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Home My WebLink AboutTR-4028 GFgoard Of Southo]d Town Trustees SOUTHOLD, NEW YORK PERMIT NO. 4028 DATE: iSSUED TO .... li~.gmz:.~.. !~!~,~ D~v~!opment Cor~p, Pursuanf fo fha prov]sbns of Chapter 61E of fha Laws of fha Sfafe of New York, i893; and Chaplet 404 of fha L~ws of fhe Sf~fe of ~w York i9~2: ~nd fhe SoufhoJd Town Ordim~ce fffbd "REGU~TING AND TH~ PLACING OF O~STRUOT~ONS IN AND ON TOWN WATERS AND PUbLiC LANDS end fhe R~OVAL OF SAND, GRAVEL OR OTH~R ~AT~JALS F~OM LANDS UNDER TOWN WA~RS;" and in accordance Resolufb~ of The Board~dop~d e{* ~ meefi.~ held on . ..~L2~ .... ~9 ~ and in co~s]derafion of fha sum of $ 50,00 pMd b~ D~cka.Lae ......... E.O. ~oz ~2~ ...................... Terms a~d Co~dff[o~s ii.ed on fhe reverse slde hereof, ~edeived ~v_ne 15, 1992 all b accordaace w[fh ']'he defM[ed specfflcaf]ons as presenfed ;n fha ongmafmg app~caflon. tN WITNESS WHEREOF, The said Boar'd of Tmsfees hare- by causes ifs Corporafe Seal +o be affi×ed, and fhese presenfs fo be subscr[bed by a maiorif¥ of ~rd es of fhis daf,e. TRUSTEES John M. Bredemeyer, III. President Henry P. Smith, Vice Presidem Albert A Krupski. Jr. lohn L. Bednoski. Jr. John B. Tuthitl Telephone (516) 765-1892 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SCOT'I' L. HARRIS Supervisor Town Hall 53095 Main Road P.O: Box 1179 Southold, New York 11971 Fax (516) 765~1823 Telephone (516) 765-1800 GRANDFA%lqER APPLICATION 1. Name of Applicant: 2. Mailing address: 3. Address Fishers Island ~Development Corperation Fishers Island, NY 06390, PO Drawer E Tel. No: 516 788 7251 of Property: Tb3~ property is shown on the attached tax map. Tax Map Nu/nber: 1000- private ROW Approx.yr.of construct: pre 1971 Prior owner if know-n: Diagram of existing structures, including all dimensions, must be included with this application: See attached application drawings for overall Plan View of the area, Plan and Profile of the dock to be re-built, adjoining property owners and shoreline characteristics. The site is a portion of a private Right of Way between parcels 13 an~ 14 on Tax Map 1000-004 block 4 e Indicate on attached map: Location, ie; reference point, telephone pole number, adjacent property owners, etcy Signature of applican~~~ Date:~ ~/~ /~-- Please note, there is a one time fee of $5U. 00 for filing tlSis application. Docko, Inc. P.O. Box 421 Mysuc. CT 06355 (203~ 572-8939 Fax: f203~ 572-7569 Mr. John Bredemeyer, President Southold Board of TrusteDs PO Box 728 Southold, NY 11971 On behalf of our reconstruction of an ex~ Corperatlon on Fishers this permit application¢ - Two prints Proje( Watem~ Locat: Date: - Two copies May 29, 1992 TOWN OF SOLtTHOL Re: Fishers Island Development Corp Dock Reconstruction Permit client, we reques= a "Grandfather" Permit for the bing fixed wood dock of the Fishers Island Development Land. We enclose the following documents in suppor~ of application drawings titled: ~ "Dock Recons%ruction" : East Harbor, Fishers Island Sound 1: Fishers Island, Town of Southold Suffolk County, New York Fishers Island Develo~men% Corp May 29, 1992 the Southold Board of Trustees "Grandfather" Corps and DEC applications, Tax Assessor's map and check in the amount of S50. I trust that acceptable; please let will find this application package complete and know if the need for more information arises. Yours truly, Enclosures cc Fishers Island Dew FiShe~Sisland Cow Jim Haggerty¢ CE Robert Green, DEC John Clavinl Fishe~ File 91-08-245 ~pment Company Club Keith B. Neilson, PE Island Harbor Master Docko, Inc, ~.0. Box 421 Mystic, CT 06355 f203) 572-8939 Fax: (203~ 572-7569 ABOVE: Aerial photograph from My 1990 showing the pre-hurricane conditions and and configuration from the south looking north at 500 feet. R~OW: Dock as it now exists showing the broken slab in foreground, which will be replaced with wood