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TR-1969 GF
John M. Bredemeyer III, Presii L �:�:.�..� .,,.�,.-. :.., 1��pFF..04> = :��L�; Town Hall Annex Michael J. Domino, Vice-Presiaeni j y� 54375 Route 25 Glenn Goldsmith o P.O. Box 1179 A. Nicholas Krupski o Southold, NY 11971 Charles J. Sanders 4,- ;DPW Telephone (631) 765-1892 Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: 1a��w�i�e 133d Completed in field by: KEVIN & DEBRA GEIGER request a Transfer of Wetland Permit#1969 from John J. Bubany to Kevin & Debra Geiger, as issued on June 27, 1985. Located: 2350 Beebe Drive, Cutchogue. SCTM# 1000-103-3-10 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=q Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet _ 5. Swimming Pool and related struci filed 6. Landscaping or gardening: 50 fed : �v/j 71Ao 9 7. Placement of C&D material: 10Q f &_)P_f{04)Cj1 TOP OF BLUFF: 0 r 1. Residence: 100 feet ►-`�� y 2. Driveway: 100 feet �� ``S Cn 3. Sanitary leaching pool (cesspool) 4. Swimming pool and related structu / V Public Notice of Hearing Card Posted, Ch. 275 Ch. 111 SE I Action Type of Application: Pre-Submi' dment Wetland Coastal,Eri; Non-Jurisdiction Survey :5 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application /Icompleteness/comments/standards: 4 pOeV� 1 �Q X�© r�lv�l 1�e�r ple�� p*,d,,,4 . ate' ^, i" Ljk-I— a(!'r^,-Wo S i55jejPOr, �W�►P�MUS�QA/��Y Tyr n cllt - Qr Hie_ &)rft -s�Yvc z�� , d ej Cut %s Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski C. Sanders Other Page 1 of 2 John M. Bredemeyer III, Presii J; �ogUFFO(o Town Hall Annex 0 ,w, Michael J. Domino, Vice-Presiaeni �o Gym 54375 Route 25 Glenn Goldsmith o P.O. Box 1179 A. Nicholas Krupski a ` Southold, NY 11971 Charles J. Sanders y�j� ao�^ Telephone (631) 765-1892 Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: KEVIN & DEBRA GEIGER request a Transfer of Wetland Permit#1969 from John J. Bubany to Kevin & Debra Geiger, as issued on June 27, 1985. Located: 2350 Beebe Drive, Cutchogue. SCTM# 1000-103-3-10 Ch. 275-12 - STANDARDS FOR ISSUANCE OF PERMIT MET=X or Comment=* A. Adversely affect the wetlands of the Town: B. Cause damage from erosion, turbidity or siltation: C. Cause saltwater intrusion in the fresh water recourses of the Town: D. Adversely affect fish, shellfish or other beneficial marine organisms, aquatic wildlife & vegetation or the natural habitat thereof: E.,Increase the danger of flood and storm-tide damage: F. Adversely affect navigation tidal waters or the tidal flow of the tidal waters of the Town: G. Change the course of any channel or the natural movement or flow of any waters: H. Weaken or undermine the lateral support of other lands in the vicinity: I. Otherwise adversely affect the health, safety and general welfare of the people of the Town: J. Adversely affect the aesthetic value of the wetland and adjacent areas: Ch. 111-9 - ISSUANCE OF PERMIT MET=X or Comment—' A. Is reasonable and necessary, considering reasonable alternatives to the proposed activity and the extent to which the proposed activity requires a shoreline location: B. Is not likely to cause a measurable increase in erosion at the proposed site and at other locations: C. Prevents, if possible, or minimizes adverse effects on natural protective features and their functions and protective values, existing erosion protection structures and natural resources: D. <_25% Expansion/Calculation Work Session Notes - Application Complete SEQRA Classification Confirmed Coordinated Review Y/N Pos/Neg Declaration CAC: LWRP: Additional information on comments/to be discussed/Public Hearing: Date: Completed By: Present: J. Bredemeyer M. Domino G. Goldsmith N. Krupski C. Sanders E. Cantrell D. Di Salvo Other Page 2 of 2 4' ®� S® �0 (/P John M.Bredemeyer III,President �� / 0 Town Hall Annex Michael J.Domino,Vice-President �® O 54375 Main Road P.O. Box 1179 James F.King,Trustee Southold,New York 11971-0959 Dave Bergen,Trustee G Q Telephone(631) 765-1892 Charles J.Sanders,Trustee �.`OU Fax(631) 765-6641 CE VE BOARD OF TOWN TRUSTEES SEP ` 1 2016 TOWN OF SOUTHOLD ' Southold Town t APPLICATION FOR A TRANSFER OF A WETLAND PERMIT DATE ` OWNER 1 P,6FOL CV- 41U)n e,19ft PHONE 17-2311—m-3 I 7 JS 9 — 1'/9 MAILING ADDRESS //S (,/ V 2 /1l AGENT PHONE ADDRESS oZ .S l ✓ C�t� CJ 1,CIL PROPERTY LOCATION TAX MAP NO. I We :Z) e-h ro_V� request a Transfer of Permit# from j G hf) � R c�h� u/ ci Signed B J guard of Trustees Applic% AFFIDAVIT kwln1 ' ae-10eg, BEING DULY SWORN DEPOSES AND AFFIRM HAT 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 BOARD OF 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, INCLUDING THE CONSERVATION ADVISORY COUNCIL, TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUST S DURING THE TERM OF THE PERMIT. 