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HomeMy WebLinkAboutTR-7876E James F.King,PresidenttioSO(/j � Town Hall Annex Bob Ghosio,Jr.,Vice-President 54375 Main Road P.O.Box 1179 Dave Bergen Southold,New York 11971-0959 John Bredemeyer H Michael J.Domino � �� Telephone(631)765-1892 Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE #0940C Date: December 6,2013 THIS CERTIFIES that the reconstruction of the+/-16' portion of existing timber sheathed bulkheading along eastern shoreline with new vinyl bulkheading in-place At 9575 Nassau Point Road,Cutchogue,New York Suffolk County Tax Map# 119-1-3 Conforms to the application for a Trustees Permit heretofore filed in this office Dated July 17,2012 pursuant to which Trustees Wetland Permit#7876 Dated August 22,2012,was issued 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 reconstruction of the+/-16'portion of existing timber sheathed bulkheading along eastern shoreline with new vinyl bulkheading in-place. The certificate is issued to PETER DORAN owner of the aforesaid property, )W)--" 0 je)r Authorized Signature Jill M.Doherty,President �*0f SOQTy� Town,Hall Annex Bob Ghosio,Jr.,Vice-President 54375 Main Road P.O.Box 1179 James F.King Southold,New York 11971-0959 Dave Bergen G Q John Bredemeyer �� �� Telephone(631)765-1892 U '� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0657C Date June 21,2011 THIS CERTIFIES that the 92 If of bulkhead 3' wide stairway,cantilevered platform atop stairs,and 8'X 20' deck At 9575 Nassau Point Rd.,Cutchogue Suffolk County Tax Map#119-1-3 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 4/27/93 pursuant to which Trustees Wetland Permit#4173 dated 5/26/93 was issued and Amended on 4/21/10 and on 1/19/11 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 921f. of bulkhead, 3'wide stairwpy, cantilevered platform atop stairs and an 8'X 20' deck. The certificate is issued to JANET I. DORAN owner of the aforesaid property. A orized Signature *®F SOUpy Michael J.Domino,President ®� off® Town Hall Annex John M.Bredemeyer III,Vice-President 54375 Route 25 P.O.Box 1179 Charles J.Sanders Southold,New York 11971 Glenn Goldsmith ® yo Telephone(631) 765-1892 A.Nicholas Krupski OIyCOUN��N Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1323C Date: March 30, 2017 THIS CERTIFIES that construction of a+/-94' bulkhead with(2) 8' returns and existingsoil oil to be used as backfill,repair the primary bulkhead and stairs to beach,and backfill with clean sand, as necessary,with the condition that the area is re-vegetated with American Beachgrass 18"on center, At 9575 Nassau Point Road, Cutchogue Suffolk County Tax Map#1000-119-1-3 Conforms to the application for a Trustees Permit heretofore filed in this office Dated January 30,2002, pursuant to which Trustees Wetland Permit#5496 Dated February 21, 2002,was issued and Amended on December 13,2006 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 a+/-94'bulkhead with(2) 8'returns and existing soil to be used as backfill,repair the primary bulkhead and stairs to beach,and backfill with clean sand,as necessary,with the condition that the area is re-vegetated with American Beachgrass 18"on center. The certificate is issued to PETER&JANET DORAN owners of the aforesaid property. ti Authorized Signature Y a� F Xel-4 h /q� zltlll 14 9� G�� �� ���''--�'ri>L�.��l—rte-• � � .