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Home My WebLink AboutTR-1652 4 Michael J.Domino,President O��OF S0!/jTown Hall Annex John M.Bredemeyer III,Vice-President ~ 54375 Route 25 P.O.Box 1179 Glenn Goldsmith CA Southold,New York 11971 A.Nicholas Krupski �p� Telephone(631) 765-1892 Greg Williams �y`,oU ,� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD October 17, 2018 Jeffrey Patanjo P.O. Box 582 Bohemia, NY 11716 RE: FOROSICH FAMILY IRREVOCABLE TRUST 1405 ANCHOR LANE, SOUTHOLD SCTM# 1000-79-4-4.1 Dear Mr. Patanjo: The following action was taken at the Southold Town Board of Trustees regular meeting held on Wednesday, October 17, 2018: RESOLVED, that the Southold Town Board of Trustees APPROVE the request for a Transfer of Wetland Permit#1652 from Anthony Forosich to Forosich Family Irrevocable Trust, as issued on July 25, 1983. Any other activity within 100' of the wetland boundary requires a permit from this office. This is not a determination from any other agency. If you have any questions, please contact our office at (631) 765-1892. Sincerely, J,ken Michael J. Domino, President Board of Trustees MJD/dd September 23, 2018 Town of Southold Trustees Town Hall Annex Building 54375 Rte. 25 D (� VP.O. Box 1179 Southold, New York 11971 Li i, SEP 2 7 2018 RE: 1405 ANCHOR LANE. -SOUTHOLD r SCTM No. 1000-79-04-4.1 so-thold Town PERMIT TRANSFER CHECK B a Tri Dear Trustees: Attached, please find check in the amount of$50 as requested for permit transfers. If you should have any questions or require anything further, please do not hesitate to call me at 631-484-9332. Very truly yours, Jeffrey Patanjo P.O. Box 582 Bohemia, NY 11716 August 9, 2018 Town of Southold Trustees P Town Hall Annex Building D 54375 Rte. 25 P.O. Box 1179 AUG 2 0 2018 Southold, New York 11971 RE: 1405 ANCHOR LANE. -SOUTHOLD Southold Town SCTM No. 1000-79-04-4.1 Board of Trustees PERMIT TRANSFER Dear Trustees: We hereby request all permits for the above referenced property be transferred into the new owner's names as follows: 1. Forosich Family Irrevocable Trust If you should have any questions or require anything further, please do not hesitate to call me at 631-484-9332. Very truly yours, effrey Patanjo P.O. Box 582 Bohemia, NY 11716 SU Michael J. Domino, Pre it OHO FFD(4C'OG s, Town Hall Annex John M.Bredemeyer III,Vice-rresident �� yam, 54375 Route 25 Glenn Goldsmithy z P.O.Box 1179 A.Nicholas Krupski ® Southold,NY 11971 Greg Williams Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: (/ �' , LU/ Completed in field by: 21&,k- Jeffrey Patanjo on behalf of FOROSICH FAMILY IRREVOCABLE TRUST requests a Transfer of Wetland Permit#1652 from Anthony Forosich�to Forosich Family Irrevocable Trust, as issued on July 25, 1983. Located: 1405 Anchor Lane, Southold. SCTM# 1000-79-4-4.1 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 structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet:, 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N; Ch. 275 Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: ak I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer 0M. Domino G. Goldsmith N. Krupski G. Williams Other tnT is i'V�C."T"GS �_�D .] r:s v:J MUST D:JPL:,Y Ul-:b'vL 1:�i��7i.G: a. K :'a Ni13J..J ALL DCC;S .'.2;D BU:. :ri ADSS MUST DiSPL, ,Y 71ISI= PEPEL'11- ;Ub1EcRS r " a J+.�.r > ICI,F, 4 \ C Jt ♦ •,_,\ c ('�Yp ti Jt{ M.z �`', pard Of South o' d T oaf.in T;ustees p SOUTHOLD, NEW YORK 1110ORS'1IG N0. N/A ( ' .a PERMIT NO F 16'52 DAT .July 1983 ,11 ISSUED TO ..... Anthony Forosich ! ff df Pursuant to fle provisions of Chapter 615 of fhe Laws of the Sfafe of New York 1893; and Chaper 404 of the Laws of dna 1 t1 !` Sfate or New York 1?5 and the Sorsflold Town Ordinance en- d 'u titled REGULATING AND THE PLACING OF OBSTRUCTIONS ,s IN AND ON TOWN WATERS AND PUELICLANDS and the REMOVAL OF SAND, GRAVEL OR OiriER MATERIALS FROM v t ;. 1F LANDS UNDER TOWN WATEDS;" and in accordance' wish the Reschfion of The Board adoptad of a m_eiir. July 5,, t tL` , JA /•E � � 5 he( an � (, r t 19..: 8 ,'and to cons 'eranon of fhe sum of $ 5y ~ �. 