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Home My WebLink AboutTR-7480BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK PERMIT NO. 7480 DATE: FEBRUARY 16, 2011 ISSUED TO: LEVIN FAMILY LIMITED PARTNERSHIP PROPERTY ADDRESS: 58855 ROUTE 48~ GREENPORT SCTM# 44-2-22 AUTHORIZATION 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 the meeting held on February 16. 2011. and in consideration of application fee in the sum of $500.00 paid by Levin Family Limited Partnership 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 for the existing beach stairs, de~king and motel building, and to conduct repairs as necessary; and as depicted on the survey prepared by Peconic Surveyors, P.C. last dated January 12, 2005, and stamped approved on February 16, 2011. IN WITNESS WHEREOF, the said Board of Trnstees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. TERMS AND CONDITIONS The Permittee Levin Family Limited Partnership, c/o Ellen Levin-Wiederlight, residing at 58855 Route 48, P.O. Box 68, Greenport, New York 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 24 months, which is considered to be the estimated time required to complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later date. That this Permit should be retained indefinitely, 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 may be cause for revocation of this Permit by resolution of the said Board. That there will be no Unreasonable interference with navigation as 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 the 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 Bob Ghosio, Jr., Vice-President James F. King Dave Bergen 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 #: 7480C Date: February 16, 2011 SCTM#: 44-2-22 Name of Applicant/Agent: Ellen Levin-Wiederlight Name of Permittee: Levin Family Limited Partnership Address of Permittee: P.O. Box 68, Greenport, NY 11944 Property Located: 58855 Route 48, Greenport, New York DESCRIPTION OF ACTIVITY: Coastal Erosion Permit for the existing beach stairs, decking and motel building, and to conduct repairs as necessary. The Coastal Erosion Management Permit allows for the operations as indicated on the survey prepared by Peconic Surveyors, P.C., last dated January 12, 2005, and stamped approved on February 16, 2011. Permit to construct and complete project will expire two years from the date the permit is signed. INSPECTION: None SPECIAL CONDITIONS: (apply if marked) N/A Bluff restoration through a re-vegetation plan is a necessary special condition of this permit. N/A A relocation agreement is attached hereto and is a necessary special condition of this permit. N/A A maintenance agreement is attached with application and is a necessary special condition of this permit. Board of Trustees Jill M. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen 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 16, 2011 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Ms. Ellen Levin-Wiederlight P.O. Box 68 Greenport, NY 11944 RE: LEVIN FAMILY LIMITED PARTNERSHIP 58855 ROUTE 48, GREENPORT SCTM# 44-2-22 Dear Ms. Levin-Wiederlight: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, February 16, 2011 regarding the above matter: WHEREAS, LEVIN FAMILY LIMITED PARTNERSHIP applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, and Chapter 111 of the Southold Town Code, Coastal Erosion Hazard Areas, application dated January 14, 2011, and, WHEREAS, said application was 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 application be found Consistent with the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on February 16, 2011, 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, 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, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees have found the application to be Consistent with the Local Waterfront Revitalization Program, and, RESOLVED, that the Board of Trustees approve the application of LEVIN FAMILY LIMITED PARTNERSHIP for the existing beach stairs, decking and motel building, and to conduct repairs as necessary; and as depicted on the survey prepared by Peconic Surveyors, P.C. last dated January 12, 2005, and stamped approved on February 16, 2011. