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HomeMy WebLinkAboutTR-5713 . P rr a(yJ y'¢ity Sof Albert J. Krupski,President 0�� �'o Town Hall James King,Vice-President �`�` Gym 53095 Route 25 Artie Foster ® P.O.Box 1179 CA Ken Poliwoda Southold, New York 11971-0959 H Peggy A.Dickerson ifi A ®�� Telephone(631) 765-1892 ®.( `1►� Fax(631) 765-1366 BOARD OF TOWN TRUSTEES, ,'� W February 26, 2003 TOWN OF SOUTHOLD �S - �a_ ro.C� Patricia C. Moore Esq. 4- %oo� j:7-ss . q fees - P�� 51020 Main Road Southold, NY 11971 �x j RE: OKI-DO LTD. 2835 SHIPYARD LANE, EAST MARION SCTM#38-7-7.1 Dear Ms. Moore: The Board of Town Trustees took the following action during its regular meeting held on Wednesday,February 26, 2003 regarding the above matter: WHEREAS,Patricia C. Moore, Esq. on behalf of OKI-DO LTD. applied to the Southold Town Trustees for a permit under the provisions of Chapter 97 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated January 31, 2003, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on February 26, 2003, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 97 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, �.. � � .: � .,•. �'�,''.z_•? _, _fir s ;3 hoard Of Southold Town Trustees .k x - - \ SOUTHOLD, NEW YORK PERMIT NO. DATE: ... Feb. .. , 200 ! s i OKI-DO LTD. r1 ISSUED TO ......-•. ....... ... .. . . �. ... r.. .. .. . a `ter Pursuant to the provisions of Chapte the Laws of 1 = the State of New York, 1893; and Chapter 404 of the Laws of the ' State of New York 1952; and the Southold Town Ordinance en- titled "REGULATING AND THE PLACING 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 in accordance with the . Feb 26, '� Resolution of The Board adopted at a meeting held on ...........�... .......... 2003 $ 200.00 paid by --., and in consideration of the sum of f ,y Oki-Do Ltd. c/o Dr. Kazuko Iatsumura••-flillyex...--...-.. . .. . ........... . ..... . . ...... - : of New York N. Y. and subject to the Y. r` Terms and Conditions listed on the reverse side hereof, . I of Southold Town Trustees authorizes and permits the following: F, �? Wetland Permit to clean up debris, and demolish tin building, k ,: r ' retain structure,remove wood building on north side of property ' 'a,• and retain concrete building board, with the condition that all loose debris is secured or removed from the bulkhead to prevent all in accordance with the detailed specifications as presented in -the originating application. it from entering into the Bay. IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. / ,> ® • Art' ter .(absen_ t) 3 1 , Trustees .ice`: A` ,�t'�' `C. ,p�,Gsf.. � Rits..� \�/ �.�Olfa �►' ,�'ili" 'a'Ki• wf1 � �1 ' "'f% !^tom" 'fs�'S' 'fg' I 'G �� •'fn. AW r TERMS and CONDITIONS The Permittee Oki-Do Ltd.. 1 Lincoln Plaza, Apt. 24E, 14Y 10023 residing at N. y,, as part" of the consideration for the issuance of the Permit does understand and prescribe to the fol- lowing: 1. That the said Board of Trustees and the Town of Southold are released from any and all damages, or clainhs for damages, of suits arising directly or indirectly as a result of any oper- ation performed pursuant to this permit, and the said Permittee will, at his or her own eqxnse, defend any and all such suits-initiated by third parries, and the said Permittee assumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold 2. That tris Permit is valid for a period of 24 mos. which is Considered to be the estimated time'required to Complete the work involved, but should cirdxm n s warrant, request for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that auth- orization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board of its agents, and non-compliance with.the provisions of the originating application, may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along tie beach between high cad low water marks. 7. