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Home My WebLink AboutTR-1413 Glenn Goldsmith,President *QF SO Town Hall Annex A. Nicholas Krupski,Vice President ,`O� Ol0 54375 Route P.O.Box 11799 Eric Sepenoski JL Southold,New York 11971 Liz Gillooly G Q Telephone(631) 765-1892 Elizabeth Peeples �Ol� a0 Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD March 17, 2022 Patricia C. Moore, Esq'. 51020 Main Road Southold,`NY 1:1971 RE: LOT 3:1 OLIRDREAMISLE, BBG LLG 2710.CEDAR.BEACH. ROAD-* SO.UTHOLD SCTM# 1000-91-1-3.1 .: Dear Mrs. Moore: The following action was taken at the.Southold Town Board of Trustees regular.meeting held on Wednesday, March"16,,:,2022;.` RESOLVED, that the Southold-Town Board'of Trustees APPROVE1 the request fora. Transfer.of Wetland Permit.#1413, as issued on February 14, 1980 from Diane Gazza' to Lot 3.1 Ourdreamisfe, BBG LLC. 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, p.lease.contact our office at (631) 765-1892. Sincerely, 4n'_n�_G o mith, President Board of Trustees GG/dd p Glenn.Goldsmith.,.President �QF S�UTy. Town Hall Annex A.Nicholas Krupski,Vice President O� �� 54375 Route 25 P.O. Box 1179 Eric Sepenoski J�[ Southold,New York 11971 Liz Gillooly . G . Q Telephone(631) 765-1892 Elizabeth Peeples • y0 Fax,(631) 765-6641 BOARD OF TOWIV.TRUSTEES TOWN OF'SOUTHOLD. .: DATE OHNSPECTION: � l5 i2-b 22 INSPECTED BY Ch 275. Ch; 111 INS.PECTION.SCHEDULE . Pre construction,, hai ale Line/silt b'oomisilt`curtain 1 Sr day of.construction. I% constructed . Project complete,:compliance:inspection COMMENTS: Gi. �th.CS W 17:n. �'►C., ecYvC1 Nie .6)V. ,. Yyia`�t�n o�r1 A IInd�� OtarYy►-r�. '0k.av +v +ray�:S�X CERTIFICATE OF COMPLIANCE: ECEIVE PATRICIA C. MOORE Attorney at Law 51020 Main Road Southold, New York 11971 Tel: (631) 765-4330 Fax: (631) 765-4643 SdAWTWi www.mooreLgs.com "dTn tees February 8, 2022 Board of Trustees Town of Southold Main Road(Town Hall Annex) Southold NY 11971 by hand RE: Transfer of permit#1413 1000-91-1-3.1 Dear President and Board members: With reference to the above property, I am respectfully requesting a"transfer"of the permit to the new owner"Lot 3.1 Ourdreamisle,BBG LLC" (John LaPolla member). John LaPolla is the managing member of the LLC and has authority to sign all documents, as owner. I have attached authorization and Disclosure for your records. Mr. Bredemeyer inspected in September 2021but we think he went to the wrong properly because he found that the dimensions of the floating dock he inspected did not match our dock. I have enclosed a print of our survey and a copy of the original Trustee's permit issued to Gaza (prior owner) enclosed. According to our survey the floating dock matches the permit exactly, the minor discrepancy is the length of the catwalk(pier approved 5' x 50') and existing is 3' x 51.9'. It is such a minor discrepancy that the Trustee's may allow it without an amendment (smaller width then permitted). My check for$50 was deposited with my original request made in September 2021. Please review with Glen and let me know what the Board wants me to do. Thank you. Ve .truly s, P-atr.cia C. Moore PCM/bp Glenn Goldsmith resident o�0S11FF0(, Town Hall Annex A. Nicholas Krupski, Vice-President 54375 Route 25 John M. Bredemeyer, III o P.O. Box 1179 Michael J. Domino o Southold, NY 11971 Greg Williams y�® a0�� Telephone (631) 765-1892 , c Fax (631) 765-6641 BOARD OF TOWN TRUSTEES l TOWN OF SOUTHOLD Date/Time: .3-s Completed in field by: B Patricia C. Moore on behalf of LOT 3.1 OURDREAMISLE, BBG LLC requests a Transfer of Wetland Permit#1413, as issued on February 14, 1980 from Diane Gazza to Lot 3.1 Ourdreamisle, BBG LLC. Located: 2710 Cedar Beach Road, Southold. SCTM#: 1000-91-1-3.1 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=4 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 �strative 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: ILI J o I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski G. Williams Other r 5u VY of PPOPEPTY JOSHUA R. WICKS P ., f'/O dots 21 to 2-4-5ubdivi5on Map of LeS SURVEYED BY:J.R.W. DRAWN BY:D.T.O. JOB NO.:JRW21-0329 Cedar Beach Park 14 Trainor Avenue Fled'December 20, 1927 -Map No, 90 Center Moriches, N.Y. 11934 SI � JoshuaRl'9icks®gmail.com 4C, Vo #631-405-8108 MM,, f0M OF 5_0UlHOtn o i GRAPHIC SCALE i 3 5UrrOLK COUN1Y NSW YOPK Suffolk Counfq rax Map No,,, 1000-091,00-01,00-005,001 PA1� 5u1?VMP: 911012021 5CA,�: 1"-40' E"'.' �3 I r__ <r f E� ' _SoutholdTown Board of Trustees CERA R BEACH ROAD L �, E 975.00, ;' S 8005 50 \ EOGE OF PAOENT 10.50' \ ...................... FIND .928.................................. -+�-O \ .................................. 