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Home My WebLink AboutTR-4145 GFBoard Of $outhold Town Trustees SOUTHOLD, NEW YORK PERMIT NO .... .41.45 ........ DATE: ....~I;Zg./9.~, ....... uthodzatiou 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 Soufhold Town Ordinance en- 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 LANDS UNDER TOWN WATERS;" and in accordance with the Resolution of The Board adopted at a meeting held on ..~..~29 ......... 19 ....... c~,~and in consideration of the sum of $ ...... paid by of ................................................................................... N. Y. and subject to the Terms and Conditions listed on the reverse side hereof, of 5outhold Town Tru~ees authorizes and permits the following: Grand£a~her Permit go replace bulkhead inkind/inplace. all in accordance with the detaiJed specifications as presented in the orlgin~atlng application. IN WITNESS WHEREOF, The said Board of Trustees here- by causes ifs Corporate Seal to be affixed, and these presents to be subscribed by a maiority of th said Board as of this date. Trustees TRUSTEES John M. Bredemeyer, III..President Albert J. Krupski, Jr., Vice President Henry P. Smith John B. Tuthill William G. Albenson Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SUPERVISOR SCOTT L. HARRIS ; Town Hall 53095 Main Road P.O. Box 1179 Southold. New York 11971 Office Use Only: DATE REC.: ICoastal Erosion Permit Application ~Coastal Erosion Variance Application ~.We.tland Permit Application ~--~. ~ n 0AWalver from Chapter 97(Applicatlon/pe~~l~' ~Trustee Lands Permit Application t].~1~ ~Grandfather Permit Application IUUl APR ~_u~Completed' Apps. Da.~e: .~t%,%-]q~ i ~ ...... ~'~ ~Inspection date: q}%~lq~?~ ~ [ CAC comments-Date: Sent Variance Required: (Y/N) Neighbors notified-Date: SEQRA Type Coord.: Date sent SEQRA Determin./date: Public Hearing/date: Findings: Approved (Y/N) Special Conditions: (Y/N) (see file) Permit(s) issued-date: Rec. Application Fee: Application Number; SCTM$1000- Applicant: Address: Interest: (owner, consultant,lessee,etc. Owner of Property: ~/~ Address ~ Ce ~ ~- Subject Property Location: / (Provide LILCO Pole #, Distance to cross Streets if not on .location map) THIS IS NOT A PERMIT Page 1 Yds. to be excavated: ~ Yds. to be filled: Manner in which material will be removed or deposited: Width of canal, creek or bay fronting property: Depth at low tide: Aver. rise in tide: Distance to nearest channel: ~~ot ~ Distance project extends beyond similar projects in area: Area zoning: ~. Land area in acres: Is project for private or business use: Intended use of property: Describe known prior operations conducted on premises: -< Has any prior license or permit been issued to erect structures, dredge, or deposit fill on said premises: ~ Has any license or permit ever been revoked or suspended by~a Governmental Agency: ~ ~ Project Description The project description must also include plans for reclamation of land disturbed during construction of the principle and accessory structures and underground structures (i.e., pipeline and septic SYstem; make additional attachments if necessary). THIS IS NOT A PERMIT · Page 2 Authorization (Where the applicant is not the owner) I ,~~ ~ residing at 5z~ ~ ~ae ~/~ (Print-owner of subject property) (Mailing address-p~one) do hereby authorize j.~ ~/~e~W0 ~ .to apply for Coastal Erosion pexmit(~) from the Southold Town Trustees Signature THIS IS NOT A PERMIT Page, 3 6177F Appendix C State Environmental Quality Review .= SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I--PROJECT IN FORMATION (To be completed by Applicant or Project Sponsor) 3. PROJECT LOCATION: M uniclsality ~ ~ '~' ~'~,~ ~t. County 4. PRECISE LOCAT10~ (Street address and road intersections, prominent landmarks, etc., or~provie/e ~ap) 5. IS PROPOSED ACTION: [] New [] Expansion 6. DESCRIBE PROJECT BRIEFLY: ?. AMOUNT OF LAND AFFECTED: 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONSa ~J I~Yes [] No If No, describe briefly 9. WHAT IS PRESENT LAi'~D USE IN VICIN TY OF PROJECT? {~esidential [] Industrial Describe: [] Commercial [] AgricUlture [] Park/Forest/Open soace ~ [] Other t0. OOES ACTION INVOLVE A PERMIT APPROVAL OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? - ~Yes F~ No If ye~, list agency(s) and permit/approvals .. 11. DOES Ah y ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ' [] Yes [~l'lo If yes. list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WmLL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE ~lf the action is in the Coastal Area, and you are a state agency, complete L Coastal Assessment Form before proceeding with this assessment OVER 1 SEQF DOUS AGTION EXCEED ANY TYPE I ~ESHOLD IN 6 NY~R~, PARr 6~7 12* ' "~ ~ , ~ Yes ~No I~ ye~, coo~ 'to the rev,aw P,Oces, an~ u~e ,~ FULL ~ WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN ~ ~YCRR PART 617 6~~ may be SUperseded by another involved ~gency.If No, a neg~uve aeclaraUon COULD ACTION RESU'LT IN ANy ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwrnten, if leq~ble) Cl. Existing a~r quality, surface or groundwater q~=lity or quantity, noise levels, ex,sling traNic patterns· solid waste Production potential for erosion, drai.ege or t oo~ing Problems~ Ex,lei. briefly: ~ or dispOSal, C2. Aesthetic. agricultural, arcr~aeological, histor c, or other natural or cultura! resources: or COmmumty or neighborhood ~haracter?'