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Home My WebLink AboutMoyle, DonaldJill 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 Southokl, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0593C Date: October 14, 2010 THIS CERTIFIES that the construction of an 8'x6' garden shed At 1920 Minnehaha Boulevard, Southold, New York Suffolk County Tax Map # 87-3-63.1 Conforms to the applications for a Trustees Permit heretofore filed in this office Dated 7/14/2010 pursuant to which Trustees Administrative Permit # 7342A Dated 7/21/2010 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 construction of an 8'x6' garden shed The certificate is issued to DONALD MOYLE 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 SOUTHOLD DATE OF INSPECTION: ~///' Ch. 275 Ch. 111 INSPECTION SCHEDULE INSPECTED BY: COMMENTS: __ Pre-construction, hay bale line/silt boom/silt curtain __ 1st day of construction % constructed v/'/' Project complete, compliance inspection. Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hail 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.: 7342A Date of Receipt of Application: July 14, 2010 Applicant: Donald Moyle SCTM#: 87-3-63.1 Project Location: 1920 Minnehaha Blvd., Southold Date of Resolution/Issuance: July 21, 2010 Date of Expiration: July 21, 2012 Reviewed by: Trustee Bob Ghosio, Jr. Project Description: To construct an 8'x6' garden shed. 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 site plan prepared by Donald Moyle, received on July 14, 2010, and stamped approved on July 21, 2010. Special Conditions: None. Inspections: 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. Jill I~ Doherty, Preside~lt Boai'd of Trustees JMD:eac /,PPROVED BY ;OARD OF TRUSTEES TOWN OF SOUTHOLD dUL 1 4- ~010 Southotd Town Board of Trustees / / ./ .." 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 (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 Ghosio, Jr. John Bredemeyer Town Hall, 53095 Main Rd. P.O. Box 1179 $outhold, NY 11971 Telephone (631 ) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: Please be advised that your application dated ~'-(.,~,~, I c//c~/O has been reviewed by this Board at the regular meeting of ,.3--~ I~, o~ l, ,-~:¥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 Bale Line inspection Fee ($50.00) __ 1st Day of Construction ($50.00) __ ~ 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 Jill M Do6erty. President James F. King, V/ce-President Dave Bergen 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/Worksession Report DONALD MOYLE requests an Administrative Permit to construct an 8'X 6' garden shed. Located: 1920 Minnehaha Blvd., Southold. SCTM#87-3-63.1 T~rea to be impacted: er 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 ~2Administrative__Emergency __Pre-Submission __Violation Info needed: "~),<~'-~c~ -~ ,~uf/l~.~5.~ Modifications: Conditions: Pres~_~t~ere: __&King __J.Doherty __J. Bredemeyer ~"-~o~ D. Dzenkowski other Form filled out in the field by '~ ~ .. Mailed/Faxed to: Date: D. Bergen__ 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: July 19, 2010 Re: Proposed Wetland Permit for DONALD MOYLE SCTM#87-3-63.1 DONALD MOYLE requests an Administrative Permit to construct an 8'X 6' garden shed. Located: 1920 Minnehaha Blvd., Southold. SCTM#87-3-63.1 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 from 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 (631 ) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application Wetland Permit Application i/Administrative Permit AmendmenffFransl~er/E~t~nsion ~Received Application:,C'/ [ [ ti ~10 ~Received Fee:$ ~q,.) ~,~ompleted Application ~. ![ k~[I 0 Incomplete SEQRA Classification: Type I Type II Unlisted__ Coordination:(date sent) ~"LWRP Consistency Assessment Form r-~ CAC Referral Sent: Date of Inspection: ~,~ Receipt of CAC Report: Lead Agency Determination: Technical Review: ~/~Public Hearing Held: Resolution: Name of Applicant Address /~/15) /WA /,cA Phone Number:( ) Suffolk