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Trustees, work shall cause unreasonable obstruction to free navigation, the said Permittee will be requh4 upon due notice, to remove or alter this work or project herein stated without expenses to the Town of Southold 8. That the said Board will be notified by the Permittee of the mViedon of the work anti orked. 9. That the Permittee will obtain all other permits and consents that may be required sup- plemental to this permit which may be subject to revoke upon failure to obtain same. Albert J.Krupski,President Town Hall �®���F®���® 53095 Route 25 James King,Vice-President P.O.Box 1179 Artie Foster ��® G�� Southold,New York 11971-0959 Ken Poliwoda co Peggy A.Dickerson 0 Telephone(631)765-1892 Fax(631)765-1366 JW BOARD OF TOWN TRUS'T'EES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICETHE WORK, BO ARD OF MAKAN TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT O APPOINTMENT FOR APRE-CONSTRUCTIONPOSSEDLE®N. FAILURE TOREVOCAT ON O F HE SHALL BE CONSIDERED A VIOLATION AND PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1St day of construction % constructed Project complete, compliance inspection. y TERMS and CfONDMONS The Permittee Oki-Do Ltd. residing at 1 Lincoln Plaza, Apt. 24E, NY 10023 N. Y,, as part of the consideration for the issuance of the Permit does understand and prescribe to the f01- lowing: 1. That the said Board of Trustees and the Town of Southold are released from any and of suits oris of indirectly as a result of any oper- all damages, or claims for damages, hg 7 ation performed pursuant to this permit, and the said Permittee will, at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes fall liability with respect thereto, to the complete exclusion of the Board of Tnmees of the Town of Southold 2. That this Permit is'valid for a period of 24 mm which is axddeted to be the estimated time required to complete the work involved, but should dr'amstanceS warrant, request for an extension may be made to the Board at-a later date. I That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that auth- orization was originally obtained. 4. That Bre work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application, may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no-interference with the right of the public to'pass and tepass $long the beach between high and low water marks. 7. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized, or if, in the opinion of the Board of Tmstees, the. work shall cause unreasonable obstruction to free navigation, the said Permittee will be requited, t upon due notice, to remove or alter this work or project herein stated without expenses to the Town of Southold. S. That the said Board will be notified by the Permittee of the completion of the work auth orb&d. 9. That the Permittee will obtain all other permits and consents that may be requited sap- plemental to this permit which may be subject to revoke upon failure to obtain same. i 7 Albert J.Krupski,President ®�0 C� Town Hall James King,Vice-President =�_ �y� 53095 Route 25 Artie Foster o - P.O.Box 1179 ti 2 Southold,New York 11971-0959 Ken Poliwoda Peggy A.Dickerson .j� ��� Telephone(631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES February 26, 2003 TOWN OF SOUTHOLD Patricia C. Moore,Esq. 51020 Main Road Southold,NY 11971 RE: OHI-DO LTD. 2835 SHIPYARD LANE,EAST MARION SCTM#38-7-7.1 Dear Ms. Moore: The Board of Town Trustees took the following action during its regular meeting held on Wednesday,February 26, 2003 regarding the above matter: WHEREAS, Patricia C. Moore, Esq. on behalf of OHI-DO LTD. applied to the Southold Town Trustees for a permit under the provisions of Chapter 97 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated January 31, 2003, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on February 26, 2003, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS,the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 