10.0' ... .. 1 Pur \ ftrw ELEV 4e A OIr \ \ `\ �ECEV \ «O 1� 0 M E— 1 ��iC11so' nus w P \ cc \ \�• \ �� ELEV. \ \ 6.97' ` 1 \ P/o i6Y' 24 OQU 'WI.F p�.' �. � 30, I \ Y LF ♦ �\ .� ELEVI •.;� 2.75 `♦ /0 LOT\ =\ o° ,meq ♦/ \ IVF ,e ..... \ \ ♦ \\WLF', WETLAND FLAG CT .� 1� \ � � '�~• SKEDI � CA LT\ \ \ \ `eSH1GN \ 1 \\ 03 O ' 40'` 1 I W \ I � FEMA OTHERWISE S%5' \ PROTECTEDAREA BOUNDARY ♦ \ 11/16/1991 LOT AREA A 50,621.12 S.F. 1.16 ACRE(S) 1�'b•.... / ��1tF Cq 0 °' GUARANTEED TO: c, OURDREAMISLE BBG LLC GRAPHIC SCALE: 1 INCH = 40 FEET 40 0 20 40 80 160 III=ZIOF NEW r ,`P vP R• k, �,p I *ALL ELEVATIONS REFER TO NAVD88'DATUM FLOOD ZONE: AE 6.0 MAP NUMBER: 36103C0167H ��CF �O05102 2SFO LAND CHECKED BY: Cb (1) UNAUTHOR 77 ALTERATION OR ADDITION TO THIS SURVEY MAP BEARING A LICENSED LAND SURVEYOR'S SEAL IS A VIOLATION OF SECTION 7209, SUB—DIVISION 2, OF NEW YORK STATE EDUCATION LAW. (2) ONLY BOLINDARYSURJEY MAPS WITH THE SURVEYOR'S EV3OSSED SEALARE GENUINE TRUE AND CORRECT COPIES OF THE SURVEYOP'S ORIGINAL WORK ACID OPINION. (3) CERTIFICATIONS ON THIS BOUNDARY SURVEY MAP SIGNIFY THAT THE MAP WAS PREPARED ICJ ACCORDANCE WITH THE CURRENT EXISTING CODE OF PRACTICE FOR LAND SURVEYS ADOPTED BY THE NEW YORK STATE. ASSOCIATION OF PROFESSIONAL_ LAND SURVEYORS, INC THE CERTIFICATICII IS LIMITED '0 PERSONS FOR WHOM THE BOUNDARY SURVEY MAP IS PREPARED, TO THE TITLE COMPANY, TO THF GOVERNMENTAL AGENCY, AND TO THE LENDING INSTITUTION LISTED ON THIS BOUNDARY SURVEY MAP (4) THECERTIFICATIONS HEREIN ARE NOT TRANSFERABLE. (5) THE LOCATION OF UNDERGROUND IMPROVEMENTS OR ENCROACHL1ENTS APE NOT ALWAYS KNOWN AND OFTEN MUST BE ESTIMATED IF ANY UNDERGROUND IMPROVEMENTS OR ENr,ROACHMENTS EXIST OR ARE SHOWN, THE IMPROVEMENTS OR ENCROACHMENTS ARE NOT COVERED BY THIS SURVEY. (6) THE OFFSET (OR DIMENSIONS) SHOWN HEREON FROM THE STRUCTURES TO THE PROPERTY LINES ARE FOR A SPECIFIC PURPOSE AND USE AND THEREFORE ARE NOT INTENDED TO GUIDE THE ERECTION OF FENCES, RETAIN;fIG WALLS, POOLS, PATIOS PLANTING AREAS, ADDITIONS TO BUILDINGS, AND ANY OTHER TYPE OF COASTPUCTION (7) PROPERTY COR'd ER MONUMENTS WERE NOT SET AS PART OF THIS SURVEY. (8) THIS SURVEY WAS PERFORMED WITH A TRIMBLE S8 ROBOTIC TOTAL STATION (9) THE EXISTENCE OF RIGHT OF WAYS m,raro n7 o — 11 A— nl cn D nr $outhold Town Trustees SOUTHOLD, NEW YORK PERMIT NO.: .....~-.~:~. ............. Pur~ua~f '~ ~'he provisions" o{ Chapfer 615 o~ fke Laws o~ Yor~ 1893; and C,hapfer 404 of fhe Laws of fha Sfafe of New York 1952: and ~ke Soufhold Town Ordinance en- ~ifled "RE~U~TIN~ AND THE P~CING 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 ~n accordance ~fh the Resolution of The Board sdopfed ~f ~ meeting held on ._.~.~..~....~.~.* ' 19..~..., and in consideration of the sum of $... ~.~.~0~ ..... paid by .................. ........................................................................................................... of ....... ~.~P.~ .................................................. N. Y. and subject fo fha Terms and Conditions llsfed .on the reverse s~e h~reof~ ~ o~ SoUfhold Town Tru~ees authorizes and permits the following: ~s~a[[~o~ cE E[oa~[ ~ock s=~ cs~a[~ o~e~ we~s ~ ~o~e~ ~oc~e~ a~ Ce~ ~eacb, So~bo[~, w~ ~be co~G~o~ ~s~ ~e ~ o~' ~be cs~s~k be ~ec~e~seG E~om ~?e Eee~ ~o ~ee all in accordance wlfh the detailed speclficaflons as presented Jn ' the orlginafing ~ppllcaf~on. IN WITNESS WHEREOF, The said Board of Trustees ~re- by causes ifs Corporate Seal fo be affixed, and these p/esenfs fo be subscribed by a majority of the ~d Board as of fh~s daf, e. Telep!