. Explain briefly: I C3. Vegetation or fauna, fish shellfish or wildlife soecies, significant habitats, or threatened or endangered s=ecies? Explain briefly: A community's existing plans or goals as officially adopted or a Change in use or intensity of use of land er other natural resources? Explain ~rlefl¥. C$. Growth, subsequent development, or relatecl activities likely to be Induced by the nreeosea action? Exr.~taln briefly. C5. Long term, Short term. CUmulative, or other effects not identified in C1-C57 Explain briefly. C7. Other imoacts (incl[~ding changes tn use of either quanhty or type of energy)? Explain briefly. D. IS[]THERE.yeS OR ISCNoTHERE LIKELy TO BE. CONTROVERSY RELA~'ED TO POTENTIAL ADVERSE ENVIRONMENTAL ht, tPACTS? If Yes, explain brielly PART Ill--DETERMINATION OF SIGNIFICANCE ~O be completed by Agency) . -- INSTRUCTIONS: For each adverse effect identified above, determine Whether it is substantial, targa, important or Otherwme significant. Each effect should be assessed ~n COnnection wilh its (a) setting (i.e. urban or rural}; (bi prooability of occurring; (c) duration; (d) irr6vers b fy; (el geographic scope: and (fi magnitude. If necessary, add attaChments or reference supporting materials. EnSure that explanations contain suffic~en I detail to show that all relevant aOverse Im pacts have been identified and adequately addresseQ. . [] Cb, ack this box if you have identifiee one or more Potentially large or significant adverse impacts which ,",'lAy occur. Then procee(~ directly to the FULL EAF and/or prepare a positive declaration. [] Check this box it' you have determinee, based on the information and analysis above and any supporting documentation, that the propose{] action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: County of Suffolk ) State of New York ) AFFI~S ~AT HE/SHE IS ~m APPLICANT FOR WE ~O~ DESCRIBED THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT WORK WIr. I. BE DoNE IN THE ~ER SET FOR~ IN ~IS ~PLICATION ~ AS mY BE APPROVED BY THE SO.mOLD ~ BO~ OF mUS~E~S. ~ ~C~ AGREES TO HOLD ~ ~ OF SO~O~ ~ ~ ~ ~US~S H~ESS ~ FREE ~OM ~ ~D ~L D~G~ ~ CLAIMS ~ISING ~ER OR BY VIR~E OF SAID PE~IT('S), IF G~TED. IN COMPLETING THIS APPLICATION, I H~EBY A~ORI~ ~ TRUSSES, THEIR AGENT( s ) ~ ~P~SE~ATI~(s) , TO ENTER ON~~ ~ PROP~ ~ INSPECT ~ P~MISES IN CON~CTION WITH ~EW OF THIS APPLI CATION. ~ ~ / SlGNA~RE / / SWO~ TO BEFORE ~ THIS /~ ~OF ~.~ ,19 ~ NOTARY PUIBLI C UNDA J. COOPER Notary Public, State of NewYork · Term E~pires uecem~er ~, Suggested space for location Map THIS IS NOT A PERMIT Southoid Town Trustees Field inspection Report Site contains the following important natural features (Beach, Bluff, DuKe, Secondary Dune, Escarpment, Kettle holes, Erratics or Significant Habitats, Ra~reatened, Endangered or species of special concern.~ Extent proposed activities are at variance from established standards of Coastal Erosion Projection; is supplemental engineering or advisory opinion indicated? Refer to CAC? Can impacts be moderated by simple project change? ~ .~' Should FEMA Regs. be checked Prior to Permitting?. / Application complete~ assement form provided/complete Public services landward of Structure. Non-movable structures/additions prohibited. Permanent foundations not attached to movable structures No movable structure within 25' of landward limit of Bluff. No movable structure placed so excessive ground loading placed within 50' of point of inflection. Relocation agreement required/acceptable. Surface water not directed to/over bluff face. The Activity is: Reasonable and necessary, considering reasonable alternatives to the proposed activity and the extent to ' which the proposed ac~ivity~ requires a shoreline location. __ Not likely to cause a measurable increase in erosion at the proposed site and at other locations. Prevents or minimizes effects on natural protective features and their functions and protective values existing erosion protection structures and natural resources. ~,/~rusnee signature Date inspected: The Southold Town Trustee office has determined that your application for a coastal erosion/wetland permit is non-jurisdictional/incomplete~ please consider the following information in this regard for any required return submission: CC: --~-~izding '-~ '~- ~ ~ -' Lpp~e~ls Conservation Advisory Council This notice makes no claim with respect to other jurisdictions within or outside the Town of Southold with respect to permits, permission required. 4/92 ~o. oo~ ~v8 / / / / / C) Yd ! E AI T TION 3ca/e /~ ' ,,, J. H. GEIDEMAN NEW YORN ' i'i':'"~:"~i~i~"' U~: "L~ & '"~:;~f~U'.:. Date