components, and other damage to be replaced. Oocko, Inc, P.O. Box 421. Mystic, CT 06355 (203) 572-8939 Fax: (203) 572-7569 ABOVE: Dock damage at the inter tidal zone including broken concrete slab, dislodge~ and damaged ramp, decking and stringers (March 1992). BELOW: Outer one-half of the dock system showing the damaged stringers, ladders decking, etc. Photo taken at mean low wa~er conditions looking west. Oocko, Inc. . P.O. Box 421. Mystic, CT 06355 1203) 572-8939 Fax: (203) 572-7569 May 29, 1992 Mr. John Bredemeyer, President Southotd Board of Trustees PO Box 728 Southotd, NY 11971 Re: Fishers Island Develo~x~ent Corp Dock Reconstruction Permit Dear Mr. Bredemeyer: On behalf of our client, we request a "Grandfather" Permit for the reconstruction of an existing fixed wood dock of the Fishers Island Development Corperation on Fishers Island. We enclose the following docoments in support of this permit application: - Two prints of application drawings titled: Project: "Dock Reconstruction" Waterway: East Harbor, Fishers Island Sound Location: Fishers Island, Town of Southold Suffolk County, New York Applicant: Fishers Island Develoument Corp Date: May 29, 1992 - Two copies of the Southold Board of Trustees "Grandfather" application, Corps and DEC applications, Tax Assessor's Map, location map and check in the amount of $50. I trust that you will find this application package complete and acceptable; please let ma know if the need for more information arises. Yours truly, Enclosures cc Keith B. Neilson, PE Fishers Island Development Company Fishers Island Country Club Jim Haggerty, CE Robert Green, DEC John Clavin, Fishers Island Harbor Master File 91-08-245 ¸7O ]¸8 40 48 20 DOC~O, INC. 203 572 8939 FAX 572 7569 DATE: M~ ~j I~ AGENT- SHEET DOCKO, INC. 203 572 8939 F~ 572 7569 Docko, Inc, · P.O. Box 421, Mystic. CT 06355 (203) 572-8939 Fax: (203) 572-7569 May 29, 1992 Mr. Robert Green NYS DEC, Regulatory Affairs Building 40, SUNY Stony Brook, NY 11790-2356 Re: Fishers Island Develo~ent Corp Dock Reconstruction Permit C~behalf of our client, we request a Tidal Wetlands Permit, including Water Quality Certifications, as necessary, for reconstruction of a fixeddock ofthe Fishers Island Development Corperation on Fishers Island, New York. We unclose the following in support of this permit application: - Four prints of application drawings titled: Project: "Dock Reconstruction" Waterway: East Harbor, Fishers Island Sound Location: Fishers Island, Town of Southold Suffolk County, New York Applicant: Fishers Island Developmunt Corp Date: May 29, 1992 -Four copies of the DEC Joint Application, including the Short Environmental ~ssessment Form, SAAF, site photographs, Tax Assessor's Map, location plan and check in the amount of $210. I trust that you will find this application package complete and acceptable; please let me know if the need for further information arises. Very truly yours, Enclosures cc: DOCKO, INC. Keith B. Neilson, P.E. Fishers Island Development Company Fishers Island Country Club Jim Haggerty, CE John Bredemeyer, Town of Southold John Clavin, Fishers Island Harbor Master File 91-08-234 JOINT APPLICATION FOR PERMIT E~]ARTICLE 9, TITLE 1, ARTICLE 45 6NYCRR 646 (LAKE GEORGE RECREATION ZONE) J~ARTICLE lS, TITLE 3 (AQUATIC PESTICIDE~ CONTROL) [~] 6NYCRR 327 (AQUATIC VEGETATION) r-J 6NYCRR 328 (FISH) J~ 6NYCRR 329(INSECTS) [~]ARTfCLE 15, TITLE 5 6NYCRR 608 (~OTECTION OF WATERS) E~]ARTICI~ 15, TITLE 15 ~J6NYCRR 601 (WATER SUPPLY) J--]6NYCRR 602 (LONG ISLAND WELL) None Knowr~ 2. APPLICANT IS A/AN r~Owner [~Operator [~ Lessee [~Municipality/Govemmental Agency (Check as many as apply) :Use Full Name) Fishers Island Development Corperation MAILING ADDRESS PO Drawer E (516) 788 7251 { Fishers Island NYj 06390 4. NAME OF J~Owner f~AgentJContact Person (Check one) DockoE Inc.F Keith B. Neilson, PE MAltiNG ADDRESS P.O. Box 421 POST OFFICE ~03 I 572-8939 j STATE ZiP CODE CT 06355 J vi.age Fishers Islapd 5. PROJECT/FACILITY LOCATION (Mark location on map, See Number la on reverse side) County Suffolk J Town or city Southold STREET ADDRESS (If different from applicant) Private Road POST OEEICE j STATE ] ZIP CODE Fishers Island NY 06390 East Harbor ~]Yes [~N0 Show work On map and/or drawi..s. [~Yes [] Public [] Commercial October 1992 January 1993 $ 210 E.clos~ ~k reco~t~ction, including 200!