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of $50.00 per inspection. (See attached schedule.) Fees: $0.00 Very truly yours, Jill M. Doherty ~ President, Board of Trustees JMD/eac Peter Young, Chairman Lauren Standish, Secretary Town HalL, 53095 Main Rd. P.O. Box 1179 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., February 9,2011, the following recommendation was made: Moved by Doug Hardy, seconded by Audrey Horton, it was RESOLVED to SUPPORT the Wetland Permit and Coastal Erosion Permit applications of LEVlN FAMILY LIMITED PARTNERSHIP to conduct repairs to the existing beach stairs and motel building. Located: 58855 Route 48, Greenport. SCTM044-2-22 Inspected by: Audrey Horton, Doug Hardy, Derek Bossen Vote of Council: Ayes: All Motion Carried Jill M. DoheCy, P~esident Bob Ghosio, J~., Vice-P~esidcnl James F King Dave gct'g¢l~ John Bredemeyer PO. Box 1179 Southold. NY 11971 Telephone(631 765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: LEVlN FAMILY LIMITED PARTNERSHIP requests a Wetland Permit and Coastal Erosion Permit to conduct repairs to the existing beach stairs and motel building. Located: 58855 Route 48, Greenport. SCTMfl~,4-2-22 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 D. Bergen__ Mailed/Faxed to: Date: 1000 044 OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cot. 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: February 16, 2011 Re: Proposed Wetland Permit for LEVlN FAMILY LIMITED PARTNERSHIP SCTMf144-2-22 LEVIN FAMILY LIMITED PARTNERSHIP requests a Wetland Permit and Coastal Erosion Permit to conduct repairs to the existing beach stairs and motel building. Located: 58855 Route 48, Greenport. SCTM#44-2-22 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 Policy Standards and therefore is CONSISTENT with the LWRP provided the following best management practice is required pursuant to: § 275-11. Construction and operation standards. A. General. The following standards are required for all operations within the jurisdiction of the Trustees: (2) Erosion control. Installation of an erosion control structure is necessary during any building, grading, landscaping or site work activity within Trustee jurisdiction. This structure may include, but is not limited to, installation of a silt fence, hay bales, wood chip berm and silt booms. The placement of the erosion control structure(s) shall be determined by the Trustees or their designee. All intertidal construction and excavation requires the installation of a silt boom that will retain all suspended sediments within the immediate proiect area. 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 Jilt 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 ~oastal Erosion Permit Application .bLWetland Permit Application AmendmentFl'rans let/Ex tension i,~ece~vved App fication:._lJJ_~ ~.~R. eceived Fee:$ ~3 ..~ompleted Application } J J~ J l~ -_ __ Incomplete __SEQRA Classification: Type 1 Type II Unlisted Coordination:(date sent) ~/'LWRP Consistency Assessment Form ~PtC Referral Sent: ] ~ ' ,.~l~ate of Inspection: ~ ! 9,'! U Receipt of CAC Report: ' ' * ' Lead Agency Determination: Technical Review: ~Fublic Hearing Held: o0~] I~/II __Resolution: Office Use OnLy Administrative Permit Suflblk County Tax Map Number: 1000- ~Tt4--r.~ ---,~. 2. (~, ~/,2.]o°~? - qq--~--2~) Prop~yLocation: ~ff~ ~ q~ /~zer~FJ . ~ //~g~ (pro.de LILCO Pole ~, dist~ce t~ cross s~eets, ~d location) ' AGENT: (If applicable) Address: Phone: Board of Trustees Appl~ion GENERAL DATA Land Area (in square feet): Area Zoning: Previous use of property:. Intended use o£property: Covenants and Restrictions: If"Yes", please provide cop-);. ' . Yes No Does this project require a variance from the Zoning Board of Appeals If"Yes", please provide copy of decision. Yes ~ Prior permits/approvals for site improvements: __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended~:g~ governmental agency?. .. [..--~-No ' Yes If yes, provide explanation: Project Description (use attachments if necessary): ~ ..4'~',' ,Z~,.~v~ ~- ~ WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area of wetlands on lot: Percent coverage of lot: square feet % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? k// No Yes If yes, how much material will be excavated? How much material will be filled? /V?/~ 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: /4//4~ cubic yards cubic yards ,///~)- feet Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of sugh proposed operations (use attachments if appropriate): 765664! o~ T~'us~eef AppL$o~t:ion COASTAL EROSION APPLICATION DATA Are wetlznds p~at witM~ 100 feet of the proposed No (~ (e-~,i¢ yards) Deoc~be the nature and ~xt~nt of thc envJroame~tal impacts reszouably m~ticipated re~ting from impl~ne~lion ofth~ proj~t as propose~L (Use altF. hmen~ ffneCeSssry) Jill M. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen 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 BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of LEVIN FAMILY LIMITED PARTNERSHIP COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING , residing at/dba ~/r*'5~'f being duly sworn, depose and say: That~on the~ day of ,201, 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 heating. Date of hearing noted thereon to be held Wed~ Febrnary 1C 2011 on or about 6:00 PM. Dated: (signature) Sworn to before me this /3~day of ~-e/,. 20 [~ ~6't~r~y Public NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES~ TOWN OF SOUTHOLD In the matter of applicant: YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: 3. That the project which is subject to Environmental Review under Chapters 96,111 and/or 275 of the Town Code is open to public comment on: DATE: F¢'~ /~, ~0Jl You may contact the Trustees Office at 765-1892 or in writing. The above-referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal. PROPERTY OWNERS NA~ME: MAILING ADDRESS: PHONE #: AGENT: MAILING ADDRESS: PHONE #: Enc: Copy of sketch or plan showing proposal for your convenience. PROOF OF MAILING OF NOTICE A'I~FACH CERTIFIED MAll, RECEIPTS STATE OF NEW YORK COUNTY OF SUFFOLK , residing at , being duly sworn, deposes and says that on the day of ,20 , deponent mailed a tree copy of the Notice set forth, in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at , that said Notices were mailed to each of said persons by (certified) (registered) mail. Sworn to before me this Day of ,20 NotaryPublic PROJECT ID NUMBER APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART '1 - PROJECT INFORMATION ( To ~e compl,eted~b~y Applicant or Project Sponsor) 1 APPLICANT/SPONSOR ~CVt~ .~,,~/W,'~YJ/~II~¢d/~/,~/"~.PROJECT NAME 4. PRECISE LOCATION: S~et Addess and Road IntersecUons, Prominent land~s etc -or provide ma~ SEQR 7 AMOUNT OF LAND AFFECTED: Initially acres UIUmately acres B.~LL.~OPOSED ACTION COMPLY VVITH EXISTING ZONING OR OTHER RESTRICTIONS? [¥'-J/L~ Yes [] No if no, descdbe bdefly: iai J-~lndustrial L...~ommercial L_!._l."'JAgricuiture ~ark/Forest/OpenSpace ~]Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (F..~.~, Slate or Local) [~Yes b~No If yes, list agency name and permit / approval: 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [~Yes [~ If yes, list agency name and permit / approvak 12. AS A Rr~ESU~,~ OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? [~','es I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor Name If the action is a Costal Ama, 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. ~O~*~ AC ~O~i EXCEED ANY TYPE I THRESHOLD IN 6 NYCPJ~ PART 617.47 If YeS, (x~*dlnate the m~,ew pro(~,s and use the FULL EAF. B. WILLAC¥~REC~-VEC~TEDREVIEVVAS PROV~DEDFORUNUSTI3)~IN6 NYCRR, PART 617.67. IfNo, anegatlve C. COULD ACTION RESULT IN ANY AO~'~-Rg~c ~FFL-~ t ~ A..,.q~3CIATED V~ITH TI4E FOLLOWING: (.Ntswe~ may be ~, ff ~) I N<) .... . goals i"° I C~. Long term. ~t ~em~. cumutaGve, or off,er effec~ not ~, I--] Y~ [] No I ,, r~,-~ ~': · WILL NOT result In any deten,Nnation.. ~g~ifl~ant adverse env~ Impacts AND Ixodde, on attachments as neoess~y, the masons supporting .~oard of Trustees Name of Lead ,a~ency .Jill M; Doherty Pdnt or Type Name of Responsible Officer in Lead Agency Date President Tlfle of Responsible Officer ~.,~;u,~ of Preparer (If difl'c~rff from respo~sible officer) Town of Southold ~ Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM p~oP~,r~ LOC~O~ S.G.T.M~. THE FOLLO~ A~ION~ MAY ~QUIRE T~ ~BMISSION OF A STORM-WA~R~ G~DING~ D~INAGE AND ER~ION ~RO~ D~ ~ ~ ~ CE~IFIED BY A DES~N PRo~IO~ ~ THE ~A~ OF N~ Y~ ~OPEOFWO~ - PRO~S~ CONdUCt'iON l'l'fi~ /WO~~ [ Y~ No a. What~TotalAreaof~eP~Pa~s? I ~Re~n~W~ (In~e To~l ~a of aR Pa~ ~ ~ ~e~ ~ a T~ (2') ~ ~ ~ ~? the S~ of W~k f~ Pm~ ~) ~.F. t ~) ~ i~ ~ [~ ~1 ~ ~ ~ ~ b. Whet ~ ~ To~ A~ of ~ ~ ~d~ an~ ~n acd~es ~ ~tl ~ ail an~or Ground Dis~ ~r ~he ~ ~.~ Si~ Im~ovemen~ and ~ ~an~t =~aon of imperious sudac~,) It~ s~ll In~ude all Pm~ G~ ~ a~ Z~ ~'/ X~ ~;* ~ Wiil~isPmjectRequireanyLandFl,ing, Gmdingor , f ~l < // Exmva~on whine them is a chan~ m ~e Natural ~ ~'~ ~S~f~' .~ ~r ~1 . ~fln9 Gm~ Inv~vi~ ~ ~ ~ ~c Ya~ . / ~ of M~efial ~n ~ Pa~l? ~i~ ~ ~ ~- .... . ~ -- 5 (5,000 S.F.) ~uare Feet of ~ Surfak? S~e? Is ~b P~T~~ or ~in One Hu~red (1~') f~t ~a We~ or STA2~ OF N~V YORK, ~ t~ COU~ OF ......~..~ .................. SS ~t I, .~m~tMl~..~.t~ ..................... ~' g ~y ~m, de~ ~d ~ ~at he/she is ~e applimt for ee~t ~d ~at hffshe is ~e ......... ~f~~ .................................................................................................... : ..... ~er ~or repre~nmfive of ~e ~er or O~ers, ~d is d~y a~o~ m ~P~r.