'z Signature of roperty Owner SWORN TO BEFORE ME THIS DAY OF�4*4na , 2011,0 Notary Public CONNIE D.BUNCH Notary Public,State of New York No.01 BU6185050 Qualified in Suffolk Ceuniy Commission Expires Aprii 14,2 da(:) anard of Trustees Applic% AFFIDAVIT BEING DULY SWORN DEPOSES AND AFFIRMS THAT /SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS) 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 BOARD OF 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, INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER.ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. r Signature o Property wner SWORN TO BEFORE ME THIS I - DAY OF ryl Lai , 20_L� a-Crn ALA Notary Public C0I4NIE D.BUNCH Notary Public,State of New York No.O16U6,1850W Qualified iri Suffolk County O Commission Expires Aprif 14,�Q� APPLICANT/AGENTIRE-PRESENT1iTM TRANSACTIONAL DISCLOSURE FORM ` The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees The purposd of this form is to provide information which can alert the town of possibly conflicts of interest and allow it to take whatever action is necessary to avoid same. I YOUR NAME:, / e_ ' (Last 4e,.firtt name,griddle initial,unless you are applying Id 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',narpe,the activity.) Do you personally(or through your company,spouse,sibling,.parent,or chile()have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by-blood,tnarriage,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%gf the shares. YES NO- V/ 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(agentfrepresentative)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,patent,or child is(check all.t.iat apply): A)the owner of greater than 5%o€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(wheir the- applicant is not a corporation); C)an officer,director,partnei;,oi employee of the applicant;or D)the actual applicant. DESCRIPTION Or RELATIONSHIP Submitted this day o r-20 Signature. Print Name �(r) FonTn TS i f APPLICANWAGENUREPRESENTAT[W 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. /? YOUR NAME: (Las ame,. first name,{Biddle initial,unless you are applying Id 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"Othee�,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'r'gterest."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- 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 behveen yourself(the applicant/agentfrepresentative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space prodided. 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(whbft the applicant is not a corporation); C)an officer,director,partnei;.or employee_ of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of Signature. Print Name; �„i���� /r• Gam _ ' Form TS 1 �� ALL MOORINGS AIqD STAKES MUST DISPLAY VISIBLE MOORING NUMBERS ALL'DOCKS AND BULKHEADS MUST DISPLAY VISIBLE pEP&iiT NU~LBERS Board Of $outhold Town Trustees SO'UTHOLD, NEW YORK Moor±nD ~ N/A -: 7.,7. ?ERM~T NO. 1969 DAT.~- June .2~.. %985. '- - ' Pursuan/ to fhe provlslons of Chapter 615 of fhe Laws of · . .'th~ S~,at~ of New York 1893~ and ChaDter 404 of fhe' Law~ of fhe ':, .Sif..afelbf New York 1952~ and the SohO'hold Town Ordinance eh- · t~iecf'~'RE~ULATING AND THE PLACIN~ OF OBSTRUCTIONS . . IN A~D ON TOWN WATERS AND PUBLIC LANDS and fhe · REMOVAL OF SAND ~RAVEL OR OTHER'MATERIALS· FROM LANEfS UNDER TOWN WATERS;" and in' accordance wlfh fhe Resolu~bn of The Board adopfed afa meeting held on .J..U~Ua_..2:fi.~. '~"'i9'.8.~' and in conslderaflon of fhe sum of 5.00 ' · · $ ..................... :pa,d by of---C.-ut__c-h-9.~Lu..e..L ............................ N. Y. and subjec~ fo the ~'Terms and Cond;Hons listed on the reverse slde hereof, of Southold ,Town Trusfees au~'horizes and [=errants ~'he follow Application approved under th~ Grandfather Clause to Secur~e a permit for two 5'x20' float docks. w~[h ra~p and ~wo 'pilings on ea6h structure. East Creek, Cutchogue. all',n accordance w|~h {'he detailed spechqcaf~ons as presented in ' fhe or{g;nat~ng appllcaflon ..... IN WITNESS WHEREOF. The said Board of Trustees h,ere- by causes. |~'s Corporate. Seal to be el?xed, and these p.resents to ' i. ..b~ subscribed by a .malorify of the sa,d Board as of tbs dat,e. Trustees Please tear off and reuurn Board Of $outhold Town SOUTHOLD, NEW YORK MOO?. I~.~G NO. PERMIT NO. to the Trus=ees Irustees DATE: ISSUED TO _, cer=if7 thac the work as authorized in tkis permit has been ccmFleced and %s now ready fcr your inspec- rich. Also, the number required on tkis project is clearly visiDle I furtker understand tkis permit is no; valid until this.tear sheet Name of Creek: East BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 728 Southold, New York 11971 TELEPHONE [516) 765q892 GRANDFATHER APPLICATION dockw 1. Name of Applicant: 2. Address of Applicant: e 4. 5.- Sketch .. JOHN Telephone Number: Year of Construction: 7~'~- ~'~'¥8 197~ of the work including sizes: 6. Mark off using an on the map attached, where your property X. Signature: Please note that the fee, for this application. ~ is zs located a one time Mooring Applications- $5.00 Application Fee and a $5.00 annual renewal fee each year.