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HomeMy WebLinkAboutTR-7865A I,,,�ilii��- #ii_``�,oF soupy- _ John M. Bredemeyer III, President (4111°1 � � \ Town Hall Annex 54375 Main Road Michael J. Domino,Vice-President `�R , P.O. Box 1179 James F. King,TrusteeSouthold, New York 11971-0959 Dave Bergen, Trustee `� �Q�tc , Telephone (631) 765-1892 Charles J. Sanders,Trustee _ eOUNTV,* l°1 Fax(631) 765-6641 0"1 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD August 19, 2015 Vivian V. Eyre PO Box 1055 Southold, NY 11971 RE: VIVIAN V. EYRE 759 ORCHARD ROAD, SOUTHOLD SCTM# 66-2-11 Dear Ms. Eyre: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, August 19, 2015: RESOLVED that the Southold Town Board of Trustees grants the Last One-Year Extension to Administrative Permit#7865A, as issued on August 22, 2012. This is not an approval from any other agency. If you have any questions, please do not hesitate to contact this office. S" c ely, ettotolsahielsr John M. Bredemeyer III President, Board of Trustees JMB:dd 3ej a�r :.fir.-a► � _ - AP` r 4efM4iIEfea/4cT If 7R - (if fatiti__Vt ;. od Port.exs_g_f-J Mrd /1g7f ,qui-tz v i� s : • o, (o s- .` s--- (197/, I John Bredemeyer, President ;•�''goFFoc = Town Hall Annex Michael J. Domino, Vice-President ' � �cO°s 54375 Route 25 James F. King I ti P.O. Box 1179 Charles J. Sanders ;e' Si Southold, NY 11971 Dave Bergen ;yol ,� � '� a°!oTelephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Fiel Inspection/Work Session Report Date/Time. (S7/1"."- / / VIVIAN V. EYRE requests the Last One-Year Extension to Wetland Permit #7865A, as issued on August 22, 2012. Located: 759 Orchard Road, Southold. SCTM# 66-2-11 p Tyf 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 Notice of Hearing card posted on property: Yes No Not Applicable Storm Water Management Review: Yes No Not Applicable Info needed: Modifications: Conditions: 0 7 Present Were: J. Bredemeyer A. Domino J. King D. Bergen C. Sanders Bay Constable Other Form filled out in the field by i 6/7(21)-eA'"*— Mailed/Faxed to: Date: • John M.Bredemeyer III,President A SO0ry+ Town Hall Annex Michael J. Domino,Vice-President I� '`� l0 ; 54375 Main Road P.O. Box 1179 James F. King,Trustee ; Southold,New York 11971-0959 Dave Bergen,Trustee ��• �� Telephone(631) 765-1892 Charles J. Sanders,Trustee �• Fax(631) 765-6641 ...Ares BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD • July 23, 2014 Vivian V. Eyre -PO Box 1055 Southold, NY 11971 RE: VIVIAN V. EYRE 759 ORCHARD ROAD, SOUTHOLD SCTM# 66-2-11 Dear Ms. Eyre: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, July 23, 2014: RESOLVED that the Southold Town Board of Trustees grants a One-Year Extension to Administrative Permit#7865A, as issued on August 22, 2012. This is not an approval from any other agency. If you have any questions, please do not hesitate to contact this office. Sincerely, Michael J. Domino Vice-President, Board of Trustees MJD/amn • John Bredemeyer, President "$uFFot Town Hall Annex Michael J. Domino, Vice-President :; 54375 Route 25 James F. King g + P.O. Box 1179 Charles J. Sanderso ct.. ..$ � Southold, NY 11971 Dave Bergen 'yo1 ,� �a°!�'' Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: VIVIAN V. EYRE requests a One Year Extension to Administrative Permit#7865A, as issued on August 22, 2012. Located: 759 Orchard Road, Southold. SCTM# 66-2-11 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 Notice of Hearing card posted on property: Yes No Not Applicable Storm Water Management Review: Yes No Not Applicable Info needed: Modifications: Conditions: Present Were: J. Bredemeyer M. Domino J. King C. Sanders D. Bergen Bay Constable Other Form filled out in the field by Mailed/Faxed to: Date: 40 4le vim, aid / 7t P... 7R-6s- A ee-goto_e__ :1*(7 /4-e-c#ft-vt--. b4"-- Ye4"-- _ 44.-1.0/( £ /s f1-19-"t-r- 7S-9 Aultet-,..t_ .� 1 2 0 2014 U _ r (d47e'" S • James F. King,President CO Town Hall,53095 Main Rd. Bob Ghosio,Jr.,Vice-President ' . 0\ P.O.Box 1179 Dave Bergen w Southold,NY 11971 John Bredemeyer lo Telephone(631)765-1892 Michael J. Domino sOj a' 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 15t day of construction A constructed Project complete, compliance inspection • • , -- OF so/i7 - James F.King,President �0' „� IyO Town Hall Annex Bob Ghosio,Jr.,Vice-President ��.'l� l0 `. 