�`"� � �`��2���e��� eellt Ad�� N y gqa �1 MAR 1 5 2011dfo uTew 1 6t r' "G 4 j SO Michael J.Domino,President �0� ypl� Town Hall Annex John M.Bredemeyer III,Vice-President 54375 Route 25 P.O.Box 1179 Charles J. Sanders y Southold,New York 11971 Glenn Goldsmith e__1 • �� Telephone(631) 765-1892 A.Nicholas Krupskiolif'COUNNFax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: .3/341-1 V` Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1 st day of construction constructed Project complete, compliance inspection. INSPECTED BY: �r�QsV COMMENTS: �(L -� ass✓�, CERTIFICATE OF COMPLIANCE: -- i Jig BOARD OF SOUTHOLD TOWN TRUSTEES ® SOUTHOLD,NEW YORK I � PERMIT NO.7876 DATE: AUGUST 22,2012 ISSUED TO: PETER DORAN PROPERTY ADDRESS: 9575 NASSAU POINT RD.,CUTCHOGUE I f 1 SCTM# 119-1-3 AUTHORIZATION Pursuant to the provisions of Chapter 275 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 August 22,2012,and in consideration of application fee in the sum of$250.00 paid by Peter Doran and subject to the Terms and �[ Conditions as stated in the Resolution,the Southold Town Board of Trustees authorizes and permits the following: d Wetland Permit to reconstruct a+/-16' portion of the existing timber sheathed bulkheading along the eastern shoreline with new vinyl sheathed bulkheading in-place; and as depicted on the site plan prepared by Suffolk Environmental Consulting, Inc., last dated July 9,2012 and stamped approved on August 22,2012. IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed, f and these presents to be subscribed by a majority of the said Board as of this date. Ghosio, Jr. — Al,sant ®y Dave Bergen — Recused A I A f SITE PLAN VIEW DETAIL EXISTING CONDITIONS Scale' 1.0"= 10 o't �� P IrI r TOP of By LUFF! l I i C I i O c. ; I STAIRS ; 1 , I _ RETAINING WALL — PLATFORM E`USTUGTDABER-SHEATHJ DRULIMEAD Q t l t It.beOD tteonstmcI'd) I 1 DECKING o. EXISTING TIMBER-SHEATHED BULKHEAD t �k AHW ALR' STA'o TIMBER-SHEATHED OUTER BULHHEAD SECTION I (to beo,BUl 1 BEACH ACCESS STAIRS(w/Platform) �� EviSrrNy I 92.0'± I I aro0Eo 3�7 - _ -- --- -- / MOM OF AS PER 1 14 SUFFOLK ENVIROtiNf AL(:ONSULT IN(.,INC.. r r^, �C �� PERW MID 38-od$6//OQOO i2 DORAN Property-Proposed Bulkhead Section Reconstruction..Situate:9575 Nassau Point Road;Cutchogue,New York-SCTM#': 1000-119-01-003 3 of 7 James F. King,President SOF sor/fyo Town Hall Jill M.Doherty,Vice-President lo 53095 Route 25 Peggy A.Dickerson P.O.Box 1179 Dave Bergen Southold,New York 11971-0959 G Q Bob Ghosio,Jr. `O �� Telephone(631)765-1892 li,'COU �� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD December 13, 2006 Janet Doran 56 Bulson Rd. Rockville Centre, NY 11570 RE: JANET DORAN 9575 Nassau Point Rd., Cutchogue. SCTM##119-1-3 Dear Ms. Doran: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, December 13, 2006: RESOLVED, that the Southold Town Board of Trustees APPROVE the amendment to Permit#5496 to repair the primary bulkhead and stairs to beach, and backfill with clean sand, as necessary, and all as depicted on the plans received by the Board of Trustees November 21, 2006. This is not a determination from any other agency. If you have any questions, please call our office at (631) 765-1892. Sincerely, James F. King President, Board of Trustees JFK/hkc "O SECTION SFD Applicant:Janet I.Doran and Peter Doran ,At,d U Location:Nassau Point Road,Town of Southold `v Purpose:Erosion control Datum:Apparent Low Water PROP N S.C.T.M.No. 1000-119-01-03 GRADE ,`, PROP BLKID u' 8'XI z 2'CCA 5P-ATH I NG 6x�tA j 8CCAPILING PROP. m DEADMEN CO t]� E X-1RADE IZ/ KTOE OF SLUFF UZ SOIL FROM EXCAVATING PROVED BY AG NCKFILL D, RD OF TRUSTEES 4 N OF SOUTNOLD •�Cy � /� Les to construct±94'of timber bulkheading, s,existing soil to be used as backfill. At Little Peconic Bay,Nassau Pomt Road,Town of Southold, 7 z Suffolk County,New York U - Q._ W SCALE I"= 2' w►ss� ;pal • ••„-E {YYM � �� r';• f�i;�3ibz .i I•r':iii" ^.JSr ry 1 i NAGSyROM NIAPTZ9 _r SCALE 1 3,000' 1- 5 N/F SPERES m II w �- UCL „ 2 0-j w N I STY SFD Q W pt O J F-n3 �� I �s�95 1NA _ DRIVE 2 JAI - *AHVftALVY LOCATED BY G.JUST �oPPLICCANT:JANET 1- DR AN Applicant proposes to construct±94'of