HomeMy WebLinkAboutTR-8863E r�;, ,
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John M.Bredemeyer III,President ��oF SOUjiy� Town Hall Annex
Michael J.Domino,Vice-President '`� ld 54375 Route 25
Glenn Goldsmith P.O.Box 1179
Southold,New York 11971
A.Nicholas Krupski � � � Telephone(631) 765-1892
Charles J. Sanders � � F�(631) 765-6641
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BOAR,D OF TOWN TRUSTEES
TOWN OF SOUTHOLD �
EMERGENCY WETLANDS PERMIT
Permit No.: 8863E
. Date of Receipt of Application: August 24, 2016 `
Applicant: Thomas Byrne &Veroneca Kaliski
SCTIVI#: 1000-52-5-1
Project Location: 2345 Bayview Avenue, Southold ,
Date of Issuance: August 24, 2016 � - _
Date of Expiration: 90 Days from Date of Issuance
Reviewed by: John M. Bredemeyer, III, President -
Project Description: Installation of two (2) 8'x10' piped together leaching pools
as close as possible to the existing system all located on the seaward side of
dwelling,�to be backfilled with clean sand.
Findings: The project meets the requirements for issuance of an Emergency
Wetlands Permit as determined by the Board of Trustees. The issuance of an
Emergency Wetlands Permit allows for the operations as indicated in the project
plan prepared by Thomas Byrne received on August 24, 2016.
Special Conditions: A full Wetland Permit must be obtained within 90 days in .
order to conduct any further activity on the property.
This is not a determination from any other agency.
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ohn M. Bredemeyer, III, President
Board of Trustees
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� * * * RECEIPT * � *
Date: 08/24/16 Receipt#: 212638
G3uantity Transactions Reference Subtotal
1 , Septic Permit- Construct- Resid. 4417 $10.00
Totai Paid: $10.00
Notes:
Payment Type Amount Paid By
CK#7523 $10.00 Byrne,Thomas M.
Southold Town Clerk's Office
53095 Main Road, PO Box 1179
Southold, NY 11971 �
Name: Byrne,Thomas M.
2345 Bayview Ave
Southold, New York 11971
Clerk ID: SABRINA . Internal ID:4417
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John M. Bredemeyer III, President �o�.�S�������oG s�. Town Hall Annex
'�'� 'y��: 54375 Route 25
Michael J. Domino, Vice-President a � ,
Glenn Goldsmith y �� P.O: Box 1179 �
A. Nicholas Krupski ����o �o���'� Tele�honed631 765 1892
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AUG 2 4 2016 BOARD OF TOWN TRUSTEES .
g '' TOWN OF SOUTHOLD
Southold Town �
L..���rao�rf S�. EMERGENCY PERMIT APPLICATION
.
Property Owner Name���� ����`K �z'���� �����
Main Mailing Address: ��� v � Py►!��
Phone Number(s): �0 �`� 7����Z �� - ' LG� ✓�� ` �Z�`'�� �Q�
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Property Address: �3���1Qv��-c�/`�v� �X,�hi�� /��'' /�9 7/
Suffolk County Tax Map Number: 1000 - So';-O� O l
Agent (if applicable)
Address:
Phone Number(s):
Board of Trustee Permit Number(s) if any:
Will any part of this project require a Building Permit?
Project Description:
' + t��� s , � 1�� `
�als m � `� � �,` ,� �o�
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� Board of Trustees Applic ion
AFFIDAVIT
. �
D �� �+ !� �G /�,�1BEING DULY SWORN
DEPOSES AN AFFIRIO�IS THAT 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 FORTI�IN THIS APPLICATION
AND AS MAY BE APPI�OVED 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 DiJRING THE TERM
OF THE PERMIT.
�/�.P
Signature of Property Owner
SWORN TO BEFORE ME THIS �� DAY OF �u�� ,20 1�
�� �
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Notary Public
DIANE DISALVO
NOTARY PUBLIC-STATE OF NEW YORK
No. O1 DI475593
Aunl{fied in sutfolk Counly jQ
My Commisslon Expires Aprll 30, 20l 0
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APPLICANT/AGENT/REPRESENTATIV�
TRA.NSACTIONAL DISCLOSURE.FORM
'The Town of Southold's Code of Ethics�rohibits conflicts of interest on the aart of town officers and emnlovees.The nurpose of
this form is to rovide information which can alert the town of ss�ble confl�cts of mterest and allow tt to take whatever action ts
necessary to avoid same. � .
YOURNf1ME:� NN�7 ''•/ �///�7 � . ` ' l�I yII�� �`
(Last na e,fust name,�iddle initi ,unless you are a lying in the name of
someone else or other endty,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
�hange ofZ�ne Coastal Erosion '
Approval of plat Mooring
. Exemption from piat or officia�map Planning
Other
(lf"Other',narne 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"inclodes by blood,tqarriage,or business interest"Business interest"means a business,
including a par[nership,in which the town officer or employee has even a partial ownership of(or�employment by)a corporation
in which the town o�cer or employee owns more than 5%of the shares_
YES NO _✓� �
if you ans�i�ered"YES",complete the balance of this form and date and sign where indicat�d.
Name of person employed by the To�vn of Southold �
Title or position of that person �
Describe the relationshiP between yourself(the applicandagendrepresentative)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,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 corporaHon);
B)the legal or beneficial owner of any interest in a non-corporate entity(when the
applicant is not a corporation); - �
�an officer,director,partr�er,or employee of the applicant;or '
D)the actua(applicant.
DESCRIPTION OF RELATIONSHIP •
� Submitted this a�day of ��� 2�(�_
Signature -
Print Name
Form TS 1 f �
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O COPYRIGHT 2007 FRANK W. UELLENDAHL, RA.
ALL FLOOR PLANS AND ELEVATIONS ARE PROTECTED UNDER FEDFRAL COPYRIGHT LAW.ALL PLANS AND DE5IGNS ARE THE SOLE PROPFRiY OF FRANK W. UELLENDAHL RA.THE RIGHT TO BUILD ONLY ONE SiRUCTURE FROM THESE PUINS IS LICENCED EXCLUSIVELY TO THE BUYER
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