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Home My WebLink AboutTR-7465EJill M. Doherty~ President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen John Bredemeyer Town Hail, 53095 Main Rd. ?.O, Box I 179 Southold. NY 11971 Telephone (631 ) 765-1892 Fax (631 ) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD EMERGENCY WETLANDS PERMIT Permit No.: 7465E Date of Receipt of Application: January 20, 2011 Applicant: Theodore Petikas SCTM#: 135-1-27 Project Location: 52755 Soundview Avenue, Southold Date of Issuance: January 24, 2011 Date of Expiration: 90 Days from Date of Issuance Reviewed by: Board of Trustees Project Description: Due to recent storm damage, temporarily install a single row of boxes, fill them with rocks and sand, remove the chain-link fence, and to clean up storm debris. Findings: The project meets all the requirements for issuance of an Emergency Wetlands Permit as determined by the Board of Trustees. The issuance of the Emergency Wetlands Permit allows for the operations as indicated in the application received on January 20, 2011. Special Conditions: A full Wetland Permit must be applied for within 90 days of the date of this permit. The chain-link fence must be removed. This is not a determination from any other agency. Doherty, Presidbnt of Trustees File Edit View Toolbar Window Help Ready 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 / Only ~Coastal Erosion Permit Application Wetland Permit Application __ Administrative Permit Amendment/Transfer/Extension __Received Application: __Received Fee:$ __Completed Application Incomplete __SEQRA Classification: Type I Type 11 Unlisted Coordinafion:(date sent) __LWRP Consistency Assessment Form CAC Referral Sent: __Date of Inspection: __Receipt of CAC Report: __Lead Agency Determination:__ Technical Review: ~Public Hearing Held: Resolution: Name of Applicant Address Suffolk County Tax Map Numbs: 1000- ] Property Location: (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: Wrd of Trustees Applicati¢ GENERAL DATA Land Area (in square feet): Aren Zoning: ~)o S/~, o~t4.¥a.~ Previous us~ of prope~y: Int~ded us~ ofpropmy: Coverts ~d Restrictions: Yes (N~ If"Yes", please provide copy. Does ~is project require a vm~ce ~om the Zoning Bo~d of Appeals If"Yes", ple~e provide copy of decision. Prior p~its/approvals for site improvements: Agency Date Yes __. No prior permits/approvals for site improvements. Has any permWapproval ever been revoked or suspended ~by a governmental agency? Yes If yes, provide explanation: Project Description (use attachments if necessary):. ,ard of Trustees Applicati~ WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area of wetlands on lot: square feet Percent coverage of lot: 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? No ~Tes ' If yes, how much material will be excavated? How much material will be fitled?~ub~ic yar'~ds Depth of which material will be removed or deposited: cubic yards feet Proposed slope ttu:oughout the area of operations: Manner in which material will be removed or deposited: Statement of the effect, if any, on the wetlands and tidal waters of the town_t)a_t ~ay result bj {-eas0n ot` such proposed operations ~US~ ~t~h~e~iiS it' Cpropriate): / rd of Trustees Applicati~ COASTAL EROSION APPLICATION DATA Purposesofproposedactivity: ~'~ />7_~/c¢~ ~o ~..zo~_ Are wetlands present within 100 feet of the proposed activity? No Yes /.~- ,, / Does the project involve excavation o f~!n~g? No Yes If Yes, how much material will be excavated? How much material will be filled? Manner in which material will be removed or deposited: (cubic yards) (cubic yards) Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) PROJECT ID NUMBER PART 1 - PROJECT INFORMATION 1. APPLICANT / SPONSOR 3.PROJECT LOCATION: 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) Municipality 4. PRECISE LOCATION: Street Addess and Road Intersection,, SEQR 2. PROJECT NAME Prominent landmarks etc-or provide map PROPOSED ACTION: [] New E~]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? [~Yes [] No If no, describe briefly: 9 WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) [~Residential r--]Industrial r-]commercial [~]Agriculture ~] Park / Forest / Open Space [~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 ff yes, list agency name and permit / approval: 11. UCYES~NY~S]:r~(~T~F-IHE AC. lION HAVE A- V LI PERMIT~ APPROVAL? [-~Yes r~No If yes, list agency name and permit / approval: I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor Name Date: / -- ~ If the actio~ is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment of Trustees Applica~n County of Suffolk State of New York BEING DULY SWORN 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 IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION Si~-n~ture SWORN TO BEFORE ME THIS ~ I S~L DAY OF (2X0,rxxKo,.C~L Notary Public CONNIE D. BUNCH Nota~ Public, State of New York No. 01BU6185050 CommlsMon ~ ~ 14, ~ AUTHORIZATION (where the applicant is not the owner) (p~int o~ner of property) '(mailing address) do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. ( Own~ ' s signature APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE. FORM Thc Town of Southold's Code of Ethics orohibits conflicts of interest on thc part of town Officers and emulovccs. Thc oumosc of this form is to nrovidc information which can alert the town oftmssible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOURNAME: '7-"'41t~3 (.O 12> ~O ~ ?~=--~'-1 · (Last name, first name,~niddle ifiitial, un]ess ~,ou are applying in the name of someone else or other entity, such as a company. If so, indicate, 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 r' 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 oftbe 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 the shares. YES ~ 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 Or position of that person Describe the relationship between yourself(the applicant/agenl/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 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, partner, or employee of the applicant; or ___D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS 1 Submitted this ._~_day of / Print Name ,---?-. ~.~.~.~ ~t~-,OKI ~= OTHER POSSIBLE AGENCIES YOU MIGHT HAVE TO APPLY TO N.Y.S. Dept. of Environmental Conservation (DEC) SUNY, Bldg. 40 Stony Brook, NY 11790-2356 (631) 444-0355 Mon., Wed., Fri., 8:00 AM-3:00 PM Suffolk County Dept. of Health Services 360 Yaphank Ave., Suite C Yaphank, NY 11980 852-5700 U.S. Army Corp. of Engineers New York District 26 Federal Plaza New York, NY 10278 917-790-8007 N.Y.S. Dept. of State Coastal Management 99 Washington Ave. Albany, NY 12231 518-474-6000