97 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, 2 NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approve the application of OHI-DO LTD. to clean up debris and demolish tin building,retain structure,remove wood building on north side of property, and retain concrete building board,with the condition that all loose debris is secured or removed from the bulkhead to prevent it from entering into the Bay. BE IT FURTHER RESOLVED that this determination should not be considered a determination made for any other Department or Agency,which may also have an application pending for the same or similar project. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of$5.00 per inspection. (See attached schedule.) Fees: $5.00 Very truly yours, Albert J. Krupski, Jr. President, Board of Trustees AJK/hns $0 UTHOL. -D TRUSTEES , No. lssued' TO, h4t -fie Lid, Date - alaetal Address tom. 'est Mktm THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION TOWN TRUSTEES OFFICE TOWN OF 50UTHOLD SOUTHOLD, N.Y. 11971 TEL.: 765.1892 Albert J.Krupski,President OSUFfo��C Town Hall ff► OG James King,Vice-President O 53095 Main Road�� P.O.Box 1179 Henry Smith c !� Southold,New York 11971 Artie Foster y = Ken Poliwoda O Telephone(516)765-1892 Fax(516)765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Please be advised that your application, dated 1 � 31 �( 3 has been reviewed by this Board, at the regular meeting of 02 and the following action was taken: ( -f-Application Approved (see below) ( ) Application Denied (see below) ( ) Application Tabled (see below) If your application is approved as noted above, a permit fee is now due. Make check or money order payable to the Southold Town Trustees. The fee is computed below according to the schedule of rates as set forth in the instruction sheet. The following fee must be paid within 90 days or re-application fees will be necessary. COMPUTATION OF PERMIT FEES: 65aa�h�( J TOTAL FEES DUE: $ f SIGNED: PRESIDENT, BOARD OF TRUSTEES BY: f) E.L. RK, BOARD OFTRUSTEES 4/98 n - = Town Hall. 53095 Main Road T O • � P.O. Bax 1179 Telephone Southold, New York 11971 (631) 765-1892 � SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Wednesday, February 19, 2003, the following recommendation was made: Moved by Bob Ghosio, seconded by Donald Wilder, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL of the Wetland Permit application of OKI-DO LTD. to clean up debris and demolish tin building, retain structure, remove wood building on north side of property, and retain concrete building board. Located: 2835 Shipyard Lane, East Marion. SCTM#38-7-7.1 The CAC recommends Approval of the application however there is a concern with regards to the tanks, soil types, and other environmental hazards. 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It Ml 1 l I I r e s.t y� • p 41 GI i� a to n .I I' it 'I li � r z- I I o 0 I 1 Albert J.Krupski,President ®� �� Town Hall James King,Vice-President �o�o®� ®��� 53095 Route 25 Henry Smith ® P.O.Box 1179 Southold,New York 11971-0959 Artie Foster esu Ken Poliwoda Telephone(631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application, .Wetland Permit Application `Major Minor _Waiver/Amendment/Changes Received Application: Received Fee:$®, ompleted Application O.3 �n _Incomplete E 0 V _SEQRA Classification: D Type I Type II Unlisted Coordination:(date sent) e� ,;;;6AC Referral Sent: mate of Inspection. Southold Town _Receipt of CAC Report: Board of Trustees _Lead Agency Determination: _Technical Review: public Hearing Held: � aG 63 Resolution: Name of Applicant ®41 Do L fff 6,",o ba , ka z uko lam vin vl�', y�/y e r Address k4, /V• Y• /A jY /DD 0 PhoneNumber:( Suffolk County Tax Map Number: 1000 - - Q 'Z - ZZ Property Location: 5A i fie/ I-R/7e- ®o',.0� (provide LILCO Pole#, distance to cross streets, and location) AGENT: / ' ' ''GZ a (If applicable) Address: 5-t 0 Z® t?? llJ (5oGt,#7®/a A�-/ 111-71 Phone: 74P D Board of Trustees Application GENERAL DATA Land Area(in square feet): Area Zoning: /L1 Previous use of property: Intended use of property: %/ D . Prior permits/approvals for site improvements: %j�� Agency Date08/ a No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? No Yes If yes, provide explanation: Project Description(use attachments if necessary)):/ jiN. 611 006/rCL Goftcl� Owner: OKI-Do Ltd. Property: 2835 Shipyard Lane East Marion, NY PROJECT DESCRIPTION AND PROPOSED PURPOSE: (1)Demolish and remove wood Building at north side of property( slabs to remain) (2)Main Concrete Building -windows and doors will be board up Interior of building will be cleaned out and dilapidated partitions removed-building remains (3) Large Tin Building at South end of property: clean up debris inside and outside demolish generator building on west side Demolish and remove partitions and concrete vaults inside bldg. Keep foundation walls,piers and concrete slabs Rgai1� FrY '�' e ^beams,tin 1G6roof and siding IZetCA'r' �/�.✓tiec�Q = Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ,/ Area of wetlands on lot: square feet Percent coverage of lot: @ o % --I— Closest distance between nearest existing structure and upland edge of wetlands: 572% feet Closest distance between nearest proposed structure and upland edge of wetlands: feet C 15--,N�-) Does the project involve excavation or filling? JJ No Yes C W i If yes, how much material will be excavated? 10 cubic yards How much material will be filled? 0 cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: l�vC- Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): Board of Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity: C J-ea.in Lip rind om a b s k Are wetlands present within 100 feet of the proposed activity? No X Yes -ccac,.-� W e�-Io-yi,4 H W fn -- 6—b -t- To -eJ c S rE.l c�- Does the project involve excavation or filling? X No Yes If Yes, how much material will be excavated? (cubic yards) How much material will be filled? (cubic yards) Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) Y-vjPerJ--J Acis QAdsrxc� (A-A CkAtJ u� ➢r(.�_�cs CA) Kcc-G, nku Q�-�lw✓ -� C-ode- � J I PATRICIA C. MOORE Attorney at Law 51020 Main Road Southold,New York 11971 Tel:(631)765-4330 FEB 1 u 8 2003 Fax:(631)765-4643 Southold Town Board of Trustees. February 1 , Board of Trustees Town of Southold P.O. Box 1179 Southold, NY 11971 RE : Oki-Do Ltd. Premises : 2835 Shipyard Lane, East Marion, NY SCTM: 1000-38-7-7 . 1 Dear Sir or Madam: Enclosed please find the Affidavit of Mailing, Affidavit of Posting, and fourteen (14) Certified Mail Receipts for the above referenced matter. ZTV -y—truly yours, Patricia C. Moore PCM/mm Enclosures ■ Complete items 1,2,and 3.Also complete A Siure item 4 if Restricted Delivery is desired. A�jent ■ Print your name and address on the reverse �ddressee so that we can return the card to you B. eceiv d by(Pn�e) C. Date of Delivery ■ Attach this card to the back of the mailpiece, ��f Q/ /e�f L// n, or on the front if space permits. AMl ` oC 1 Article Addressed to: D Is delivery address different from item 1? ❑Yes If YES,enter delivery address below: ❑ No Barbara Terrell 132 N. Jefferson Avenue Lindenhurst, NY 11757 3. Service Type N Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O D 4 Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (rrensfer from service labeq', ' 'I. 7,0 01 25-10 , .0,0 0 2 , 9 6 0.3 619,0 PS Form 3811,August 2001 Domestic Return Receipt 102595-01-M-2509 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No. G-10 Sender: Please print your name, address, and ZIP+4 in this box • PAT MCC*IA G. M00PE 51720 MAHN ROAD SOUTHOLD, NY 11971 Hillyer Wzy- ■ Complete items 1,2,and 3.Also complete A Sig ure item 4 if Restricted Delivery Is desired. ❑Agent ■ Print your name and address on the reverse X ❑Addressee so that we can return the card to