54375 Main Road P.O.Box 1179 Dave Bergen Southold,New York 11971-0959 John Bredemeyer Q % Michael J. Domino O ea Telephone(631) 765-1892 *ns �`. ' Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 7865A Date of Receipt of Application: August 6, 2012 Applicant: Vivian V. Eyre SCTM#: 66-2-11 Project Location: 759 Orchard Road, Southold Date of Resolution/Issuance: August 22, 2012 Date of Expiration: August 22, 2014 Reviewed by: Trustee Michael Domino Project Description: To remove invasive species and cut back bushes and plant low salt tolerant plants or grasses. 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 project plan prepared by Vivian V. Eyre, received on August 6, 2012 and stamped approved on August 22, 2012. 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. yara James F. King, President Board of Trustees • • r Vg11FF0E,�CO '' V James F. King,President 1 y ‘ Town Hall Annex Bob Ghosio,Jr.,Vice-President : u• �� ; 54375 Route 25,P.O.Box 1179 ` Dave Bergen ' -4 t' ,,1 Southold,NY 11971 John Bredemeyer i,$1 It lb,"' Telephone(631)765-1892 Michael J. Domino __,,,,,,,,�'' Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: VIVI(,1V1 Vt Eyre- Please be advised that your application dated Augu SF- 4 2-Of 2- has been reviewed by this Board at the regular meeting of ,Lt.lquS4- 2112 and your application has been approved pending the conipletion o 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) A 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: Film I inSe.c-hove Fee 'SSD. DD TOTAL FEES DUE: $ SD. OD BY: James F. King, President Board of Trustees • 0 .lames F.King,President o�OSOFFO(,�CO P O. Box 1179 Bob Ghosio,Jr.,Vice-President Oy Southold.NY H971 Dave Bergen w Telephone(631 765-1892 John Bredemeyer Fax(631)765-6641 Michael J. Domino yyo! o� Southold Town Board of Trustees Field IInspection/Worksession Report Date/Time: -.7/-t//1" Vivian Eyre requests an Administrative Permit to remove invasive species and cut back bushes and plant low salt tolerant plants or grasses. Located: 759 Orchard Road, Southold. SCTM#66-2-11 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: J. King/. B. Ghosio D. Bergen, J. Bredemeyer /Michael Domino D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: • 4 ... • --�: . r.,.....„ .t,„, • , , . . .... .. .... . t . ...,. ••., .. t ...,„t. , . ,,,, .,... .,e.- • 4 •,. - :=,..--',` - ..^---air'''• 141117.1011°°— - .yam "0y. • ' il.. , • _ .j'.I . ,,rii %I,. •t, 1 't .. te1 •t .fi .',-. ii,',VC--" 1. � �r:• � , , x- SR" f t. ' ` t- _ iR \•. , • — . t+[t�p.N,•w ,4,. : ,.—, i is r . - ..t.'' it( ' :-1 '' 7 i "liki' •-•: -• • '••a It Ai IP 'r " •fib r • ,,i. t 1111 , . , ,..i" "''siX-2.1-.4•0,.•-•, 4.11. c*". .• ;54 .. ilf { i r. ,:„„,* . . t 4 'A . ' ' /I 1 .0 t 4* 2°4. - . I°I-_ - i__ .._..._ ---- I I _. T sussc 7 Gr t r Na z N gr° .,, _�, �NO L-gip a i ta ® . 49,4*. z---:) O / 57 i . ttj �. ,4„,/ ,, ,,,o♦ 4 i � y, ,,404. , , „eryo( L ♦ r • r `® _ __ _- _ __.-- _ NOTICE �G-.. COUNTY OF SUFFOLK © • s.e a me" 'xo •__� —�-- 'a --Heel 66 • • oo OFFICE LOCATION: /,� ��F $()(/T* ` MAILING ADDRESS: Town Hall Annex O : P.O. Box 1179 54375 State Route 25 , * *, Southold, NY 11971 (cor. Main Rd. & Youngs Ave.) H 4 1 Southold, NY 11971 Q Telephone: 631 765-1938 � II Fax: 631 765-3136 `y '. 00UNTI ""' LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Jim King, President Au Town of Southold Board of Trustees ' 1 `u" From: Mark Terry, Principal Planner LWRP Coordinator Date: August 16, 2012 Re: Proposed Wetland Permit for VIVIAN V. EYRE SCTM#1000-66-2-11 VIVIAN V. EYRE requests an Administrative Permit to remove invasive species and cut back bushes and plant low salt tolerant plants or grasses. Located: 759 Orchard Road, Southold. SCTM# 66-2-11 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 Policy Standards and therefore is CONSISTENT with the LWRP provided that: 1. The action is limited to the removal of invasive species. 