~one 5t 6-765-1938 BO,a 11971 February 25 ~ 1980 Ms. Judith Terry, TownClerk Town Hall Southold, New York 11971 The following action was taken by the Southold Town Trustees ara regular meeting held February 6, 1980. RESOLVED to recommend to the Southold Town Board approval of the wetlands application #45 of Diane Gazza To install a floating dockand catwalk over wetlands at property located at' Cedar Beach~ Southo~d, with the condition that the width of the catwalk be decreased from five feet to three feet. Yottrs truly, ANNA T. HATAZER, PRESIDENT BOARD OF TOWN TRUSTEES By Muriel Tolman., Clerk BOARD OF TOWN TRUSTEES Town of Southold Main Road Southold, New York 11971 P/1 I~ev/6/72 To: Diane Gazza ]. Your applicaffon, dated ........ ............... ......... has been reYJewed by th;s February 6, 1980 Board, at a meeting of the Trustees held on ............................................................................................. and resulting in the action, as indicated below: (......x~......) ( ............ ) ( ............ ) Application approved. Application denied. Application tabled. 2. Comments and remarks: RESOLVED to approve the application ofDiane Gazza to install a floating dock-and catwalk over wetlands at property located at Cedar Beach, Southold, with the condition that the width of the catwalk be decreased from five feet to three feet 3. If your application is approved above, A Permit Fee is now due, and should be mode payable to the order of the Board of Southold Town Trustees. This fee is computed below according to ?he Schedule of Rates os set forth in the Instruction Sheet (Form I/1). If the Permit Fee is paid in person to the Secretary of the Board, The Permit will be ob?oinable at the same time. If the fee is paid by mail, the permit will be mailed in reply. Computation of Permit Fee: 5' x 10' ramp 50 s.f. @.10 = 5' x 16' float 80 s.f. @.10 = 6' x 24' float 144 s.f. @.10 - pilings to secure floats @$1 = $5,00 8.00 14,40 $27.40 4.00 $31.40 Total Fee for this application ............................................................ $ 31.40 Signed ./~NNA T. HATAIER Chin. Board of Southold Town Trustees. Secretary. SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL Southold~ N. Y; February 25, 1980 Ms. Judith T. Terry, Town Clerk Town.Hall 8outheld, New York 11971 Dear Ms. Terry: ~g~.~v~i~v~The,.~o!lowzngactzon, was taken by the Southold Town Conservat~on :~Y ~0~cit at.a ~gular':meeting hold February 2, 1980,' ~ RESOLVED to recommend to the Southold Town Board approval o£ Wetls~dAppiication #45 submitted by Diane Gazza to install a £Zoating dock and catwalk over wetlands. Yours truly, FRANK CICHANOWICZ III, CHAIRMAN CONSERVATION ADVISORY COUNCIL By Muriel Tolman, Secretary JUDITH T. TERRY TOWN CLERK REGISTRAR OF VITAL STATISTICS Southold, L. I., N. Y. 11971 January 28, 1980 TELEPHONE (516) 765-1801 Mrs. Anna Hataier, President Southold Town Trustees Town Hall, Main Road Southold, New york 11971 Dear Mrs. Hataier: Transmitted herewith is application no. 45 for a wetland permit submitted by Diane Gazza. Please prepare a written report of findings and recommendations with respect to this application and submit said report to me within 20 days of receipt of this letter. Very truly yours, Judith T. Terry Town Clerk JTT/bn cc:file Enc./ FLIDITH T. TERRY - TO~,'~2~ CLERK P. EOlS~FRAR OF V~r^l~ TELEPHONE (516) 7654~0] Southold, L. I., N. Y. 11~)71 January 28, 1980 To Whom It May Concern: Attached hereto is Environmental Assessment Form completed by Diane Gaz~a in connection with her applica~io~ no. 45 for a wetland perm±t. Ms. Gazza is requestin~ permission to install a floating dockand catwalk over wetlands, property located at 2710 Cedar Beach Roadr Southold, New York. ~ Judith T. gerry~/ JTT/bn Town Clerk cc:file Posted on Town Clerk Bulletin Board on 1/28/80 TOWN OF SOUTHOLD SHORT ENVIRONMENTAL ASSESSMENT FORM INSTRUCTIONS: (a) In order to answer the questions in this shor~ EAF i~ is assumed that the preparer will use currently available information concerning the project and the likely impacts of the action. It is not expected that additional studies, research or other investigations will be undertaken. (b) If any ~uestion has been onsweredYes the projec% may be significant and o completed Environmental AsseSsment Form is necessary. (c) If all questions have'been answered No it is likely that this project is not significant. (d) Eh~ironmental. Assessment 1 Will project result"in a large physical change to the projeat site or physically alter more %hen 10 acres of land? ........................ 