County Tax Map Number: ?rop ty oat on: (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: of Trustees Applicat Land Area (in square feet): Area Zoning: Previous use of property:. Intended use of property:. Covenants and Restrictions: If"Yes", please provide copy. GENERAL DATA Yes 3/ No Does this project require a variance from the Zoning Board of Appeals __ Iff "Yes", please provide copy of decision. Prior permits/approvals for site improvements: Date /? Yes __ 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: ~X~ No Project Description (use attachments if necessary):. / WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ~c'~ .~ ~ ~ ~::a.~ -~,~/~ Area of wetlands on lot: ' .square feet Percent coverage of lot: , t~) ~ % Closest distance between nearest existing structure and upland edge of wetlands: .~---(Z) feet Closest distance between nearest proposed structure and upland edge of wetlands: ~(~ 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 ._S.~atement of th__ e effec[, iffy, 9n [h~ w_etl_a_n_ ds.and tid_a_l wat~rs__°f~ town that _may_ _r_e_s_ul_t_.b_y- reason of such proposed operations (use attachments if appropriate): PROJECT ID NUMBER PART 1 - PROJECT INFORMATION 1. APPLI~_T / SPONSOR 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 provide map SEQR 5. IS PROPOSED ACTION: ,J~ New ~ Expansion [] Modification / 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? DYes [] NO If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) [~Residential E~]lndustrial [~Commercial f-~Agricutiure []ParklForest/OpenSpace [~Other (describe) 10.'DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) ['--~Yes ~]No If yes, list agency name and permit / approval: 11. DUE.~ ANY A~P[:~;I OF IHE AG[ION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ]Yes ~No If yes, list agency name and permit / approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? [~Yes ~No I CERTIFY THAT THE JNFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE / Sponsor Name ~/"~J Signature f the action is a C~al 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 A~lenc¥) · A. DOES ACTION EXCEED ANY TYpE I THRESHOLD IN 6 NYCRR, PART 617.4? If yea, coordinate the review process and use the FULL EAF. [--']Yes [~]No B. W1LL ACTION RECEIVE COORDINATED REVlEVV AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PANT 617.67 If No, e negative dedaratlen may be superseded by another invoived agency. I-'1 Y- 171.o C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwrffien, If legible) Ct. Existing air quality, surface or groundwater quality or quantity, ~)lse levels, e~dsting traffic paffem, solid waste prnduc~on or disposal, potsntlal for erosion, drainage or itceding problems? Explain blletiy: I"° I C2. Aesthetic, egdsulturbl, archaeological, historic, or other natural ~r cuitsral resources; or community or neighborhood character? F_xplsin briefly: C3. Vegetation or fauna, fish, she,fish or wildlife species, significant habitats, or threatened or endengemd species? Explain briefly: C4. A cemmuni~e/~ ~xisiing ~an$ or ~o~l~ as offi~ll~ adeptS, or a cba~§e in u~ or I~.*n~ o~ u~ of'land or othar natural m~Jrc~$7 ........... C5. Growth, subsequent development, or related activities likely to be induced by itle proposed ac6o~? Explain briefly: ~. Lo~ ~ma, ~hort to~n, cemulstive, or otbar efl~ts not Identifind in G,I-t~? F~in ~: I, I ° , D. V~LL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTAI3LISHMENT OF A CRITICAL ENVIRONMENTAL AREA [CEA~? (If ~es, explain briefly,: E. IS THERE, OR IS THERE LIKELY TO BE1 CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If ),es ex{)lsln: [:]Yea r "o I I PART III - bi=/I=RMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significanL Each effe(~ should be assessed in connection with its (a) se(ting (i.e. u~oan or rural); (b) probability of occurring; (¢) duration; (d) Irreversibitity; (e) geographic soope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that exptanations contain sufficient detail to show