timberbulkheading LOC�TIQU: NASSAU r INT ROAD, With(2)8'returns,existing soil to be used as backfill. At PURPOSE= EROSION CONTROL Little Peconic Bay,Nassau Point Road,Town of Southold, — vlye 50 S.C.T.M,N 0- oR.wH GJ Suffolk County,New York. DATE-.I I JAN'02 1000- II 9-01-03 rtcvnm DATUM:APPARENT LOW WATER LOCUS: a 20' 9p°59' J.M.O. ENVIRONMENTAL CON5ULTlN6 VR�W1,10 MVM�lII -3ASFD CN A SUR\,EY BY S.ISAKSEN JR. LAST DATED 18 JUNE'01 SERVICES,0U0GVE , NY-631-653'060} I OF 2 - + • Jill M.Doherty,President �QF souTy Town Hall Annex Bob Ghosio,Jr.,Vice-President ,`O� �� 54375 Main Road P.O.Box 1179 James F.King Southold,New York 11971-0959 Dave Bergen cn Q John Bredemeyer ^p �® Telephone(631)765-1892 cO01n�� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD January 19, 2011 Mrs. Janet Doran 23690 Merano Court#201 Bonita Springs, FL 34134 RE: 9575 NASSAU POINT RD., CUTCHOGUE SCTM#119-1-3 Dear Mrs. Doran: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wed., January 19, 2011: WHEREAS, JANET DORAN applied to the Southold Town Trustees for an Amendment to Wetland Permit#4173 under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated November 29, 2010, 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 recommended that the proposed application be found Inconsistent with the LWRP, and, WHEREAS, the Board of Trustees has furthered Policy 6 and 6.3 of the Local Waterfront Revitalization Program to the greatest extent practical through the imposition of the following Best Management Practice requirements: the reduction in the size of the deck from 8'X 30'to 8'X 20', and, WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, and, 2 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 for the mitigating factors and based upon the Best Management Practice requirements imposed above, the Board of Trustees deems the action to be Consistent with the Local Waterfront Revitalization Program pursuant to Chapter 268-5 of the Southold Town Code, and, BE 1T FURTHER, RESOLVED, that the Southold Town Board of Trustees APPROVES the Amendment to Wetland Permit#4173 for the existing stairway and an 8'X 20' deck, as depicted on the revised plan stamped approved on February 18, 2011. This is not a determination from any other agency. Fees: $50.00 Sincerely, JillDoherty, Preside Boa of Trustees JMD:Ims D SrA� ytiw STYEt L/r,- � Iq �Lf LONjS l��" j ?7 f L✓/7E r!AtJ�iru�. 'X20 _� ?R'M4--fv P2VLK�ftr/F� --� 1>15 AP-PROVED BY c ' - BOARD TRUGUES OWN zz•VL 6 0 James F. King,President O��fFO(,t•CTown Hall,53095 Main Rd. Bob Ghosio,Jr.,Vice-President Q y � P.O.Box 1179 0 Dave Bergen Southold,NY 11971 w John Bredemeyer Telephone(631)765-1892 Michael J. Domino j � Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: I Z' Ch. 275 Ch. 111 X, Hl 'vri,canc- Sandy r-m e r9 ,eIn cY per-r64 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 151 day of construction Y2 constructed uurlrlcane_ Sandy Project complete, compliance inspection. Emer9 efl ey Per+n ran,L INSPECTED BY: �� �� e COMMENTS: CERTIFICATE OF COMPLIANCE: CD so - U UTHOLD TR ST No. 79761: i S7 �� �ulfr;GAAC c.�y PERM ,I T . Issued To- Date 1 a ff Address � THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION TOWN TRUSTEES OFFICE DOWN OF SOUTHOLD SOUTHOLD, N.Y. 11971 TEL.: 765-1892 DORANProperty 1---, Proposed Bulkhead Section Reconstruction Situate: 9575 Nassau Point Road; Cutchogue, New York - SCTM #: 1000- 119 -01 - 008 SITE PLAN VIEW Scale: 1.0" = 40.0' ± A Timber-Sheathed Bulkhead Section (to be ReConstiucted) 4 Wolf D. Bergen Pathway Existing Dwelling Y �0 d Be h Aceess Stairs PLill latfo �' O 'fo 'fG ZI£ riN�'r1�fJ /J' DS TOP of BLUFF— I d WO SPERES E 15yr OPRT l SPERES E 18 yr OPRT Retaining wall -To '64 �2E�ar�1Rv'tXp Timber-Sheathed Bulkhead NOV — 2 