you. g, eceived by(Printed Nam C. Date of eJivery ■ Attach this card to the back of the mailpiece, /�J or on the front if space permits. �'`b /wlyg / « -� 1. Article Addressed to D. Is delivery address different from item 1 ElYes 1/' If YES,enter delivery address below: 11 No a r Joseph Licciardi and6 gEB Catherine E. Pin+ � 50 Cleaves Point Ro��c1 �,�_/Sn East Marion, NY 11935` 3. Service Type ®Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number — " (Transfer from service label) ! ?00k 2 510 0002 9603 6176 1 PS Form 3811,August 2 o sic a urn Receipt 102595-01-M-2509 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No. G-10 • Sender: Please print your name, address, and ZIP+4 in this box • FATRICIA C. 510112-01 iNtF IIN ROAD SOUTHOLD, NY 11971 Hillyer Y�>•I.7�: •u• ., �$iliTir]�����:r�-;���r.�ar.�.��.»wia: ■ Complete items 1,2,and 3.Also complete A Signatur item 4 If Restricted Delivery is desired. `❑ gent ■ Print your name and address on the reverse X X Addressee so that we can return the card to you. a eced eiv ■ Attach this card to the back of the mailpiece, \� Y(Punted Name) `e D�eJ�yery or on the front if space permits. C� D Is delivery address different from item 1? `❑des 1. Article Addressed to If YES,enter delivery address below M No John Kent 2195 Shipyard Lane East Marion, NY 11939 3. Service Type ®Certified Mad ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mad ❑C O.D 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (Transfer from service label) j_ . 7001 :2510 0002 9603 6 2 7 5 . PS Form 3811,August 2001 Domestic Return Receipt 102595-01-M-2509 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No G-10 Sender: Please print your name, address, and ZIP+4 in this box • PATPICOA C. MOORE A-r ORNEY AT LAW 51020 (MAIN ROAD SOUTHOLD, NY 11971 Hillyer jj {ii 1 y}ty Sy ii i(( qq �}Ilf�il}Iflii{Itil1lfllliti�}}111{!1!l11il�Iltfl�l���litlt�}1� *1011111 4: •u• • . . . . , ■ Complete items 1,'2,and 3.Also'complete A. Sign tur. item 4 if Restricted Delivery is desired. i ❑Agent ■ Print your name and address on the reverse X ❑Addressee so that we can return the card to you. eceived by(Punted Name) C. Date of Delivery ■ Attach this card to the back of the madpiece, I�Q or on the front if space permits. D Is delivery address different from item 1? El Yes 1. Article Addressed to: If YES,enter delivery address below- ❑ No Barbara McKenzie and others 28 Gould Road Centereach, NY 11720 3. Service Type iR Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (Transfer from'service label) ; 70,01 2 510 00-02 9603 -6268--- PS 6268;-- PS Form 3811,August 2001 Domestic Return Receipt 102595-01-M-2509 UNITED STATES POSTAL SERVIC u 11 ---7-- --First- "—a���-� � _ Ftrst=Class Mail Postage&Fees Paid USPS- - �: _ PermiLNo.G-10icc _ -z • Sender: Please prXtyo'ujr,name, address, and ZIP+4 in-tfais_box- PATPICIA C. MOORE ATTORNEY AT LAW 51020 MAIN ROAD SOUTHOLD, NY 11971 Hillyer 3 it fill 3 3 f i5 3 3 if it if i fill 3 it lit tntirintnattttttatutatnaatttatfill ttttctrrar►tattaaat1 ■ Complete items 1,2,and 3.Also complete A. Si ure item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X 11 Addressee so that we can return the Card to you. B ecenred by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits 01- D L`L Z - 0 3 D Is delivery address different from dem 1 ❑Yes 1. Article Addressed to: If YES,enter delivery address below ❑ No Colin Crowley P.O. Box 343 East Marion, NY 11939 3 Service Type IN Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4 Restricted Delivery?(Extra Fee) ❑Yes 2 Article Number (Transfer from service label 7001 2 510 0002 9603 6251 PS Form 3811,August 2001 Domestic Return Receipt 102595-01-M-2509 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • PATRICIA C. MOORE ATTORNEYAT LAW 5110201" iA(N ROAD SOUTHOLD, NY 11971 Hillyer t it i!! ! ! t i1 ! ! it i! i! ! ti! 1 ftinnrnurtttuttttrnii ii-Mil ulilt+tttuttttutttift:t# ■ Complete items 1,2,and 3.Also complete A. Signat�}re k. - :.