2. Will there be a major change to any unique or 'unusual land form found on the site? Yes 3. Will project alter or have o large effect on '/o~/N existing body of water? ....................... Yes 4. Will project have a potentially large impact ~-/N/o on groundwater quality? ....................... Yes 5. Will project significantly effec~ drainage flow on adjacent sites? ........................ Yes~-/No 6. Will project affect any threatened or endangered plant or animal species? ........... Yes-no ~. Will project result in a major adverse effect s':Z~,~ on air qu~li~y? ............................... Ye o 8. Will project have a major effect on visual character of the community or scenic views or vistas known to be important to {he community? ..... Yes ?. Will project adversely impact any site or structure of historic, prehistoric or paleontological importance or any site designated os a critical environmental area by a local agency? ............ -.~..-~.~-.~..-;...~ Yes... Will project have a major effect on existing or future recreational opportunities? ......... Yes Will project resul~ in major traffic problems '' or cause a major effect to existing transportation 10. 11. 12. 13. 14. Yes '~/No systems? ....................... . .. Will project regularly cause objectionable odors, noise, glare, vibration, or electrical disturbance as o result of {he project's opera{ion9 Will project have any impact on public health or.safety? ............................ . ....~.. Will project affect the existing community by directly causing a growth in permanent popula{'ion of more than 5 percen{ over a one year period or have a major negative effect on {he Character of the community or neighborhood? ................................. Is there public controversy concerning the project? 15. PREPARER'S SIGNATURE REPRESENTING Yes ~/No Yes ' /~O SOUTHOLD TOWN CONSERVATION AIXVISOi~Y COUNCIL Southold, N. Y. February 5, 1980 Ms. Judith Terry Southold Town Clerk Town Hall Southold, New York Dear Ms. Terry: The following action was taken by the Southold Town Conservation Advisory Council at a special meeting held February 2, 1980. RESOLVED to recommend to the Southold Town Board approval of Wetland Application #45 submitted by Diane Gazza to install a floating doek and catwalk over wetlands. ~ Yours truly, Frank Cichanowicz III, Chairman Conservation Advisory Council FO/mt Town OE $outhold Town Clerk's Office Southol& N. Y. APPLICATION FOR WETLANDS PERMIT Applicotion No ......~.~..>~.. ................. Dote of Application ............................../~z/~...~.~'....~..~.~.~.~.~.. Identity of Applicant INSTRUCTIONS FOR PERMIT A. This application is to be completely filled in by typewriter or ink and submitted to the Town Clerk in quadruplicate, accompanied by writterTM permission from the owner of the property if not the same as the applicant. B. Pilot Plan must be drawn to scale on the reverse side of this application showing the location of property, the names and locations of owners of adjoining properties, and a detailed description of proposed prolect. (Note: Copies of the Pilot Plan may be made by o copy machine and attached ta the Permit Application.g C. No operation shall be initiated by the applicant until all permits that are required ore issued. D. A detailed statement of the rehabilitation and proposed condition of the premises offer the work is completed must be given, including a survey if required. E. Jf permit is being sought for a more sizeable excavation thot~ the construction of o private single dock or jetty, 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 local coordinate system. The vertical control for elevation and sound- rags shall be based upon United States Coast and Geodetic Survey and/or United States Geological Survey datum. F. A statement must accompany the application describing any known prmor operations conducted on the premises 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 revoked or suspended by a governmental agency. G. A filing fee of $25.00 shall accompany the application. This filing fee includes one inspection. there is a $5.0Q fee for each additional inspection. H. The Town Board upon requesJ~o,f~l]e applicant for a perm~it, may waive in whole or in par~, the provisions of ArTicle II, Sect~.o~ g'~, subdw~sions ~1) and ~ Where it finds that nature of the proposed operations are such that '~he requirements of such provisions are not necessary for a proper consideration of a permit application. I. Upon approval of this application the Town, Clerk will issue o permit to the applicant. Such permit shall be available for inspection at any time, upon request. Examined .................................................. 