~ of 9 f~t wide fix~, ass~iat~ r~ and ladd~s. 14 WiLL THIS PROJECT REQUIRE ADDITIONAL FEDERAL, STATE AND/OR LOCAL PERMITS? [] Yes [] NO If yes, please list: US Army Corps of Engineers Nationwide C~neral Permit Town of SOuthold, "Grandfather" Permit and Coastal ~.~rosion Permit /~?~ - ~ PERMIT ADMINISTRATOR 14-16-4 (2J87)--Text 12 PROJECT I.D. NUMBER 617.21 Appendix C State Environmental Quality Review ;Only FORM PART I--PROJECT iNFORMATION (To be completed by Applicant or Project Sponsor) , 1. APPLICANT/SPONSOR 2. PROJECT NAME Fishers Island Development Corperation Dock Reconstruction 3. PROJECT LOCATION: Municipality Fishers Island, Town of Southold County Suffolk t14. PRECISE LOCATION [Street address and road intel'sections, prominent landmarks: etc., or ploy/de map) I!The site is located on a pr~ivate road at the easterly end~ of Fishers Island. I~See a~ache~ Tax,AsseSSor's Map 1000~004 Block 4/~the private right of ~ay between Iparcels 13 and 12. SEQR 5. iS PROPOSED AC~flQN: [] Neb [] Expansion [] Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: Dock reconstruction, including 200-+~ of 9 foot wide fixed, ~Dod dock, with associated ramp and i~dders. 7. AMOUNT DE LAND AFFEOIED~ Not applicable - this is a dock reconstruction project. Initiagy acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? r~ Yes [] No If NO, aescnbe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? [] Residentia [] Industrial [] Commercia [] Agriculture ~ ParklForest/ODen space [] Other Describe: There ~re two residential properties immediately adjacent to the site to the east; the club grouds and golf course lie to the south. 10. DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDING NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY IFEDERAL, STATE OR LOCALI? ~ Yes [] NO If yes, list agency(s} and permit/approvals US Army Corps of Engineers, Nationwide General Permit Town of Southold ~oard of Trustees, "Grandfather" Permit and Coastal Erosion Permit 11. DOES ANY ASPECT OF THE ACTION NAVE A CURRENTLY VAEID PERMIT OR APPROVAL? [] Yes ~ No If yes, list agency name and permit/approval Not Known 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? [] Yes X} NO KNOWLEDGE If the action is inthe Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 PART It--ENVIRONMENTAL ASSESSMENT(To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE t THRESHOLD fN 6 N¥CRR, PART 617.127 Jf yes; coordinate tbs review p~oc~ss and use the FULL EAF. [] Yes [] No B. WiLL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative declaration may be superseded by another invoived agency. [] Yes [] No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING; (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain btiefly: C2~ Aesthetic, agricultural, archaeological, historic, or other natural or cultural ~esources; or community or neighborhood character? Explain brief 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 of ficial[y 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 Cl-C57 Explain briefly. C7, Other impacts (including changes in use of either quantity or type of energy)? Explain briefly. D. S ~HERE OR IS T~flERE L~IKE~.Y TO. aE CONTROVERSY RELATE~'O PO'[EN'~IAL AD:VER~aE;ENVlF{f3NMENTAL IMPACTS? [] Yes [] No If Yes. explain briehy PART Ill--DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above determ ne whether it is substadtial large, ~mporta~t ~r otherwise signif canT. Bach effect should be assessed in ~onnection with its (a) se~{ ng (i e.'urb~an or ~-ural); (b) probsbilit~ ct; occurr rig; (c) duration; (d) irreversibHity; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference support ng materials. Ensure that explanations contain sufficient detail ro show that all relevant adverse impacts have been identified and adequately addressed. [] Check this box if you 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 declaration. [] Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, [he reasons supporting this determination: Date FICC 91-08-245 5/29/92 New York State Department of Environmental Conservation Supplement to Application for Permit STRUCllJRAL-ARCHEOLOGICAL ASSESSMENT FOP34 (SAAF) PART I - APPLIC;%NT COI4PLETES Applicant Information 1. Applicant Name Fishers Island De_veloF~-ntCorperation 2. App]iCant~Address FishersIsland, NY 06390, PO Drawer-E Project Information 3. 4. 5. Project/Facility Hame Dcx~k Reconstruction Project/Facility Location East Har)~Dr, Fishers Island, NY Is the proposed project adjacent to, or does it contain a building or structure listed in the State or National Register of Historic Places? Yes No x 6. Are there any buildings or structures built prior to 1940 adjacent to or within the proposed project area? Yes X No If the answer to question 5 and/or 6 is yes, provide the f0l]0wing information for each building and structure (use attachments if necessary): a. name of structure Two homes fol~ei~_;7 the East Harbor Coast Guard Station and boathouse b. ]0cation A private road near the easterly end of Fishers Island. C. type of structure (ex: house, 0utbui]ding, barn, bridge, dam, ruins) House d. approximate age or date of construction 1935 7. Might the proposed project have any impact (physical/visual) upon any buildings or structures listed in the State or National Register of Historic Places o__cr built prior to 19407 Yes No X This project is ~econstruction of an existing dock. If yes, describe briefly (use attachments if necessary): 8. Provide photographs efeverybui]dinga~d s~ucture,thatmaY be impacted bY the project aZ described in number 7, a6~e;'~T~ fOTtow~'ng s[andards are recommended: o o minimum of two photographs o minimum size 4" x 4" prints from negatives preferred; polaroid photos are acceptable o photos must be clear and focused o clearly label photos so it is obvious what is being illustrated; key photos to map or plan, if possible o photo 1: show both the entire front and side of the structure in a single shot from as close to the building as possible. Be sure the structure is not partially or fully blocked by trees or other obstructions o photo 2: show relationship of building or structure to roadway or surroundings Has the land within the proposed project area been previously disturbed or altered (excavated, landscaped, .filled, utilities installed}? Yes × No Ifyes, describe briefly, ncmual g depth of disturbance (use a~$achments if necessary): A dock has existed at this site for many years, prior to 1970. 10. Approximate percentage of proposed project area with slopes: 0-10% % 10-15% % 15% or greater 11, Approximate percentage of proposed project site-with the following drainage characteristics: Not Applicable Prepared by Date well drained % moderately well--d-~l~ed % poorly drained Docok~,Inc., KeithB. Neilson, PE May 29f 1992 Not ApDlicable % SAAF1.LK/G 10/90 STRUCTURAL-AR~I4EOLOGICAL ASSESSMENT FORM (SAAF) FICC 91-0852_~5 5/29/92 PART 2 - DEPARTMENT OF ~VIRONMENTAL ~ONSERVATION. (DEC) COMPLETES Applicant/Project Information 1. Applicant Name' 2. Project/Facility Name 3, DEC Number Fishers Island Development Corperation Dock Reconstruction Buildings and Structures Historic Places o~rbuilt prior to 19407 Yes No If yes, DEC.must consult with the Office of Parks, Recreation and Historic Preservation {OPRHP}. The DEC must request a