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Home My WebLink AboutTR-7934E SOUTHOLD TRU'ST Issued To 4...~..~.~iJAb~ Date~ Address THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION 'TOWN TRUSTEES OFFICE 'TOWN OF sOUTHOLD SOUTHOLD, N.Y. 11971 TEL.: 765-1892 Page 1 of 1 Nunemaker, Amanda From: Nunemaker, Amanda Sent: Friday, November 02, 2012 10:59 AM To: 'betsy@mooreattys.com~ Subject: Gray Property Hi Betsy, Can you let Pat know that I spoke to Jim regarding the Gray property on Rabbit Lane in East Marion? We can accept the Emergency Permit application even though it is in a Coastal Erosion area. I just want it to be clear that the once the Emergency Permit has been issued, it is only for temporary measures to shore up the house and covered porch with plywood. In order to repair or restore structures, they must apply for a full Coastal Erosion Permit which would go through the normal process. Also, if you could have Pat or the homeowner forward me photos of the damage along with a current survey. Thank you! Clork Tgpisf Town ot Southold Board of Tn*st~* 631-7§3-180~2 11/2/2012 Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemcyer BOARD OFTOWNTRUSTEES TOWN OFSOUTHOLD Office Use Only ~ Emergency Permit Application __Coastal Erosion Permit Application ~Wetland Permit Application __ Administrative Permit ___~endmenVTrans fer/Extcnsio n ~Received Application: ___Received Fec:$ __Completed Application __Incomplete __SEQRA Classification: Type I Type II Unlisted __Coordination:(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: Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Phone Number:( ) Suffolk County Tax Map Number: 1000 - '~ ( Property Location: (_,, c:~O (d bb V (provide LILCO Pole #, distance to cross streets, and location) AGENT: '~'~c-~'~¥', c.~ o,. C., [f~ C ~ (If applicable) Address: Phone: ~-o3{-- 4350 Board of Trustees Application GENERAL DATA Land Area (in square feet): "Tt (~ ~ ~ Area Zoning: [~- ~ O Previous use of property: Intended use of property: Covenants and Restrictions: Yes If"Yes", please provide copy. T(~D Does this project require a variance from the Zoning Board of Appeals ~ If "Yes", please provide copy of decision. Prior permits/approvals for site improvements: Agency Date __ No prior permits/approvals for site improvements. Has any permiffapproval ever been revoked or suspended by a governmental agency?. X: No Yes If yes, provide explanation: Project Description (use attachments if necessary):_ il lX l~r~ Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Pulpose of the proposed operations: ~'~t'b~ ~ Area of wetlands on lot: /q ~x] square feet Percent coverage of lot: k~o o~ % Closest distance between nearest existing structure and upland edge of wetlands: ! ,~' T feet Closest distance between nearest proposed structure and upland edge of wetlands: /5'- ~ feet Does the project involve excavation or filling? ~< No Yes If yes, how much material will be excavated? cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: Statement of_t)e effect, !f any, ~_n th~ we[l_an_ds and.fid.a)_ w.a_tErs_ 9(~e ~tow![ tha_t ._re. ay_.r__e_s_u_!t_b_y _ reason of such proposed operations (use attachments if appropriate): BO of Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity: Are wetlands present within 100 feet of the proposed activity? No ~ Yes Does the project involve excavation or filling? ~.- No Yes If Yes, how much material will be excavated? /q[J¥ (cubic yards) How much material will be filled? b¢] ,~ (cubic yards) Manner in which material will be removed or deposited: 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 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) 2. PROJECT NAME PRECISE LOCATION: Street Addess and Road Intersectiom 5. IS PROPOSED ACTION SEQR Prominent landmarks etc-or provide map [] New [--]Expansion r-~ Modification / alteration ~-.~l~.-E~t- ~ 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially m 2~'- acres Ultimately ,~(-5.~'- acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? 9. WHAT tS PRESENT LAND USE ~N VICINITY OF PROJECT? (Choose as many as apply.) ~Residential [~lndustria, [~Commorciai ~]Agricalturo ~-~Park/Forosl/OpenSpace []Other (descr,be) 10/DOES ACTION INvoLVE A PERMIT APPROVAL. OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) ]Yes ~ No if yes. list agency name and permit / approval: 11. L)U~:;5 ANY ASFE[JI Ut- I Hb A{.;I~ON HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ]Yes ~]No If yes. list agency name and permit I approval: I CERTI~ TH~_A.~HE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / S~~/./.%__...~ Date: If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE. FORM The Town of Southold's Code of Ethics nrohibits conflicts ofinternst on the anrt of town Officers and emvlovces. The DUn~SO of this form is to urovide information which can alert the town of oossible conflicts of inter~t and allow it to raise whatever action is neegs~trv to avoid samc. (Last anme~rrst name, ~niddlc initial, unlass you are applying in the name of someoan else or other cndty, such as a company. If an, indlcate, the otber person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Varianco 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 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 more than 5% oftbe shares. YES NO y~, If you answered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by thc Town of Southold Title Or position of that person Describe the relationship between yourself(the applicanttngcnt/reprosenlative) and thc 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 shams of thc corporate stock of thc applic~o~ (when the applicant is a corporation); ___B) the legal or beneficial owv4'r of any interest in a non-corporate entity (when the applicant is not a corporation); C) an officer, director, parmer, or employee of the applicant; or __.D) the actoai applicant. DESCRIPTION OF RELATIONSHIP Form TS 1 of Trustees Applicat: County of Suffolk State of New York ~.~,:~ J ,,*"fro ~,--,-~ BEIN~ DULY SWO~ I~EPOSES ~ ArumS TH^T m/sim IS Tim APPUCANT FOR Tim ~OVE r~EsCRmEr~ PERmT(S) ANO TI-IAT ALI. ST^TEMENTS CONTX, NEr~ HEREIN ,Urn TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH 1N 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), Il* 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 ~VO ~/, ,20 /o~- { No'fy PubliCMARGARET C. RUTKOWSKI Notary put31ic, State of New York No. 4982528 Qualified in Suffolk County.., ..~ Commission ~-~xpirss June 3, i~-,~./-> Board of Trustees Application AU~HOR~ ZATTON (where the applicant is not the owner) (prin~ owner ~f property) residing at I ~ ~ (mailing address) do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. ' ~Owner~s signature) 8