19 ....... Approved ................................................................ Disapproved ........................................................... Conditions, if any ...................................................................... ; .......................................................... Examining Body ..................................................................................................................................... Signature of Chairman ......................................................................................................................... APPLICATION IS HEREBY MADE to the Town Board of the Town of Southold, Suffolk County, New York, I:or the issuance of a permit pursuant to the Laws, Ordinances and ~Regulations govern- ing the Coastal and Interior Wetlands, Flood Plains and Drainage Areas of the Town of Southold: Permit requested ~ ' ~ to ..... ~/~./..~...~.~..~.~.~.~....~....:~../~4~.. .......................... ~......~.~/~..~...~.: .............................................................. - .......................... Location of property for which permit wanted .......................................... ~/~ ..... ~ ................................................... Home address of permit applicant if different from aforesaid Iocotlon .....~...~...'~...~.......~' .4~C~...4~.. ........... Creek, Bay or Harbor fronting property ............. . .~...7..~...~4~.~.....~...~..~.j';~. ........................................... Size of proposed work: ~/ Length .................................................................................................................................................... Width ................................................................. ~..~ ............................................................................. Height Above High Water ..................................................................................................................... Depth Below Low Water ......................................................................................................................... Yards to be ExcavaCed ..................................................... ...................................................................... Yards to be Filled ................................................................................................................................... Width of cartel, creek oF bag fronting proportg ................... ..~.. ......................................................... ~ ~/~I Depth at Low Tide ................................................................................................................................. Average Rise in Tide .............................................. ' ............... 1..!./..'~...;.....~...i..~...'. ....... ............................... Is this for prJva~te or business use.;) ............ ..~,~.~.~/~.. ........................................................................ ^rea Zoning ..................................................................................................................... Manner in which materiel will be removed or deposited .................................................................. Written consent of owner of property, if not the same as the applicant ........................................ COUNTY OF SUFFOLK ) STATE OF NEW YORK ) SS: .............................. .................. ......................... b ing swam deposes and says that he is the applicant for the above described permit, and 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 fort~ in this application and as may be approved by the Town Board of the Town of $outhold, The applicant agrees to hold the Town of 5outhold and the Town Board harmless and free from any and all damages and claims arising under or by virtue Of s. aid permit, if granted. Signature of Appli~<~nt J~' Sworn to before me this ......... .