3 l pcld. y r. 105 00 ' - f Antklony Forosich .................................._... of , Southold zl`• .-- � ,� �- ..... .._ N. Y. and subjecf fo the is s r Terms and Conditions 1,sled on the jreverse side hereof, - r of Soufrold 'Town Trustees auflnorizzes and permits the following: Approved to construct a bulkhead consisting of a 25 ' �;�:�` .section connected 5' .landward of corner of existing ;� z bulkhead extending southward: 51 section in E-W di r t:_ , T 'e ection This will connect to Koch' s lulkhead. ti I al, in accordance with the deailed specifications as presented in f - 4 the originating app;lcaficn. backfill with 25 cu, yds. sand trucked in from t _` I a Ft3; upland IN WITNESS WHEREOF, The said Board of Trustees here- } iE -\ sitby causes ifs Ccrporafe Seal 'o be affixed, and hese presents fo i 1 s t be subscribed by a majority of the said Board as cf this daf.e. i 111 a . Y /� ' �I rv.>� .3 � _&, ra.�o- �„ Y :c^�' .v ... _n.�L"E� CI(/ll •x��'� `\ Tmstees q.ra a'� d4 � y�b—. "".��' , lk... yA.Y.r�<�.,-+•'h ;dui '��rJ,t rte. „ �a+eY- .'..-�� jr ,�)` ----= --- , — BoarOf Southold Town Trustees N ®S _$ SOUTHOLD, NEW YORK '�� ( G NO N/A O � V PERMIT NO. .. 1652, DATE: _.;.July _25, 1983 I ° ISSUED TO ...... ..... Anthon ,...Fgrosich- " Z, cerriry that the work as authorised in this permit has been completed and is now ready for your io n� ec tion. Also the numb-ar required on this - pro�ect is clearly visIble. I further understand this per^tit is not valid until this tear sheet is returned to the Trustees. 7i ryTERMS and CONDITIONS Tne Permittee Anthony Forosich aI ` Anchor Lane Southold t. residing at ' N. Y., as a t ( pan of the consideration for the issuance of the Permit does understand and pr=saiue to the fol- lowing: 1: That the Southold Trustees Permit_ must be prominently displayed on the premises effected thereby during the period of 2. That That the said Board of Trustees and the Town of Southold are released from anv and all damages, or claims for daWages, of suits arcing directly or indirerdy as a result of nay oper- u;aer ation performed pursuant to this permit, and the said Permittee will, at his or her.own ecp�.se, 7 , defend any and all such sots initiated by third parties, and the said Permirtee assumes full linbility the ill with respect thereto, to the complete exclusion of the Board"of Trustees of the Town of SoerholdpeLm= kI i; 3. That this Permit is valid for a period of hR which is considered to be 1 sufficient time required to complete the work involved, but should axcunastances warrant,.zecu.-,t $=! for, an extension may be made to the Board at a Iater date. f'� P1 4. That this Permit should be retained indefinitely, or as Iong as the said Permittee wishes ^i tomaintainthe structure or project involved, to provide evide:.ce to anyone concerped that auth- +a orizarion was originally obtained. - �I 3 @;: 5. That the work involved will be subject to the inspection and approval of the Board or CSI its agents, and non-compliance with the provisions of the originating application, may be ause:for 'I revocation of this Permit by resolution of the said Board. A G a 6. That there will be no unreasonable interference with navigation as a result of the-work- herein he.work- herein. audiorized. _ f =I7, That.there shall be no interference with the right of the public to pass and repass .along r the beach between high and low water marks. 3� B. That if future ..operations of the Town of Southold require the removal..and/or alterations t=1 in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, the t work shall cause unreasonable obstruction to free navigation, the said Permittee will be required, K;I upon,due notice, to remove or alter this work or project herein stated without expenses to the Town of Southold. r'- 9. That the said Board will be'notified by the Permittee or the completion of the work amu- 3 pried, (See tear off sheet. ) til 10. That the Permittee will obtain all other permits and consents that may he renuired sup. �r 'i plemearal to this permit which may be subject to revoke upon failure to obtain same. (P 01 in,. . BOARI7�Oi TO INV TRUSTEES _ p Town of Southold Blain Road Southold, New York 1194-1 0 _ NONCE OF ACTION — NOT A P81011T Tc: ....,Anthony Forosich, Anchor Lane; Southold, New. York 11971 ........................................................... ........ ................ .......... 1. Your application, doted ......6115/83,•... ............. has ceen reviewed by this Board, at a meeting of the Trustees held on ....................auly.•5,.,..lm$ ....... ti and resulting in the action, as indicated beiow: � A; 1 (....,XXX) Application approved. (............) Application denied. *-"u g . z u. (............) Application fabled. r `., 2. Comments and remarks ,' Your application was approved at the July 5, 1983 Meeting. k"5 A PEB,%11T FEE 3. IF vcur c,,o'}r�ri is n^m„nr9 n ,vin-: +=rr 77 4- d uic be mode payable —fin•-, �. Vii._ rr d on she to, the order of me Board of Southold Town Tructces T}us tce is computed be;o.v accordire to tha,`;-hedul pt RQros Fs 'et forth in the !n<_rructimi `I;cer dFcrm 1/11 This fe ^•:usu tae paid to tefiin J0 ca_vs c,. re—applying �,t:d .3dcai.cioral �se t+;.LI l e recessa,: If the Permit fee is ce d :n person totre ;acrerarY of the Bcerd, F he Pc:mir will be cb'ecmcblc of the same time. If the fee is paid by mail, the permit will be mciied in reply. Ccmdutation of Permit Fee: 25 feet of Bulkhead at $3. 00 a lin. . ft . _ $75. 00 Total amount due for this application. 1 '. yTotal F.-e for this application ...... 75.00 _.................................. 3 ....... ............................ ire: Pres , c BaorrJ c a�rncld iGwn TfusIse, .. .... . Cl�r>< TELEPHONE (516)765-1892 BOARD OF TOWNTRUSTEES TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 728 Southold,New York 11971 August 26, 1983 Mr. Anthony Forosich 190 14 47 Ave. Flushing, New York 11358 Re: Bulkhead Fees Dear Mr. Forosich: Transmitted herewith is your receipt for the additional bulkhead fees. _ I have enclosed another permitwiththe proper amount of fees paid entered. Again, my thanks to you, for your co-operation. Enjoy your structure, and please be sure to post your permit number on the work, after the work is done. Very truly yours, Board of Town Trustees Ilene P£ifferling Clerk Attachments , �JFTELEPHONE (516)765-1801 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 728 Southold, New York 11971 July 25, 1983 Mr. Anthony Forosich P. O. Box 299 Anchor Lane Southold, New York 11971 RE: Bulkhead Dear Mr. Forosich: li Thank you for your prompt payment for your bulkhead. I am sorry, but I neglected to include in that fee, two 5' sections of bulkheading. The additional feeforthis will be (10 lin. ft. @ $3. 00 per lin. ft. ) $30. 00. additional. Again my apology. Very truly yours, Board of Town Trustees Ilene Pfifferling Clerk Attachments TELEPHONE (516)765-1801 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 728 Southold, New York 11971 July 6, 1983 Mrs. Judith T. Terry Southold Town Clerk Southold Town Hall Main Road Southold, New York 11971 Dear Judy: Transmitted herewith is the action taken by the Board of Southold Town Trustees at a regular meeting held on July 5, 1983: RESOLVED to recommend to the Southold Town Board approval of the Wetland Application #147 submitted by En-Consultants, Inc. on behalf of Anthony Forosich to construct a bulkhead off a dug canal at Harbor Lights, Southold. Very Truly yours, Board of Town Trustees Paul Stoutenburgh President PS/ip Town Hall; 53095 Main Road P.O. Box 728 Southold,New York 11971 JUDITH T.TERRY - TELEPHONE TOWN CLERK - ' (516)765-1801 REGISTRAR Or VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD June 9, 1983 1 r 1i Mr ., Paul Stoutenburgh; President Board of Southold Town Trustees Southold Town Hall Southold, New York 11971 Dear Mr. Stoutenburgh: Transmitted herewith is application no. 147 for a wetland permit submitted by Enconsultants, Inc. , on behalf of Anthony Forosich. Please prepare a written report of findings and recommendations with respect to this application. Very truly yours, Judith T. Terry Southold Town Clerk Attachment a APPENDIX E N9NS OF PROJECT SHORT ENVIRONMENTAL ASSESSMENT FORM INSTRUCTIONSr (a) in order to answer the