2. Applicant submits a detailed re-vegetation plan to the Board 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 • „ ,„ --- • Town Hall Annex James F. King, President ttJI SOF SOUTy' Bob Ghosio,Jr.,Vice-President tt'`O - 0� ' 54375 Main Road O y P.O. Box 1179 Dave Bergen 4f * I Southold,New York 11971-0959 Johnn Bredemeye • G t` Michael J. Domino * �O t1 Telephone(631)765-1892 tt Fax(631)765-6641 ap., BOARD OF TOWN TRUSTEES \ H % 1'4 H i TOWN OF SOUTHOLD `` ) it %1 Office Use Only j AUG _ 6 2012 Coastal Erosion Permit Application Wetland Permit Application Application/ Permit -- c / Amendment/Transf r/ xtension „s eceived Application: g�'y 7� ___/Received Fee:$ 10 ompleted Application _ IS _Incomplete SEQRA Classification: Type I Type II Unlisted iLoordination:(date sent) WRP Consistency Assessment Form_ to 11- /CAC Referral Sent: Date of Inspection: g 15 (-- Receipt of CAC Report: Lead Agency Determination: ;technical Review: ./ 'Public Hearing Held: ?.z IZ Resolution: �” Name of Applicant V/y/AA/ LSV . exec'-jc- Address200 Rom Rd //� o rncr J Phone Number:0) 745--39t 3 Suffolk County Tax Map Number: 1000 -- 9. 7 3819 CC- 2. ^/ Property Location: 759 0,echt4t.d Rona (1144, -ha 1200as /` d \. (provide LILCO Pole#, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: Board of Trustees Application ,/ GENERAL DATA / Land Area(in square feet): 47 . C /o .37 �•ck 41Vc 6272. Area Zoning: Res I7,n L_ Previous use of property: As, Cgw /wry r Intended use of property:(Sfrsse Covenants and Restrictions: Yes V No If"Yes", please provide copy. Does this project require a variance from the Zoning Board of Appeals Yes ✓ No If"Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept. Yes 1/ No Does the structure (s) on property have a valid Certificate of Occupancy Yes ./No Prior permits/approvals for site improvements: Agency Date VNo prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? 1/No Yes If yes, provide explanation: Project Description(use attachments if necessary): Paww4t o F ,wfjsi/F spades tvetD r G.j 15Ac k &iso s • I Description of Site & Proposed Action Owner: Vivian Eyre 631-765-3463 200 Rogers Road & 759 Orchard Road Southold, NY 11971 Property Location: 759 Orchard Road (Lot behind 200 Rogers Road) On Beixedon Estates Site Map Lot 10 On Tax Map: 473889-66-2-11 The following request is in 2 parts (See photos. Locations described as you face the cedar tree). The request spans 2012-13 for removal and landscaping, and ongoing maintenance for future. Part of this project will be implemented by the owner and part through Chris Mohr Lawn & Landscape. Part 1 —Area Left of the Cedar Tree 2012 • Weed area and eliminate poison ivy • Cut back 2 verbena bushes to one foot 2013 • Remove verbena bushes (2) • Plant low, salt tolerant plants or grasses in place of verbena • Maintain weeding and poison ivy control Part 2-Area to the Right of the Cedar Tree 2012 • Weed and cut/lower mugwort plants. • Cut back invasive species (see photo) to 1 foot. (Invasive species is unidentified, but has a bamboo-like stem. It has increased in size 5 fold in the last 4 years, and has overtaken the pond bank.) 2013 • Remove invasive species and replace with low salt tolerant plants or grasses • Remove mugwort and replace with mountain daisy/lavender or salt tolerant grasses Board f Trustees Application 1. e yiC WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: OVAL of fait- 5c/es t/.ePiD t ccgr bAck Adslges ifo1AL 10537 Tide 4•Arc s01 -c. s8. 7z Area of wetlands otV square feet Percent coverage of lot: / % Closest distance between nearest existing structure and upland edge of wetlands: feet T iot Petr Closest distance between earest proposed structure and upland edge of wetlands: 11,4 feet a (it%St D Srac it'zc Does the project involve excavation or filling? No t/ Yes Jur diztbrfr'w mna-rteS ?gates If yes, how much material will be excavated? cubic yards S 0 F &,ft-r How much material will be filled? cubic yards A Rio/ B� Depth of which material will be removed or deposited:~ ma4efeet I t o T Proposed slope throughout the area of operations: 7 Manner in which material will be removed or deposited: 6.442-1. 