determination of eligibility for the State Register of Historic Places and/or comments regarding project impact. Include information supplied by the applicant in response to question,'5, 6, 7 and 8 of Part 1 of this form. Archeological Sites 5. Does the proposed project area coincide with a circle, square or stippled area on OPRHP's Statewide Archeological Inventory Map? Yes No Is the proposed project area outside of a circle or square, butlone for which information has been provided (eS: documented reports Of known sites} that suggests the area is archeologically sensitive? Yes No If yes, what is the nature and source of information? 7. Is the proposed project area apparently undisturbed? Yes No 8. Will the proposed action include a physical disturbance of the project area? Yes No ~ g. Is the stO~iil, i~n~th~i~ea~,~ha~acterist~cal]~y ]ess::~ban~.]5% (unless on limestone/flint esCarpments)~ ~ ~, Yes No 10. Is the proposed project area characteristically moderately well orwell drained? Yes No If the answers to 5, 7-10 are yes, an archeological survey should be performed by the applicant. Provide the applicant with a copy of Report Format for Cultural Resource Investigations and list of archeological consultants. If the answers to 6-10 are yes, DEC must consult with OPRHP before requiring that the applicant perform an archeological survey. Results of Evaluation No buildings,~structures or ar~cheological sites identified at the project location {SHPA~I) Buildings, structures or archeological sites identified, but no impacts will occur, no survey required. No further cultural resources review required {SHPA-2} Consultation by DEC with OPRHP required structures archeology Archeological survey required Prepared by Date SAAF2.LK/G 10/90 APPLICATION CHECKLIST FICC 51/%9~ 9~ pages NOTE: APPLICATION MUST INCLUDE: X1. STANDARD FORMS - Appropriate Application for Permit. Short Environmental Assessment Form, Structural Assessment Form. NOTE: For all projects requiring Wild, Scenic & Recreational Rivers Permits and for commercial, industrial or multi-residential pro- jects, submit a long Environmental Assessment Form. $2102. APPLICATION FEE: Refer to enclosed fee schedule $10.00 minimum, Check or Money Order payable to NYS DEC. You will be notified of additional fees, if any. X 3. Authorization letter from the owner where the applicant is not the owner. X 4. Staking and labeling of the seaward/wetland side of the proposed structure or fill area. X 5. Photographs of the staked project area mounted on a separate and labeled page. X 6. County Tax Map Numbers: Photo of Tax Bill will suffice. Suffolk: Dist. Sect. Blk. Lot Nassau: Sect. Blk. Subblock Lot × 7. Project Plans (four copies) - Plans must clearly show the pro- posed project and include all appropriate dimensions, elevations and must be at a scale of 1" to 100' or larger. X 8. Address of project location (if vacant land; telephone pole # or other identifying landmark). MINIMUM PLAN REQUIREMENTS (FOUR COPIES REQUIRED) PROJECT: Alterations and/or Extensions New House Construction Accessory Structures Repairs to Existing Structures Dredging Catwalks and Docks SUbdivisions Bulkheads. Groins and Jetties Filling 1, 3, 5, 6, 7, & 8 1, 3 5, 6, 7, & 8 3 5, & 3, & 4 3 4, 5, 3 4, & 2 3, 5, 2 3, 4, 2, 3 4, 5, 9, & 10 4 5, & 6 & 6 5 & 6 5, '6, 9, & 10 KEY: 1. Stamped Sealed Survey 2. Plot Plan 3. Location Map 4. Sectional View 5. Wetland Line or Mean High Water, 6. Fill and Clearcut Area 7. Sanitary System Location 8. Test Hole and Data 9. Profile View 10. Distances from fixed structures as appropriate NOTE: IF YOU WISH CONFII~MATION OF RECEIPT OF YOUR APPLICATION, PLEASE SUBMIT A SELF-ADDRESSED, STAMPED POSTCARD. NOTE: THE PERMIT PROCESS TAKES AT LEAST EIGHT (8) WEEKS. Docko, Inc, P.O. Box 421. Mystic, CT 06355 ~203) 572-8939 Fax: (203) 57247569 May 29, 1992 Mr. Jim Haggerty, Regulatory Us ArmyCorps