~...~...~..~. ........ day of ....~..C~.-./~../,¢-~.~7~.~.T ............... , , ..... ~£~ZABET~ ANN N~IL~ NO~RY PUBLIC, Sta~e o~ New Y~ N~. 52-8125850, S~ffolk Coua~y_ Term ~pJres March 30, ~9~ Rev. BOARD OF TOWN TRUSTEES Town O£ Southold Main Road Southold; New York 11971 APPLICATION FOR FIXED and/or FLOATING DOCKS 2. C°ntractor's name and address: ...... :.~...~...~..~...,..~..~...~.,../....~.,.'~.. ............................................. / i ...... 3. Briefly explain the purpose of this application: ...... ~ ..........~.....~(?.~..cz...%. ......... ...~... .......... · ....... ........ ........ ......... 6~J c~ ~?-~/~DS ........................................................................................................................... After issuance of a Permit, I expect to: (mark by an X~ (a) Commence work AT ONCE ............ ; ASAP ....~.....; UNKNOWN ............. (b) Complete work in ~ DAY ............ ; 1 MO ............. ; I YR. ,.'.~........; FUTURE .., Secure the correct Area Map from the Secretary of this Board, and by using an X WITHIN A CIRCLE indicate as closely as possible the ocation of this dock. On the reverse side of this map, provide a SCALE DRAWING which will show Ordinary High Water Mark, the shape and size of the dock and any supplementai pilings which are needed to hold a floating dock or tie-up a boat. Give all dimensions necessary to determine the area of the dock surface which extends offshore from the O H. W. M. 6. Will any portion of this construction extend offshore into Town Waters beyond an imaginary ine or boundary formed by other similar structures along the area's shoreline? YES or NO. If it does extend beyond this so-called dock line indicate by how for, approximately, .......... ft. 7. Provide the following documents: (o) A Licensed Engineer's Survey of the property involved. (b) A copy of the Contractor's Plans and Specifications. Wil 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? YES or NO. If it does, Form Al4 (Application for Dredging/Filling) must be completed and attached as pa,rt of this application. In requesting approvc 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 ~ 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. Accepted by: Dated: Town 0f Southold Town Clerk's Office $outhold, N. Y. APPLICATION FOR WETLANDS PERMIT dentlty of ^pp'cant .................. ...... ............................................................. IN,STRUCTIONS FOR PERMIT A. This application is to be completely filled in by typewriter or ink and submitted to the Town Clerk in quadruplicate, accompanied by written permission from the owner of the property if not the same as the applicant. B. Pilot Plan must be draw~ to scale o, the reverse side of this application showing the location of property, the names and locations of owners of adjoining properties, and a detailed description of proposed project. (Note: Copies of the Pilot Plan may be made by a copy machine and attached to the Permit Application.') C. No operation shall be initiated by the applicant until all permits that are required are issued. D. ,A detailed statement of the rehabilitation and proposed condition of the premises after the work is completed must be gwen, including a survey if required. E. If permit is being sought for a more sizeable excavation than the construction of o private single dock or jetty, then this application must be accompanied by a survey and topographical map certified by c registered land survey or Professional Engineer. The horizontal control of survey shall be based upon an approval local coordinate sysi'em. 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 statement must accompany the application describing any known prior operations conducted on the premises in question and whether any prior licenses or permits have been issued to erect structures or to dredge or deposit /:ill on said premises and whether any such permits or licenses were ever revoked or suspended by a governmental agency. G, A Filing Fee of $25.00 shall accompany the application. This filing fee includes one inspection there is a SS.00 fee for each additional inspection. H, The Town Board upon requesL, o.f t,b~ applicant for a permit, may waive in whole or in part, the provisions of Article 11, Section'/-~, ~subdivisions ~) and ~ where it finds that nature of the proposed operations are such that 'the requirements of such provisions are not necessary for a proper consideration of a permit application, i. Upon approval of this application the Town Clerk will ~ssue a permit to the applicant. Such permit shall be available for inspection at any time, upon request. Examined .................................................. 