that all relevant adverse impacts have been identified and adeduataly addressed. If quesiton d of part ii was checked yes, the,determination of sig nifica nco must eveluata the potential impact of the proposed action on the environmental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse Impacts which MAY occur. ~ proceed directly to the FULl EAF and/or prepare a positive declsralio~. Chedx this box if you have detsm~thed, based oa the infmmatle~ and analysis above and any supporl~g documentation, that the proposed antler WILL NOT result in any significant adverse environmental impacts AND provide, mt attachments aa necsssap/, the masons supporting thl; determination. Board of Trustees Name of Lead Agency Dale Jill M. Doherty President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signalure of Preparer (if different from responsible officer) S) Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.C.T.M. W: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A /*~)(~ ~ ~ ~'f.-~. (/ STORM-WATER? GRADING, DRAINAGE AND EROSION CONTROL PLAN msutet ,*cuon ak)ck Lot CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION rl'~# / WORK ASSESSMENT [ Yes No a. (IncludeWhat is theTotaiTotalAmaAreaof all°f Parcelsthe ProjeCtlocatedParcelS?wi~in "~' ~' 1 Will this Project Retain A]I Storm-Water Run-Off /'~, ~<~ C'~, ~{ Generated by a Two (2')Inch Ratntall on Site? the Scope of Wod( for Proposed Constrecfiou) (This item will include all run-off creatud by site r~ b. What is tha Total Ama of Land Cleating '(S.F. t Ac~s) clearing and/o~ construction activities as well as all and/or Ground Disturbance for the proposed Site Improvements and the permanent creation of construction activity? ~/"~/~' impervious surfaces.) is.F.,,~) 2 Does the Site Plan and/or Survey Show Ali P.~oposed PROVIDE BRIEF PROJF. CF DESCRIPTION (P,~d*~,S~,,~P~,,,,N,~) DreinageStructureslndicating Size& Location?This r~ Item shall include all Proposed Grade Changes and .~,~/~ I~ ~,_.~ %~"/~ /)~0~ ! Slopes Coofrolling Surface Water Flow. 3 Does the Site Plan and/or Survey deschbe the erosion r~ and sediment control practices that will be used to con~'ol site erosion and storm water discharges. This item must be maintained throughout the Entire Construction Peded. 4 Will this Project Require any Land Filling, Grading or Excavation where there is a change to the Natural Existing Grade Involving more than 200 Cubic YardsL~ -- of Material within any Parcel? 5 Will this Application Require Land Disturbing Activities 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 the Trustees judsdiction General DEC SWPPP Requirements: or within One Hundred (100') feet of a Wetland or Submission ora SWPPP is requked for all Consth~cfion activities ~vc~ving soil Beach? disturbances of one (1) of mo~e ac~es; inciudin§ disturbances of loss than one acre that 7 Will there be Site preparation on Existing Grade Slopes am part of a lar;er c~amon plan that will ultimately disturb one or mere acres of land; which Exceed Fifteen (15) feet of Vertical Rise to inctuding Construction activitlas involving soil disturbance~ of lass than one (1) acm where One Hundred (100') of Horizontal Distance? the DEC has determined fllat a SPDES permit is required for stem~ w~ter discharges. SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways, Paddng Areas or other Impewious r~ required, post-consflucfion storm wwiei' management practices that will be used andfor Removal of Vegetation and/or the Constrection of any D/~_- SI'ATE OF NEW YORK, ~. bt'~,~, COUNtrY OF . O..U'.... _'E~.~ 1,, .................... SS ~lhat I ....~....~....=~..~.~.~.~.,1:~/~..,~.~..~ .................... being duly sworn, deposes and says that he/she is the applicant for Permit, And that he/she is the ........... : ............ ff...~.,/.,d.~..~.~'~ ................................................................................................... 