of Engineers Jacob Javits Federal Building, Room 1937 New York, NY 10278-0090 Re: Fishers Island Develotmment Corp Dock Reconstruction Permit DearMr. Haggerty: On behalf o~ our client, we request a Deparh~nt of the Army Nationwide General Permit for reconstruction of a fixed dock of the Fishers Island Development Corperation on Fishers Island, New York. We enclose the following in support of this permit application: - Two prints of the application drawings titled: Pro~ect: "Dock Reconstruction" Waterway: East Harbor, Fishers Island Sound Location: Fishers Island, Town of Southold suffolk County, New York Applicant: Fishers island Develotm~_nt Corp Date: May 29, 1992 - Two copies of Corps of Engineers, Town and DEC Application Forms - Two copies of site photos, Tax Assessor's Map, and location map. I t_rust that you will find this application package complete and acceptable; please let me know if the need for further information arises. Very truly yours, DOCKO, INC. Keith B. Neilson, P.E. Enclosures cc: Fisher Island Development Corperation Fishers Island Country Club Mr. Robert Green, NYS DEC John Brede~yer, Town of Southold John Clavin, Fishers Island Harbor Master File 91-08-245 ~he D~t o~ the .Army permit p~ogram is aulhodzed by Section 10 0! the Rivm's and Harbors Act of ~t899, Secfio~ 404 of the Clean Wale,; Ac~ and ~an a pem~it be issued. 2. NAME AND ADDRESS OF APPtJCANT Fishers Island Development Corperation PO Drawer E Fishers Island, New York 06390 Attention: Mr Thomas Doherty, Mar~ger Telephane no. during business hours ~C ( ) (R~,de~e) ~°(51@ 7~ 725t (o~flce) 3. NAME. ADOREe~S. ANQ TITLE eF Docko, Inc., Keith B. Neilson, PE PO Box 421 Mystic, C~ 06355 ~O (203) 572-8939 Docko ~ Inc. ~) (of[ice) behalf is my egent ~ the ~'ocesslng o! this permit ipp~icatio~ and to Dock reconstruction, including 200' of 9 foot wide fixed, wood dock with associated ramp and ladders. The dock is privately owned and is used for recreational boating. The aged facility was irreparably damaged by Hurricane "BOB" and must be completely re-built. Not Applicable ENG FORM 4345, Aug 89 ~c~rr,o. ~ Rea as ,s oeso~ ~,..~.,~,,: czcw.o~ East: West: Ms. Lucille Balcom Fishers Island Development Corperation c/o Fiduciary Trust PO Drawer E Mr. Francis Shepherd Fishers Island, NY 06390 2 World Trade Center New York, NY 10048 WATF. RBOOY~LOCA'i~3N~WATERBOOYTNHEREACTIVi3~'EXI~SOR~PROPOSED The dock system is in East Harbor. The site is located on a private road at the aesterly end of Fishers Island. STR~E'r; ROAD. ROLrm OR OTHF. R DESC~P'nVE LOC. AnON Suffolk NY COUNTY STAT~ Southold Board of Trustees The project is the reconstruction of an existing dock. iSSUING AGENCY TYPE APPROVAL IOENTIFICATION NO. DATE OF APPLICA31ON DATE OF APPROVAL DATE OF DENIAL NYS DEC Tidal Wetlands Pending May 29, 1992 Pending Water Quality Certificate Southold Board of Trustees "Grandfather" Pending Coastal Erosion May 29, 1992 Pending 10. Application is hereby made for s pmmit o~ permits to authorize the activities described he~e~n. I cm'tily that I am farrdlie~ with the intemt~tie~ contained in the apj:dicafion, and that to the best of' fay kAowledge and belief such information is true. complete, and accurate. I turthM cerdfy that I .,,,,ee.e~ the authority te The application must be signed by ~le person who desires to undertake ihe proposed acfivily (applicant) or it may be signed by a duiy authorized agent if zhe statement in block 3 has been filled OUt end signed. 18 U.$:C- Section 1 O01 provides tha~ Whoever. in any manner wi~in the jurlsciiction ol any deparlment or agency of The United States knowingly and willfully f~Tsifies, co,~e_ ~at_e; Of: covers up by any trick, scheme, or devic~ a matariai ~ or maXes any faJs~, r~titious or Iraudulent statements or representa~ons or makes or uses any false writing or documen[ knowing same to corTtsJfl any laJse fk:btious or