questions in this short ERF is is assumed that the praparar will use currently available information concerning the project and the llik4y impacts Of the %action,- It is not expected that additional studise, research or other investigattoas will be undertaken; (b) If any question has been answered Yea the project may be significant and a COmplatad-Environmental Assessment Form is necessary, (c) If all questions have been answered No it is likely that this project is Z�ot significant. (d) Environmental Assessment I. Will project result in a large physical change to the project site or physically alter more than 10acres of.land? , , . t . , . , . • • .- Yea—J'). NO 2. Will there be a major change to any unique or unusual land form found on the site? , . e • . Yes No 3. -Will project alter or have a large off act`on } an existing body of water? , , . . . . , ,` , . Yea 1 No 4. Will project have a potentially large impact on groundwater quality? , . . . , . , . , , . e Yea No 5e Will project significantly effect drainage flow On adjacent Sites? , .. , . . . . . . .. • . Yea No b. Will project affect any threatened or endangered Plant`or animal s'pecie`s7 . . . . ,, , . ��' Yea No 7. Will project result in a major adverse effect on air quality?:. , , , , . . . e • . • • . Yea NO S. Will project have a major affect on visual char— acter of the community or scenic views or vistas known to be important to the community? , , . __ Yes No 9, Will project adversely impact any site or struct- ure of historic, pre-historic, or paleontological importance or any site designated as a critical environmental area by a local agency? , Yes ,� No 10. Will project have a major effect on existing or ((( future recreational opportunities? . . , — Yee No lle_ Will project result in major traffic problems or cause a major effect to existing transportation system S? , . . .. , . . 0 . . . • �� Yes l NO 12. Will project regularly cause ob-jectionable odors, noise, glare, vibration, or electrical disturb- ance as a-result of the projectia operation? Yes No 13• Will project have any impact on public health or safety? i , , . . . ,. , . , . , -_ Yes T. No 14. Will project affect the existing community by directly causing a growth in permanent popula- tion of more than 5 percent over a one-year period or have major negative effect on the character of the ccunity or neighborhood? . Yes No 15. Is there public t oversy concerning the project Yes No PREPARERS SIGNATURE: TITLE: REPRESENTING: DATE: /�✓ 9/t/78 r x +a � 1 i Town Hall, 53095 Main Road P.O. Box 728 Southold, New York 11971 JUDITH T.TERRY ,. si:- `"� TELEPHONE TOWN CLERK (516)765-1801 REGISTRAR 01 VITAL STAI'ISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD NEGATIVE DECLARATION NOTICE OF NO' SIGNIFICANT EFFECT ON THE ENVIRONMENT Dated: July 20, 1983 Pursuant to Article 8 of the Environmental Conservation Law State Environmental Quality Review and 6NYCRR Part 617, Section._ 617.10 and Chapter 44 of the Code of the Town of Southold, notice is hereby given that the Southold Town Board, as lead agency for the action described below, has determined that the project , which is unlisted will not have a significant effect on the environment . DESCRIPTION OF ACTION Application of Enconsultants, Inc. , on .behalf of Anthony Forosich, for a Wetland Permit to construct a bulkhead and fill behind the bulkhead at Anchor Lane, on dug canal off Peconic Bay, Southold, New York. The project has been determined not to have a significant effect on the environment for the following reasons: An environmental assessment has been submitted which indicated that no significant adverse effect to the environment are likely to occur should the project be implemented as planned. Because there has been a response. from the Board of Southold Town Trustees and Southold Town Conservation Advisory Council indicating that this project would not have a significant effect to the environment. Because there has been no response in the allotted time from the New York State Department of Environmental Conservation and the Southold Town Building Department , it is assumed that there are no objections nor comments from those agencies. Further information can be obtained by contacting Mrs. Judith T. Terry, Southold Town Clerk, Southold Town Hall, Main Road, Southold, New York 11971. Copies to: David DeRidder, DEC, Stony Brook Commissioner Williams, DEC, Albany Southold Town Building Department Southold Town Trusteest,/ Southold Town Conservation Advisory Council Town Clerk' s Bulletin Board Enconsultants, Inc. , on behalf of Anthony Forosich I HEREBY AUTHORIZE EN-CONSULTANTS , INC . 