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 application are U-ue to the best of his knowledge and belief; and that the work will be performed in the manner set fogh inl~lll~lta~ll~l$8 herewith. ;;worn to before mc this-Nfif~O~l~..~tl bl_liK ~tate of NOw YO~ ~y ~ ;t- ' ~o. 01ST6164008 _// / Qualified I k ............. /../"]. ......... ;~ ............... dayof..~{...(~. ........ ~,0nlrai~s,,~' 9,1~/ /// ~ /~ FORM - 06/10 Board of Trustees Application County of Suffolk State of New York ~dS? ~.//~-3 //~ fi~ ~7 BEING DULY SWORN DEPOSES ~ ~F~S THAT ~/S~ IS T~ ~PLIC~ FOR T~ ~O~ DESC~ED PE~T(S)~ T~T ~L STATE~S CONT~D ~ ~ TR~ TO T~ BEST OF ~S~R ~OWLEDGE ~ BEL~F, ~ T~T ~L WO~ W~L BE DO~ ~ T~ ~R SET FORTH ~ ~S ~PLICATION ~ AS MAY BE ~PRO~D BY T~ SOUTHOLD TO~ BO~ OF TRUSTEES. T~ ~PLIC~T AG~ES TO HOLD T~ TO~ OF SOUTHOLD ~ T~ TO~ TRUSTEES ~ESS ~ F~E FROM ~Y ~ ~L D~AGES ~ CL~S ~S~G ~ER OR BY VIRT~ OF S~ PE~T(S), ~ G~TED. ~ CO~LET~G T~S ~PLICATION, I ~BY AUTHO~E T~ ~US~ES, T~ AGENT(S) OR ~P~SENTATI~S(S), TO EN~R ONTO ~ PROPERTY TO ~SPECT T~ P~SES ~ CON~CTION ~TH ~W OF T~S ~P~N. APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics nmhibits conflicts of interest on the na~t of town officers and emolovees. The ouroose of ~hi~; form is to orovide information which can alert the town of ~ossible conflicts of iatore~t and allow it to take whatever action is necessary to avoid same. YOmN E: (Last name, first name, middle initial, unless you are applyingin 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 Zone Coastal Emsion Approval of plat Mooring Exemption from plat or official map Planning Other Of"Other", name the activity.) Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of Soutbeld? "Relationship" includes by blood, nlarriage, 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 the shares. YES NO ,/~ If you answered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by thc Town of Southold Title Or position of that person Describe the relationship between yourself(the applicant/agent/representative) and the town officer or employee· Either check the appmpriate 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) thc o?vnar of greater than 5% oftha shares of the corporate stock oftha applic0nt (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, par~ei', or employee of the applicant; or __D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS 1 Submitted this Signature Print Name __day of 200 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 he 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. The Application has been submitted to (check appropriate response): Town Board A copy of the LWRP is available in the following placd~[~ine at the Tom-of Southold's website (southoldtown.northfork.net), the Board of Tr~e~$ Office the Planning Department all local libraries and the Town Clerk's office. ;-! ~ ' ~ ~ DESCRIPTION OF SITE AND PROPOSED ACTION ~ '" ~ [~ Planning Board ~ Building Dept. [] BoardofTrustees ~7[ 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: ~57_ -i~ ~/~ 7'-/Z~-.~ If ~ application for ~e proposed action h~ been filed M~ ~e Tom of Sou~old agency, ~e following iffomation shill be provided: (a) Nme ofapplic~t: ~J~ ~ ~ (b) M~ling address: /¢~ ~/~~,~X ~Z ~ (c) Telephone nmber: ~ea Co~5 ~- ~/~ (d) Application n~ber, iffy: Will ~e action be directly ~dea~e~ req~m ~d~g, or approv~ by a s~te or federal agency? Yes ~ No ~ If yes, w~ch state or feder~ 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 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 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 f~-]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. Yes No Not Aglicable 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. [] YeJ-'--] No ~ Not Applicable Attach additional sheets if necessary WORKING COAST POLICES · Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent nses in suitable locations. See LWRP Section Ill- 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 ~'~ 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. D 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 DATE/~~