SIGNIFICANCE (To be completed by Agency)
INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important.or othen~se significant. Each
effeof should be assessed in connection with its (a) setting (i.e. U~an or rural); (b) probability of occuntng; (c) duration; (d) Irreverslbility;, (e)
geographic sc~pe; and (0 magnitude. If ne,-e~_ _~, add attachments or reference supporting materials. Ensure that explanatkms contain
suffictent detell to show that all rulevent adverse impacts have been identified and adequately addreased. If queniton d of part Ii was cbeckad
ye~, Ihe,determination of~gnificence must evaluate the potential impact oftbe proposed action off the environmental charectedstlce of the CEA
Check Ihle bex If you ham Identilled one or mom poleflt~ally large or slgnlltcant ae, mme impacts which MAy occur. Then preceed dlrecby to lira FUU
FAF and/or prepare a pe~lve declaration.
Ct~ck this box if you have detemdnsd, based oo the In~tioo and analysis abeve and any suppe~lg documefltado~, that the I~,,ed acd(x
WILL NOT result in any significant edveme ~ Impacts ASD provide, off attach0~ as ilece~, the reasofla supporting thl~
detmmlmiflorl.
Board of Trustees
Name of Lead A~ensy
Jill M. Doherty ·
P/lint or Type Name o~' Responsi~!e Officer.,in Lead Agency
//~---Signa'tum of ReSpOnsible Offi~l~in Lead Agency
President
Signature of Preparer (If diiferont from responsible officer)
Title of Responsible Officer
Town of Southold
Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM
PROPERTY LOCATIOH: S.C.T.M.~ THE FOLLOWING ACTIONS MAY REQUIR~ THE SUBMISSION OF A
~ S~ ~)(~ ~ STORN-WATEI~ GRADING, DRAINAGE AND EROSION CONTROL PLAN
E)l~-ss .~:~ CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK.
SCOPE OF WORK. - PROPOSED CONSTRU~,TION ITEM # / WORKASSESSMENT [ Yes No
a. What is the Total Ama of the Project Parcels? / ·
(IncludeTotalAreaofallParceislocetedwithin ~/~ Or'3-./ L'Z~ I WitithisProjectRetainAIIStorm-WaterRun-Off
the Scope of Work for Proposed Construction) c~' ~o/~ ,, ,~' Generated by a Two (2') Inch Rainfall on Site?
(s.~/~.s) O~is item will include all mn-off created by site
What is the Total Area of Land Clearing '1
b. and/orOroufldDisturbanceforthepruposed )--~::)-- ,.O--~ / ~' cleadng and/or construction activi§es as well as all --
Site Improvements and the permanent creation of
construction ac~ (~[F. IAcms) impervious sudaces.)
PROVIDE BRIEF PROJEC~ DF~CIIII:'TION (P.~d. Add~.a,.g..~Ne~ed) 2 DoestheSitePlanendlorSurveyShowAtiProposed
Drainage Structures Indicating Size & Location? This
Item shall include all Proposed Grade Chenges and
Slopes Controlling Surface Water Flow.
~rY)oDIC~'~ C"~tST, [J~--rl~--'~'T-10~"J' I 3 Does the Site Plan andlor Survey describe the erosk)n
~ I-'~,'~,l~ {k.J j¥1--; ~/~ ~:;~'~ 0,.~ 10~ ~'~ and sedlmenl contrct prentices that will be. used to
~ control site erosion and storm water discharges. This --
/~T~ ~- (~ ~'~(At~ . item must be maintained thronghout the Entire
Construction Period.
4 Will this Project Require any Lend Riling, Grading
Excavatien where there is a change to the Natural D ~'~
E×isfing Grade Invol¥ing moro then 200 Gubic Yards
of Matadal withte any Parcel?
5 Will this Applice~on Require Land Distud~ing Activities r'~
Encompassing an Area in Excess of Five Thousand V
(5,000 S.F.) Square Feet of Ground Surface?
6 Is there a Natural Watar Course Running through ~.~e
SitO? is this proj~C't wi~ln the Trustees iufisdictio~
t~ml D~C ~lt~ R~qulmm~nt*: Or within One Hundred {100'} ~t of a Wetland or
am pelt of a lal~jer commo~ lYan that ~11 ultimately disturb ~le or mom acres of land; which Exceed Fffieen (15) feet of Verflcel Rise to
required, posi-eonstmc~n storm ,,,~le~ management practices that wil be used andlor Removal of Vegetation and/or fl~e Consfmction of any r~
ST.&T~ OF NEW ¥O~,_-%
COUNTY OY ........................................... SS
That ,. ........................................................................... bem~ duJy sworn, deposes and szys th~ be/sbe is thc applJcam for Permit,
Owner and/or representative of the Owner or Owners, and is duly authorized to ~ ~.i$1rMll~Slbnned the said work and to
make and file this application; that all statements contained in this application all, tam .~[~,t~.. t.~l~ ~%wledge and belief; and
that the work will be performed in the manner set foah in the application fried hqfff~'iii~t;ik ~unt~
Sworn to before me this; C0~nmi"~i0n ~~,~
........... ...3....tr..., .................. ............................ /7 W
.................. ........