~effom~ fl~e md ~rk ~d mae ~d file ~ application; ~at ~1 s~men~ con'ned in ~is application ~~~edge ~d · at ~e work ~l be ~ffozmed in ~c manner set fo~ in ~e appE~bon fil~ h~¥9 fS}g 164008 uualified ~n 8~Jffo~k Cotmtv S~o~ to before m~ .............. ........................ ...................... ........... ........ FORM - 06/10 Board of Trustees pp lcation County of Suffolk State of New York OSES AND AFFIRMS THAT HE/S4rIE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN AKE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN TttE MANNER SET FORTH IN TH/S 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), 1~ 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 DAY OF~61 r3 . ,20 / t No~ar~ Public ~L!REN M. STANDIS~ N~,~. 01ST6164008 Oualifio, d ir, Suffolk Count~ . APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSIJRE FORM The Towm of Southold's Code of Ethics omhibits conflicts of interost on the oart of town Officers and emolovces. The ouronse of this form is to orovide infor/natlon which can alert the town of ~ossibl¢ confli~ of interest and allow it to take whatever action is YOUR NAME: (Last name, first name, ¢iddle initial, unles~ yOU am applying in fl~ name of someone else or other entity, such as a company. If ~o, indicate thc other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building . .e~ Variance Trustee ~ Change of Zooe Coastal Erosion Approval of plat Mooting Exemption from plat or official map Planning Other (lf"OtbeF, name thc activity.) Do you personally (or through your company, spouse, sibling, paronl, or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or buginess 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 moro than 5% of the shams. YES NO ~ If you answered ~YE S", complete the balance of this form and date and sign wbere indicated. Name of person employed by the Town of Southold Title or position of that person Describe the rolationship between yourself (the applinant/agent/reprose ntative) and the town officer or employee. Either cheek the appropriate line A) through D) and/or describe in the space provided. The ~own officer or employee or his or her spouse, sibling, parent, or child is (cheek all that apply): ___A) the owner of groater than 5% of the shams 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 the applicant is not a corporation); __.C) an officer, director, partner, or employee of the applicant; or D) the actual applicant. DESCRIPTION OF RELATiONSHIP Form TS I 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 significanl 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 suooortin~ 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 To~vn of Southold's website (southoldtown.nortlffork.ne0, the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCT # qq 9L The Application has been submitted to (cheek appropriate response): TowaBoard [] Planning Board F-] Building Dept. ~ Board ofTrustees 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) Pa'mit, 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) ameo, appl,c t: £//,,"...*,.,,: (c) Telephone number: Area Code ( ) ~3 ! -- qT? -I?/O (d) Application number, if any:. Will the action be directly undertaken, require thnding, 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 Ill -~Pag~ 3 through 6 for evaluation criteria [~ Yes ~'] No I" I 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 [~fiOt 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 th~l for evaluation criteria [] Yes ~-~ No IU-~lNot 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 N~Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southoid. See LWRP Section III ~- Policies Pages 32 through 34r~fo~alua tion criteria. ~] Yes [--] No I ~ Not applicable At, ach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and w~ LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria. ~ Yes [] No t_~ 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. ~'] Yes~ No [~NotApplicable Attach additional sheets if necessary WORKING COAST PO~IES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses/n suitable locations. See LWRP Section III - Policies; Pages 47 through 56 for evaluation criteria. ~ V es [] No Mot Appli~ble Attach additional shec~s 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 ~No, Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section IH - Policies; Pages 62 through 65 for evaluation criteria. ARach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section HI - Policies; ~ages 65 through 68 for evaluation criteria. ~ va ~ No [~NotApplieable PREPARED BY TITLE DATE