6ALjdw Ac- &AT 1_,4/41 A*/T, c,f s rA It -ID -t AWAY mdAsices Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): PROJECT ID NUMBER 617.20 • SEQR • APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1.APPLICANT!SPONSOR 2.PROJECT NAME VviltN Exec ewee-hI frc( e Lid iiok Ai . 3.PROJECT LOCATION: F 1.--/AilDrairAS Municipality Lc Q nt4 1- D County Sa P, oe_ac 4. PRECISE LOCATION: Street Addess and Road Intersections, Prominent Iandw a ks etc -Or provide map 759 OCctAtb ROAD ay # 93 eel rear .700 k cls Rant) 5. IS PROPOSED ACTION: n New Expansion I�IOrodification/alteration 6. DESCRIBE PROJECT BRIEFLY: L�1 See frrofallep At Remo t- d F fie ;44g/el s-r i Tr 4 Ove- d F rnp,v dXoof c ()Aide t ReM d t/A-C.- d F �Llta-Ab4- f bovreA/S s4c- r ToLt,,r /Lair•vG-s T AMOUNT OF LAND AFFECTED: Initially acres Ultimately - acres 8.WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RES/ ONTRRICTIONS?? Yes I I No If no,describe briefly: 14(040/417/$> R13csc /K+'^eV�L d I /N VA-Sr v6 �" res 9 WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) fesidential n Industrial Commercial Agriculture n Park/Forest/Open Space n Other (describe) 10:DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) nYes o If yes, list agency name and permit / approval: -- -- --11.UUES I—ANY ASPECT OFTHE AC.I UN HAVE A CURRENTLY VALID PERMIT OR APPROVAL? nYes I I o If yes, list agency name and permit / approval: 12. LA'S A RETS OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? Dyes rNo I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / S or Name GDate: Signature- Q -6-/Z • If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment • S PART II - IMPACT ASSESSMENT(To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR,PART 617.4? If yes,coordinate the review process and use the FULL EAF. 0 Yes No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative dedaration may be superseded by another involved agency. ❑ Yes 0N 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 pattern,solid waste production or disposal, potential for erosion,drainage or flooding problems? Explain briefly: C2. Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources:or community or neighborhood character?Explain briefly: C3. Vegetation or fauna,fish,shellfish or wildlife species,significant habitats,or threatened or endangered species?Explain 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 natural resources?Explain briefly: C5. Growth,subsequent development,or related activities likely to be induced by the proposed action?Explain briefly: C6. Long term,short term,cumulative,or other effects not identified in C1-05? Explain briefly: - C7. Other impacts(including changes in use of either quantity or type of energy? Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA(CEA)? (If yes,explain briefly: ❑ Yes a No E. IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain: El Yes El No • PART III-DETERMINATION OF SIGNIFICANCE(To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large,important or otherwise significant. 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 reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked yes,the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. Check this box ifyou have Identified one or more potentially large or significant adverse Impacts which MAY occur.Then proceed directly to the FULL EAF and/or prepare a positive dedaration. Check this box If you have determined,based on the information and analysis above and any supporting documentation,that the proposed actor WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting this determination. Board of Trustees a fit v'o- to 2.01 ] Name of Lead Agency Date M l9 M 15 F. 1 )/0471 President a Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer ' nature of Respoible t r in L Agency Signature of Preparer(If different from responsible officer) Board of Trustees Application • • County of Suffolk State of New York V(✓�41/ V. EyR€ 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. V,NIG/ot, ct-A— Signature SWORN TO BEFORE ME THIS rck DAY OF QUSU.0 r ,20 /3 Na/ 1AIn saticiftroh otary Public LAUREN M.STANDISH Notary Public,State of New York No.01ST6164008 Qualified in Suffolk County