10 rIPPL': 101 ON MY BEHALF. ark °.: rtp r 0 Aviv, yS.' a 1,] �FS OArury:HLtJ � � E' — PuaposE:ERosmly 7 Co,vTROL � AOJAGEN7- OUe/ERS: R. HILT A. Rog`T. HALL a. Roo'-r &foRSC14' D O; ROQT. TRE0 Jr co Y BAYviE�J AREA 'ro 8F Of $oN REM0v40 To $ufPO L!,' Co• IIA6$TK4F( S nGu - QE'NOTES MAP J3- SCALE . . . EKis7/wa- PKofos*v GocrCMEAO + t y.KMEAD � W -,sn t 2 G •�' li 4 Deo VO5t0 �jY�+X/B�RLOATS � D uGCANAL (t) M'X/B' RAMP FL000 ' _�1i.M VAC/gMT Lo-r K E6e� vcr iyi G. Ko c H = [ `1 V it-o r a = Q61 L• � f� et- �+ e J Y v A. Fo2oSp<H 2 V J ii J x Q , O ~ y V R 1274141JA is Iq m W CL- °w a v' RAMP FLO - /8' AT$ m jkVSjVfiAT9IWel MHv-2-6"MLkJ- FoRo S/c14 PQoPoSBO A°GKNERD DOCK$X./ c/N4S EORGE KOcHPRoPoSEo Af/LKNBAO e0RE06/r/(r QD fr RagERT N/LTL 'F- �O 4z�O of SovTHOLO, SufFoLK Co., N.}' � , P14./NF or Ova CANAL " CROSS- SE<T/O/V TH/t0 (RO POSED I�ULK- by •EN�CONSULT�//T$/ 2NG . FIEA0 (ALL) j` DOCK (K0C. Sc ALE Y� /l Cie yr bot y fl, put �oNq a o 4 Z m N /z 50 U THO F t fit 1 ti F fn Y / F G� l 1 2TEESTHOLD NO. m E E,. -issued To rmenzt6k Date- %J Address A nek o p- Lane. sw'Aordi V THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION TOWN TRU.STEES;:OFFICE, TOWN OF SOUTHOLD SOUTHOLD. N. Y. 11971 TEL.: 765-1801 m AIR -Rev. 8/72 BOARD OF TOWN TRUSTEES Town Of Southold " 4 Southold, New York 11971 4 Main Road APPLICATIOAT FOR A BULKHEAD, DIKE, OR JETTY 173 I. Does this project involve the use of WETLAND'S as defined in the Southold Town Wetlands Ordinance? YES''ep,MF3. 7f it does, you must file through the Town Clerk's Office. 2. Is the proposed work entirely within the boundaries of your own property as substantiated by your Deed or Survey? YES er*W. If it is, a Permit is NOT required from this Board, but the Town Building Inspector should be contacted for full details. 3. Applicant's name and address: .Arkth9MY..EPK90gh....Anch]r..;ane,,,,Southold,,,,,,,,,,,,,,,,,,,, NY 11971 ................................................................................................................................................................. 4. Contractor's name and address: ,EN-CONSULTANT57 INC..: ..,64.North Main Street SA u.th=P.tron,..JIX......119. 5............................................................................................................... 5. Explain briefly the purpose of this application: .�.P.Astrugt„a,bulkhead„consisting„p;f„ 45,'„section;connected,5',,,landward..of..corner,of„existing,,bulkhead,.extendin5.......... southward,;,;and a 5' in,E-W direction. This..will be connected to proposed bulk. head; of Koch;, Backfill with,25„cu, yds„of clean sand to be trucked in from com- .. . ..................................................... mercial upland source. Bulkhead wi11 be landward of MHW. 6. After issuance of Permit, I expect to: (mark with an X) (a) Commence work — AT ONCE............: ASAP ....R......; UNKNOWN TIME ............. (b) Complete work in — 1 DAY ............: 1 MO. ............; 1 YR. ............; FUTURE ...3„weeks. 7. Secure the correct Area. Map from the Secretary of this Board, and by using an X WITHIN A CIRCLE as a mark, indicate as closely as possible the location of this project. On the reverse side, provide a SCALE DRAWING which will show Ordinary High Water Mark as well as the size and shape of the structure or work to be done. Also include all dimensions for portions which extend offshore from the O. H. W. M. 8. Provide the following documents: (a) A Licensed Engineer's Survey of the property involved. (b) A copy of the Contractor's Plan and Specifications. 