2012 Date: Tv 9 20/L SUFFOLK ENVIRONMENTAL CONSULTING, INC. Scale: As per View / Drawn by: mdi P.O. Box 2003 • Bridgehampton • NY • 11932 OF Comments: Adapted from the Survey of subject property,as prepared by STANLEY 1.ISAKSEN IR. Prepared (631) 537 - 5160 (phone) - (631) 537 - 5291 (facsimile) E :1 for regulatory submission 000 op op 1 Doran Property Situate: 9575 Nassau Ponit Road; Cutchogue; Southold NY SC-FM #: 1000 - 119 - 01 - 003 m� g s` *t. . L . a � I i — _^�`-ter Ph< topraph showing the existing bulklicading on the Doran Property (lel" and the existing bulkhcading on the Bergen property (right). Photograph taken from Little Peconic Bay facing landward. Doran Property Situate: 9575 Nassau Point Road; Cutchogue; Southold NY SCTM #: 1000 - 119 - 01 - 003 i C ttt it a , Photograph showing the existing 16 foot return on the Dorm property. Photograph taken from the top of the bulkhead facing north. Doran Property Situate: 9575 Nassau Point Road; Cutchogue; Southold NY SC-rM #: 1000 - 119 - 01 - 003 ITL L Ar Photograph showing tic existing bulklicading on the Doran Property. Photograph taken from Little Peconic Bay lacing landward. Doran Property Situate: 9575 Nassau Point Road; Cutchogue; Southold NY SCTM #: 1000 - 119 - 01 - 003 i• i, r t, i§ 1 i l i I a' i l\ sf i Photograph showingtheconditiotioliliccxistinghulkhcadingon heDoran Property. DORAN Property — After Hurricane Sandy (October 81, 2012) r . °� i III���E � }µms �a•., X11 , k r uw • • Jill M.Doherty,President �Q►�F�VTyO Town Hall Annex Bob Ghosio,Jr.,Vice-President �� 6 54375 Main(toad yy P.O.Box 1179 James F.King 4 T Southold,New York 11971-0959 Dave Bergen John Bredemeyer Telephone(631)765-1892 y Fax(631)766.666 41 BOARD OF TOWN TRUSTEES TOWN OFSOUTHOLD January 19, 2011 Mrs. Janet Doran 23690 Merano Court#201 Bonita Springs, FL 34134 RE: 9575 NASSAU POINT RD., CUTCHOGUE SCTM#119-1-3 Dear Mrs. Doran: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wed., January 19, 2011: WHEREAS, JANET DORAN applied to the Southold Town Trustees for an Amendment to Wetland Permit#4173 under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated November 29, 2010, 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 recommended that the proposed application be found Inconsistent with the LWRP, and, WHEREAS, the Board of Trustees has furthered Policy 6 and 6.3 of the Local Waterfront Revitalization Program to the greatest extent practical through the imposition of the following Best Management Practice requirements: the reduction in the size of the deck from 8'X 30' to 8'X 20', and, WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, and, 0 -- 0 2 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 for the mitigating factors and based upon the Best Management Practice requirements imposed above, the Board of Trustees deems the action to be Consistent with the Local Waterfront Revitalization Program pursuant to Chapter 268-5 of the Southold Town Code, and, BE IT FURTHER, RESOLVED, that the Southold Town Board of Trustees APPROVES the Amendment to Wetland Permit#4173 for the existing stairway and an 8'X 20' deck, as depicted on the revised plan stamped approved on February 18, 2011. This is not a determination from any other agency. Fees: $50.00 Sincerely, (✓� Jill Doherty, Preside Boa of Trustees JMD:Ims r M1 _ a 1 Board Of Southold" Town Trustees SOUTHOLD, NEW YORK j PERMIT .... DATE: .. ...5/2.6/9.3. .. r 3 ISSUED TO ........J05Ep..H..MANDELBApM....... .... .... .�ut�nri�tt#iun , Pursuant to the provisions of Chapter 615 of the Laws of the State of New York,_ 1893: and Chapter 404 of the Laws of the State of New York 1952: and -the Southold Town Ordinance on. titled "REGULATING AND THE PLACING,OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the \ REMOVAL OF SAND, .GRAVEL OR OTHER.MATERIALS FROM t' LANDS UNDER TOWN WATERS;" and in accordance with the Resolution of The Board adopted at•a meeting held on ....5/26193_ , 19.. ... 