19 ....... ' Approved ................................................................ Disapproved ........................................................... Conditions, if any ................................................................................................................................. Examin,ing Body ..................................................................................................................................... Signature of Chairman ......................................................................................................................... APPLICATION IS HEREBY MADE to the Town Board of the Town of Southold, Suffolk County, New York, for the issuance of o permit pursuant to the Laws, Ordinances and Regulations govern- ing the Coastal and Interior Wetlands, Flood Plains and Drainage Areas of the Town of Southold: Permit requested to ...... ~~....~.....~/~..-~..'.~.~-...~.....~..-~ ........................................ ............. ................................................................... Location of property far which permit wonted ........... ..~.(.0. ........................ ............................. · ................................... Home address of permit applicant if different from aforesaid location .....~...~.0 ....................... Creek, Bay or Harbor fronting property .............. ~...7.~fiLz~......~...~..?./..'.,~.. .............................................. Size of proposed work: / Length .................................................. ~..~.] ...................................................................................... Width ~ / Height Above High W'crter ..................................................................................................................... Depth Below Low Water ......................................................................................................................... Yards to be Excavated ........................................................................................................................... Yards to be Filled ................................................................................................................................... 00/ Width of canal, creek of bay fronting property ................. .{.., ........................................................... / Depth at Low Tide Average Rise in Tide . 2 ]~ / ~ ~/ ..... ls this for private or business use? ................. ' ............................................................. ,. .... Area Zoning ............................... ........................................................................... Manner in which material will be removed or deposited .............. ..~..V~fZ~.~.... ............................... l~tended use of property ........................................................................................................... written consent of owner of property, if no~ the same as the applicant ........................................ COUNTY OF SUFFOLK ) STATE OF NEW YORK ) SS: .......................... ~.~...~.Z1.C~.i .......... .~.'.,~.~..~.d ............................... being duly sworn deposes and says that he is the applicant for the above described permit, and 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 forth in this application and as may be approved by the Town Board of the Town of $outhold. The applicant agrees to hold the Town of Southold and the Town Board harmless and free from any and all damages and claims arising under or by virtue of said permit, if granted. .......................... Sworn to before me this ....~..~i~.~ ............. ~~N~ Public E[~ZA,3k-[F~ ANN N~. 52-SZ25B50, Suffo/~ Term ~pires March %