9. Does this project extend into Town Waters beyond an imaginary line or boundary formed by existing works of a similar nature along this area's shoreline? NO. If it does, state the approximate distance beyond. ............ ft. 10. Will this construction require the Filling of any land offshore of the Ordinary High Water Mark or the Dredging of any material from Town Lands under water? 1A=ZV NO. If it does, Form A/4 (Application for Dredging/Filling) must be completed and attached as part of this application.. 1 i. In requesting approval of this application, I submit that: the information presented herein is true and correct to the best of my knowledge and belief; I am the person accountable for the performance of the work in accordance with the plans and specifications attached; I have read or am familiar with the provisions of any Southold Town Ordinance pertinent to the work involved; and further, I intend to adhere to and abide by the Terms and Conditions of the Permit, when and if issued to me:. S ..... ........... . ........................ .......... Accepted by: Dated. June 13, 1983 Town Of Southold Town Clerk's Office { ---• _w Southold N. Y. �-XYe--------��, APPLIC-NTION FOR WETLANDS PERMIT i Application No. .... . J��ne 1953 ...... PP /��. .. .... .. Date of Application ..�. ,4.�.a.........�.............. Identify of ?, F,3 o^.nte'orosich64 N .................. �Pt �'C ............ NEW YOPK Address of Appliccnt ......?.: 7. ..? 9.,,.,1405,Anchor La. Southold N.Y 11971 ...................................... INSTRUCTIONS FOR PERMIT A This ep a kation is to be completely filled in by typewriter or ink and submitted to the Town Clerk in quadruplicate, accompanied by writter permission from the owner of the property if not the some as the applicant. 3 Pilot Pon must ce drawn to scale on the reverse side of this application showing the location of properly, the r,a:nes and locations of owners of adjoining properties, and a detailed description of ,)ropos< d ort;;ec,t, UNotet Copies of the Pilot Plan may be made by a copy machine and attached o the Permit Acp! cohon.) � I C. No operation shall be initiated by the applicant until all permits that are required are issued. D. A de ai ei statement of the rehabilitation and pn,posed condition of the premises after the work is c mp'eted must be given, including a survey if required. L It pe m;- is being sought for a more sizeable excavation than the construction of a private single dock or Petty, then this application must be accompanied by a survey and topographical map certified by a registered land survey or Professional Engineer. The horizontal control of survey shall be based upon an approval Iacal coordinate system. The vertical control for elevation and sound- ings shall be based upon United States Coast and Geodetic Survey and/or United States Geological Survey datum. F. A staten+ent must accompany the application describing any known prior operations conducted on the ptemises in question and whether any prior licenses or permits have been issued to erect structures or to dredge or deposit fill on said premises and whether any such permits or licenses were ever rev 4e,1 or suspended by a governmental agency. G. A filing fiat_ of $25.00 shall accompany the application. This filing fee includes one inspection, there is a 55.00 fee for each additional inspection. H. The !-own Board upon requestgapplicant for a permit, may waive in whole or in part, the provislans of Ar,icie PI, Section ��, subdivisions (b) and (/'-where it finds that nature of the Proposed o erallons are such that the requirements of such provisions ore not necessary for a proper ccnsiderction of a permit application. 1, Upon approval of this application the Town Clerk will issue a permit to the applicant. Such permit shall be available for inspection at any time, upon request. i Examined ....... 3d.................. 19.. E Approved ......... ('F. s�;..sa�..�../.. .�'.. ............. ,I Disapproved .................(/.......................................... Conditions, if any ...............:............................................................. ............................................................................. ........................................ Examining Body .a. ..... ......................... Signatureof Chairman ........................................................................................................................ t r t t APPLICATION IS HEREBY MADE to the Town Board of the Town of Southold, Suffolk County, New York, for the issuance of a permit pursuant to the Laws, Ordinances and Regulations govem- in t al and Interior Wetlands Flood Plains and Drainage Are he Coast as of the Town ofSouthold: 9 9 Permit requested to .,construct a bulkhead„cpn. i,$,f:.ip�;,,q,€„a ',,,g ka 5' landward of corner of existing bulkhead extendinn southward; and a 5' section in E-W direction. This will be connect,�2 to proposed bulkhead of Koch. itli"25"cy"oP"clean'§arid'"to'"b"e"trucked""In "from commercral'upT3ri3""source. Bulkhead will be landward of MHW. Location of property for which permit wanted............. .AVjghgr.. aSouthgt _1971 Home address of permit applicant if different from aforesaid location ... Anchor..La:.z.,Southold NY 11971 ................................................................:............... Creek, Boy or Harbor fronting property ..Dug. canal.,of,fPeconic...Bay Size of proposed work: Length .....See..at.`..a.Gh(�.......................................................... n/a Width ....................................................................................................................... .. HeightAbove High Water ....................i.:......................................................................................... r DepthBelow Low Water ............ tr.a....................................................................................................... none Yardsto be Excavated ...................................... .................................................................................... Yardsto be Filled ..........................25.................................................................................:.................. Widthof canal, creek or bay fronting property................SA.:........................................................... Depthat Low Tide ..............Q 1............................................................................................................... 216 AverageRise in Tide ............................................................................................................................. 4y � 9 is ;his for private or business use? ...,.Private AreaZoning ....Re.S.i.delft. !-.......................................... ..................................................................... I. M.cnner ;n which material will be removed or deposited ..................... ............................................ . _............................................................................................................................................................ ntcr ed use of property .......No,.chanSe.:............. .... _. .. .. ......... .... ...... ........ ..................... .... .. ..... ..... . .... .. ��.s i%*;aen consent of owner of property, if not the some as the applicant . ...5es ' COUNTY OF SUFFOLK ) STATE OF NEW YORK ) SS: h,f .. . ...... ............. . ................................... qy...? .. tIaje................................ being duly sworn deposes cnd says that he is the applicant for the above described permit, end that all statements contained herein are true to the best of his knowledge and belief; that the work will be done in the manner set rt-hin this appliccticn and as may be approved by the To car of the T own of Southold. T`:e applicant agrees to hold the Town of Southold and the/Town Board hormiess ana free from ony and all demoges and claims arising under or by virtue //'of said ker4riit„if grontea 3 x Signature o Applicert Swrm to before me this ................................ dcy of . ... .—....:.... ....... 19.,✓... � Notary Wic SMU A rtri1 "VA”PUIM,State of New Ye14 j No,010Fµ715211.SutWk Cwnk. f, Teem Expires 1111190 30, 19. ' I ',1