9. paid by . 3anrj in consideration of the sum of $. .. .................._ ........ _. _ ........ r i " 4' N. Y. and subject to the Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: Remove & replace (in same location and configuration) 92 1.f. o "r j excisting timber bulkhead and backfill with 200 c.y. of clean sand will be 6trucked in from upland source. Replace 3' wide staii a'cCortlaraiCe with the detailed specifications as presented in the originating eppricafion. IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of A said Board as of this data. i,` 9 I LITTLE AcE3 � I � HOC ko�W NECK J NASSAU POINT a ■ �/ 11 Wun a H gNOE RE 1554 '. i CNOT /NC 1.uOLO /MTM/S APPL/<) e.waa Q NWfle I CL /FEeT c �S So / Q Nasyaa Point O Nn I I � nAP SZ y 60.H3PooAo/Y � �/9cc/PAENT I ! O ' � to fl 1 J nZ I N P t I h IN IV v a �.., aIv J q Si»Ne Ts 6� : I � a" �• � Q � h T OuaK N2AOTs p r F J NSe. d 9t Ren.•-< I �� wi _�( Il y V V e ,�RFP4weea ry ;�„ x Q N hIANOELDA!//f 2 ax FF a • � a o J � • � a9� 2" Qh SPEacs f; I � m� n J iI �3uR✓tY /N HAM, e� PRE✓/auy I It IS Y O/�NER GRBLN STL/N. NO ' , HeufE Lo<ATioN SNee+MJ ; O i I�� N r C II < � M1E O � N ( I � m Z N p 0 n/er6a: 1. I CATV":Ad✓ PROP03E0 etXKMEAO R neEr/1/T PuRPsSE:ERoSyw Cosy-T'Ato< STAIK I./A Y 4EPA IR 5/R6PkAGE— A9)JAt4ffNT Oy+HE R3: M6AlT FOR A 50 -rg ePSPERFS Jo3EPN MANOEL gqu/y ON ROCCN/� 8Ay AT .Z. A/oA'TN OF A"S: NASSAu PO/Nr/ SuFFOtK �e//I/Y a 0 SiMm \\ �.y LIME P f ^ N\ PECONIC \\ t arNm O'i\ O &1Y IP \ , COUM OFSUFFOLK © v crrou .� _ -_ --.-- Reeiwnm�M Te...r3ervi FBpe .— _ ,,._ 119 Jnutee F.ICu,g P�sidenl �0�tQUjy�'a Taves Holl nanex 64375 NWa Bob Ghoaw,Jr., vied tFrmkl4nt 1 ti�� P.O. Dox 1179d Dave Bergen 9onthold,New York It 971-M59 John Bredoneyor Teleox".(F01)7861 M2 bKohnel J. Domino Pax(081)'746-s 11 BOARD OF TOWN TRUSTEES NOV - 2 2012 TOWN OF SOUTHOLD HURRICANE SANDY EMERGENCY APPLICATION Valid thru June 1, 2013 Property Owner Name- PETER DORAN Permanent Mailing Address: 23690 Merano Court; Bonita Springs, FL 84134 Phone Number(s): 239 495_ 8644 Property Address: 9575 Nassau Point Road; Cutchogue, NY 11935 Suffolk County Tax Map Number. 1000 - 119 -01 - 003 Agent(If appllcabie) SUFFOLK ENVIRONMENTAL CONSULTING, Inc. Address P.O. Box 2003; Bridgehampton, NY 11932 �1/ Phone Number(s): (631) 537 - 5160 ; r" U �\ Board of Trustoo P(xrrtlt Number(s1:_7876 F5 190 � Will any part of this project require a Budding Permtt? No. \� How much fill will be required? 500 + cubic yards of clean fill I / Project Description: Reconstruct upper ("Retaining Wall" and to bulkhead all stairs and decking- associated with the bulkheading, all to re ce existing conditions prior to storm dames a resulting from Hurricane San October 29 2012). Upper wall to be vinyl-sheathing lower wall to be sheathing. Please refer to the attached 0 Plans prepared by Suffolk Environmental Consulting, Inc. last dated July 9. 2012 for specifications (highlighted) > d of Trustees Applicatioio County of#4" �Ef- State of 4&*-i Z"& - 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. Signature SWORN TO BEFORE ME THIS �0 DAY OF ,20CYNTHII ,� My AISSION EE E1040P2 .I . MY COMMISSION f 7,1015 EXPIRES:June 27,2015 Otary PllbilC J�'?arSM°' Boded Thu&dgd NdaY Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) We, PETER DORAN residing at 13690 Merano Ct.; # 207; (print owner of property) (mailing address) Bonita Springs, FL do hereby authorize Suffolk Environmental (Agent) Consulting, Inc. to apply for permit(s) from the Southold Board of Town Trustees on our behalf. (Owner's signature