-- item 4 if Restricted Delivery is desired. X ■ Print your name and address on the reverse ;"� ' ❑Addressee so that we can return the card to you. B. Received b Frir ed Namef f C. Date of Delivery ■ Attach this card to the back of the mailpiece, 1 r ), or on the front if space permits. -')/N, ,� I�� "I S-0-3 1. Article Addressed to: b.'is delivery address different rom item 1? 11 Yes If YES,enter delivery address below: R No Mr. and Mrs. John Manoglu 2420 Gillette Drive East -Marion, NY 11939 3. Service Type El Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 7.U 1 ;2.510 000-2: :9603::6213 PS Form 3811,August 2001 Domestic Return Receipt 102595-01-M-2509 UNITED STATES POSTAL SERVICE �C�\S it( .F-first C ss Mail- P ti{ -hostage&Fees'Paid USPS' "�Permit No:G=1'0 _� • Sender: Please print your name, address, and ZIP+-4-i to his box •" '- PATRICIA C. MOORS 51020 {11IWN ROAD SOUTHOLD, NY 11971 Hillyer ■ Complete items 1,2,and 3.Also complete A. Signatur item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X Addressee so that we can return the card to you, a _g Receivedby(Printed Name) C. DPW of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. 0 '�T rA (2 /510-3 D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No Robert F. Muir & Nancy Muir 2850 Gillette Drive East Marion, NY 11939 3. Service Type ®Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2 Article Number (Transfer from service label) ?001 , 2,510 00029603 6183 PS Form 3811,August 2001 Domestic Return Receipt 102595-01-M-2509 UNITED STATES POSTAL SERVICE First-Class Mad Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • PATRICIA CA1OOR iE ATTORNEY All I.A�q 511323 Is/lAIN ROAD SOUTHOLD, NY 11371 Hillyer its's}ttl'ifiltft}1t1:!}}2�llliit}t�1}i6}}(l1 U!}llll�i�}ti!fFT�E ■ Complete items 1,2,and 3.Also complete ature item 4 if Restricted Delivery is desired. t ■ Print your name and address on the reverse X ❑Addressee so that we can return the card to you. B. Received by(Printed Name) C Date of Delivery ■ Attach this card to the back of the mailpiece, 12,1131 or on the front if space permits. D. Is delivery address different from item 1 9 ❑ es 1 Article Addressed to. If YES,enter delivery address below, ❑ No Suffolk-County 330 Center Drive Riverhead, NY 11901 3. Service Type ® Certified Mail ❑ Express Mad ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (Transfer f�orn service label) .7 0 01 2 510 0002:: 9603 6220, PS Form 3811,August 2001 Domestic Return Receipt 102595-01-M-2509 UNITED STATES POSTAL SERVI,, ciND ..Rostages8'Faesd3aid z M O • Sender: Please p e?r Ari e, address,_and.ZIP4.4-icy PATRICIA C. MOORE ATY'ORN'EY AT LAW $1020 MAIN ROAD SOUTHOLD, NY 11571 Hillyer ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. Ment ■ Print your name and address on the reverse XGA/ � ,Addressee so that we can return the Card to you. B Received by Pnnted Name) C. D too Delivery ■ Attach this card to the back of the mailpiece, c1lb or on the front if space permits. �-l>LA D. Is delivery address different from item 17 'I]Yes 1. Article Addressed to If YES,enter delivery address below ❑ No Martin A. Sarandria & Eva McGurre P.O. Box 101 East Marion, NY 11939 3 Service Type ®Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O D. 4. Restricted Delivery9(Extra Fee) ❑Yes 2 Article Number j� 70012510 0002 9603 6244 (Transfer from service label) ___,_---- -__---- _ -- _ ____ ___ - _ PS Form 3811,August 2001 Domestic Return Receipt 102595-01-M-2509 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • PATRICIA C. MOORE ATTORNEY AT LAW 51020 MAIN ROAD SOUTHOLD, NY 19971 Hillyer 1 t6 1 1 { ii1 t f1 5 i{ i t61 i' ■ Complete items 1,2,and 3.Also complete A. Sin ure item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X W/ ❑Addressee so that we can return the card to you. Received by(Panted Name) C. Date of Delivery ■ Attach this card to the back