FORM - 06110
Board of Trustees Application
County of Suffolk
State of New York
~(~"~/k~' & Ct~' BEINGDULY SWORN
DEPOSES ~ ~F~S THAT ~/S~ IS T~ ~PLIC~ FOR T~ ~O~
DESC~ED PE~T(S) ~ T~T ~L STATE~S CO~D ~ ~
TR~ TO T~ BEST OF ~S~R ~OWLEDGE ~ BEL~F, ~ T~T ~L WO~
W~L BE DO~ ~ T~ ~R SET FORTH ~ T~S ~PLICATION ~ AS MAY
BE ~PRO~D BY T~ SOUTHOLD TO~ BO~ OF TRUSTEES. ~ ~PLIC~T
AG~ES TO HOLD T~ TO~ OF SO.HOLD ~ T~ TO~ TRUSTEES
~ESS ~ F~E FROM ~Y ~ ~L D~AGES ~ CL~S ~S~G
~ER OR BY ~RT~ OF S~ PE~T(S), ~ G~ED. ~ CO~LET~G T~S
~PLICATION, I ~BY A~HO~E T~ ~US~ES, T~ AGENT(S) OR
~P~SENTATI~S(S), TO EN~R ONTO ~ PROPERTY TO ~SPECT T~
co TiO TiO .
,,-
SWORN TO BEFORE ME THIS ~}'"~ DAY OF ~ ~/
,20/0
ublic
LAUREN M. STANDISH
Notary Public, State of New York
No, 01ST6164008
Qualified n Suffo/k County
Commission Expires April 9, 20L(.
~ C~:C~),~_~ , _to a~ly ~o:];4z~(a) ~om ~he
Sou~hold BOLt'd Of Torn Trul~e~l on ml~btha~.
APPLICANT/AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE. FORM
The Town of Southold's Code of Ethics orohibits conflicts of interest on the uart of town officers and emnlovees. Tho nuroose of
this form is to nrovide information which can alert the town of uossible conflicts of interest and allow it to take whatever action is
(Last name, first name, lniddle initial, unless you are apPlying:in the name of
someone else or other entity, such as a company. If so, indicate thc other
person's or company's name.)
NAME OF APPLICATION: (Check all that apply.)
Tax grievance Building
Variance Trustee
Change of Zane 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, sthling, parent, or child) have a relationship with any officer or employee
of the Town of 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% of~lmres.
YES NO
If you answered "YES", complete the balance of this form and date and sign where indicated.
Name of person employed by the Town of Southold
Title i>r position of that person
Describe the relationship between yourself (the applicant/agent/representative) and the town officer or employee. Either check
the appropriate line A) through D) and/or describe in the space provided.
The town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply):
__A) the owner of greater than 5% of the shams of the corporate stock of the applicant
(when thc applicant is a corporation);
__B) the legal or ~eneficial owner of any interest in a non-corporate entity (when the
applicant is not a corporation);
C) an officer, director, partoei', or employee of the applicant; or
__D) the actual applicant.
DESCRIPTION OF RELATIONSHIP
Form TS 1
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~
sum~orting 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
PROJECT NAME ~0 ]~ ~/t'tOff/~ ~D ~--' p-J
The Application has been submitted to (check appropriate response):
TownBoard [] Planning Board [] Building Dept. ~ BoardofTrustees~f~
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: q~
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:
Co) Mailing address:
(c) Telephone number: Area Code ( )_
(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. ~NotA
[-~Yes ~ No pplicable
Attach additional sheets if necessary
Policy 2. Protect and pr~rve historic and archaeological resources of the Town of Southold. See
LWRP Section III - Po~es Pages 3 through 6 for evaluation criteria
~ Yes ~'] No ~[-~ Not Apphcable--
Attach additional sheets if necessary
Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See
LWRP Section III -~s Pages 6 through 7 for evaluation criteria
~ Yes ~ No ~_Jr~r/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 Pa~e~s 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 throu~21 for evaluation criteria
[~ Yes ~ No~t/--1 Not Applicable
Attach additional sheets if necessa~3,
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 evaluati~ criteria.
/
Yes No
ot pp ~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~/Not Applicable
Attach additional sheets if necessary
Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous
substances and waste~ See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria.
[] Yes ~ No f[-~ 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. ~No
~ Ye? No tApplicable
Attach additional sheets if necessary
WORKING COAST POLICIES
Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in
suitable locations. 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 wa~ers. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria.
~ Yes [--] Nofi~-l~Not Applicable
Attach additional sheets if necessary
Policy 12. Protect agricultural lauds in the Town of Southold. See LWRP Section III - Policies; Pages
62 through 65 for~tation criteria.
[] Yes ~ No ~ Not Appbcable
Atlach additional sheets if necessary
Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP
Section III - Polic~ges 65 through 68 for evaluation criteria.
~'~ Yes [--] No yl~Not npphcable"