Commission Expires April 9,20 I N S APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same./ �7 YOUR NAME: Vi /4-/V V. Y�\E (Last name,first name,ipiddle initial,unless you 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 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 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 l/ 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/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 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 • • Submitted L . f_t_200LZ Signature Print Name V/ ✓/AN V. WE Cr Form TS 1 Town of Southold • • LWRP CONSISTENCY ASSESSMENT FORM ; 1 `i i II I I A. INSTRUCTIONS 'Lii LE A 3 - u LuiL 1. All applicants for permits* including Town of Southold agencies, hall !omplete this CCAF for proposed actions that are subject to the Town of Southold Waterfront onsistencyd eet w:aw-"Yhis 1 assessment is intended to supplement other information used by a .Tomn_Qf titlthc ld'`at ency_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. 2. 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). 3. 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- supporting 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# (E tp - Z - 1 PROJECT NAME ORE— jib,* A4/11 "fide live 4'adsc}r„v�' The Application has been submitted to (check appropriate response): Town Board Planning Board Building Dept. ❑ Board of Trustees l nn-I 1. 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: See Errfolio/ n • Location of action: 7s. .cc6fA 44 40. -cd. Site acreage: 4f4./ Ste hag. Present land use: A Si T1 L Present zoning classifrcation:4 CI 4711 TM. h- 2. 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: VIII(At/ E (b) Mailing address: i o 8 ex co 5 S .S:ici114c. . m (U/ 7 / y (c) Telephone number: Area Code (S ! 6 5-3 T 6 3 (d) Application number,if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes No FC". 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 kN(No n 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 n"olNot 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 ✓r Yes n No n 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 otApplicable 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. n Yes No Not Applicap • 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 n 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 L` 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. Yell No "Not Applicable 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 n 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. n Yes ❑ No /I 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./ Yes No I/Not 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 PREPARED BY V NDN 4h. Z TITLE _ DATE ' "6�2 \I SURVEY OF PROPERTY AT SOUTHOLDLII\/1 60° aAD; TOWN OF SOUTHOLD SUFFOLK COUNTY NY. �0Z zo A0 � N 1000 - 38 - 01 - n 16 aWo- yo ,, �. �ts, SCALE. 1" = 30' MAY 1, 2003 I - — $ ,-Y,-S O 0APPROVED BY ' `` ,„ ' o of �' 3I -F b Is°. ,,� '1� .fid° � a6o�� O BOARD OF TRUSTEES TOWN OF SOUTHOLD a,�n% ® _ g1.d s ZpayPi . DATE A q �^ s t ■ (l 1 S Z 1) Z \.0 // �0 g' z �( 0 CERTIFIED I N\ R0 VIV/AN EY' / i is�. .0 \� oO BARRY LFP 1 ',p • �' p0? o PP /v 11 o � sV ,o7 NOTE, LOT NUMBERS ARE REFERENCED TO -SK ' 944 PVNp >� _ "MAP OF BEIXEDON ESTATES BLOCK 4 " '0 \ FILED IN THE SUFFOLK COUNTY CLERK'S MB p��\s '� -c....°4.Na, „�• MNEW K09 OFFICE ON MAR. 16, 1946 AS MAP NO. 1472 0 4 1i ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION �/ ,D' •y-" R G OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. EXCEPT AS PER SECTOR!7209-SA/V S.CW 2.ALL CERTEICA DONS -l.' D . . '4 •R... HEREON ARE VALID FOR TMS MAP AND COPES THEREOF ONLY IF Fh .�� SAO MAP OR COPES BEAR THE OPRESSED SEAL OF TIE SURVEYOR ' OS' H g?; ROSE SOONA TYRE APPEARS HEREON. '' OAj7 s :IAQ/. .18 ADDITIONALLY TO COMPLY WITH SAC LAW TERM•ALTERED BY• ' CONIC SRS, P.C. MET BE USED BY ANY AND ALL SURVEYORS UTLIZAVG A COPY IF L 1.765 - 5020 FAX (631) 765 - 1,97 O'ANOTHER SURVEYOR'S MAP. TERMS SUCH"NSPECTEO "AND "WRIXRHT- TO -DATE•ARE NOT M COMPLIANCE WITH THE LAW AREA = 78,919 sqt 1; - ll 1TRAVELER STREET ( I. - A40gi: OLD, N.Y. 11971 ;114' _ 11;i ^ 03 - 168 , X12