of the mailplece, �� 1 �. or on the front if space permits. £ U d D. Is delivery address different from item 17 ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No Gene Walker and Heather Walker 2530 Gillette Drive East Marion, NY 11939 3. Service Type ®Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4 Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (Transfer from service label) ' ' 700.1 2 510 0002' -160,3 6206 , PS Form 3811,August 2001 Domestic Return Receipt 102595.01-M-2509 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No. G-10 • Sender: Please print your name, address, and ZIP+4 in this box • PATRICIA C. MOORE A I-TORNEY AT tA�v 51020 IVI IN POAD SOUTHOLD, NY 11,971 Hillyer laaallaaa{{Isiaalaaa�aaa{{ala:ialiaaaaa{{e{{!aaala{{laa!llai'! ■ Complete items 1,2,and 3.Also completenature item 4 if Restricted Delivery is desired. ent ■ Print your name and address on the reverse °a X Addressee so that we can return the card to you. Recery d by(Printed Name) C. �ate f Delivery ■ Attach this card to the back of the mailpiece, p `�or on the front if space permits. V 4 D. Is delivery address different from item 1? ❑Yes 1 Article Addressed to: If YES,enter delivery address belowNo Joseph A. Cherepowich and Iielen Polak and M. Santacroc 6500 Main Road P.O. Box 103 East Marion, NY 11939 3. Service Type ®Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2 Article Number 7001 21510 0002 9603 61138 (transfer from service label)' ._ PS Form 3811,August 2001 Domestic Return Receipt 102595-01-M-2509 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • PATP-m IA C. .. 1 t D, N`, 'i 757 r Hillyer i }` 6'i i { I i i it 76 it i iii i i itttflitttftit!sitttit n l�titti tilttt!tittfitt a ttt iiftit!i ii� • • o • •� •�1RF�Pl�a' ■ Complete items 1,2,and 3.Also complete A Signat item 4 if Restricted Delivery is desired. X ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B Re ed by(Pante Name) C Date of Delivery ■ Attach this card to the back of the madpiece, or on the front if space permits. I V L` f D Is delivery address different from item ❑Yes 1 Article Addressed to If YES,enter delivery address below- ❑ No John Cadwallader P.O. Box 1653 t Presque Isle, ME 04769 3 Service Type - ®Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mad ❑C O D. 4. Restricted Delivery (Extra Fee) ❑Yes 2. Article Number (Transfer,from service label) 7001 2 510 0002 9603 6237 j PS Form 3811,August 2001 Domestic Return Receipt 102595-01-M-2509 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • PATRICiA C. MOORE ,91020 MAIN ROVD SOUTHOLD, NY' 11971 Hillyer r III JIM 11111iIIll Itill dilifIIIli,,,:1II1II„z,i,11111ItIII!i ■ Complete items 1,2,and 3.Also complete A Sign ur item 4 if Restricted Delivery is desired. [IAgent ■ Print your name and address on the reverse 6, 0(21L ❑Addressee so that we can return the card to you. Receiv y(Printed Name) C Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. LJC — D. Is delivery a dre Firm 17 11 Yes 1 Article Addressed to: If YES,enter 4 address 1 ❑ No c? > Cleaves Point Club & Marina In P.O. Box 29 FEB 4 2003 Greenport, NY 11944 3. Service Type (/�+p ®Certified Mail Exp ss Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mad ❑ C.O.D. 4 Restricted Delivery?(Extra Fee) ❑Yes Art 2 (Transfer nsfer fomcle eservice label) ` 7001 2 510 0002 9603 6145 PS Form 3811,August 2001 Domestic Return Receipt 102595-01-M-2509 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box AA A Hillyer RAYRICIA C. MOORE E0 E Q V E Attorney at Law ® 51020 Main Road hold,New York 11971 ly 6� a p� � � el:(631)765-4330 x.:.:(631)765-4643 Southold Town Board of Trustees March 13 , 2003 Board of Trustees Town of Southold 53095 Main Road P.O. Box 1179 Southold, NY 11971 RE: Oki-Do Ltd. Premises : 2835 Shipyard Lane, East Marion, NY SCTM: 1000-38-7-7 . 1 Dear Sirs : Enclosed please find thirteen (13) signed Return Receipt Cards for the above referenced matter. F Very truly yours, Patricia C. Moore By: Melissa McGowan, Secretary /mm Enclosures i PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: see attached list Ln Vj PEE M pPostage $ 0" Certified Fee Po mark ru Return Receipt Fee H re i C3 (Endorsement Required) C• S Restricted Delivery Fee ®®� O (Endorsement Required) 6, O �q ,-3 Total Postage&Fees Ln Ak ru Sent To y �, Cleaves Point Club—Marina, Inc. I 'a Street,,Apt NNoo- ------------------------------------------------------- ----- ------ A , O or PO Box No. P.O. Box 29 at 695 Theresa Drive, Mattituck, (t CSO:State,Z/P+4 -------------------------------------- Greenport, NY 11944 (Hill er) ly sworn, deposes and says • oo ; , 2003, deponent mailed a'=true copy=oz- zrie=NOL-rce set=forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at Southold that said Notices were mailed to each of said persons by (certified) mail. Aararet t ows -L Sworn to before me this jqy�i day of February k1k 2003 Notary Public MELISSA McGOWAN Notary Public,State of New York No.4995913 Qualified in Suffolk County Commission Expires May 4.20 dU 6 J Subject- 1000-38-7-7.1 1000-38-1-24 John Kent 2195 Shipyard Lane East Marion,NY 11939` 1000-38-1-25 Barbara McKenzie and others 28 Gould Road Centereach,NY 11720 1000-38-1-26 Colin Crowley P.O. Box 343 East Marion,NY 11939 1000-38-1-27.1 Martin A. Sarandria and Eva McGurre P.O. Box 101 East Marion,NY 11939 1000-38-1-27.2 John Cadwallader P.O. Box 1653 Presque Isle, ME 04769 1000-38-1-28 Suffolk County 330 Center Drive Riverhead,NY 11901 1000-38-2-25 Mr. and Mrs. John Manoglu 2420 Gillette Drive East Marion,NY 11939 1000-38-2-26 Gene Walker and Heather Walker 2530 Gillette Drive East Marion,NY 11939 1000-38-2-27 Barbara Terrell 132 N. Jefferson Avenue Lindenhurst,NY 11757 1000-38-2-29.1 Robert F. Muir and Nancy Muir 2850 Gillette Drive East Marion,NY 11939 1000-38-2-30 town 1000-38-2-31 Joseph Licciardi and Catherine E. Pino 50 Cleaves Point Road East Marion,NY 11939 1000-38-7-8 and 1000-38-7-9 Parkside Heights Co. 43 West 54th Street New York,NY 10019 1000-38-7-14 and 1000-38-7-15 Cleaves Point Club &Marina Inc. P.O. Box 29 Greenport,NY 11944 1000-38-1-1.9 Joseph A. Cherepowich, Helen Polak and M. Santacroce 6500 Main Road P.O. Box 103 East Marion,NY 11939 PATRICIA C. MOORE Attorney at Law 51020 Main Road Southold,New York 11971 Tel: (631) 765-4330 Fax: (631) 765-4643 Margaret Rutkowski Secretary February 10, 2003 BY CERTIFIED MAIL RETURN RECEIPT REQUESTED Neighbors Re : Oki-Do ltd. 2835 Shipyard Lane, East Marion, NY SCTM# 1000-38-7-7 . 1 Dear Neighbor: I represent Oki-Do Ltd. with regard to the property located at 2835 Shipyard Lane, East Marion, NY. They are seeking a permit to clean-up debris, dismantle the tin building and remove the wood building on the north side of the property. Enclosed is the Notice of Hearing. The hearing on this matter has been scheduled for Wednesday, February 26, 2003 at 7 : 00 p.m. at _Southold Town Hall . If you have any questions, or you wish to support this application, please do not hesitate to contact me. Very ~�)ruly yours, Patricia C. Moore PCM/mm Enclosures NOTICE OF HEARING NOTICE IS HEREBY GIVEN that a public hearing wilt be held by the SOUTHOLD BOARD OF TRUSTEES at the Town Hall, 53095 Main Road, Southold, New York, concerning this property. OWNER(S) OF RECORD: Ohlw-bO Lam . SUBJE TTOF PUBLIC HEART • C`�h-� s4 U � h b1dq. , �tvrouQ w��iot9 . on nkS 04. efteertA. TIME & DATE OFP�BLIo� A �t .� Pm . uod• f&bru&N o� o If you have an interest in this project, you are invited to view the Town file(s) which are available for inspection prior to the day of the hearing during normal business days between the hours of 8 a.m and ,4 p.m. BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (631 ) 765- 1892 Albert J.Krupski,President ®�®$VFFOg�C® Town Hall G� .53095 Route 25 James King,Vice-President cP.O.Box 1179 Henry Smith Southold,New York 11971-0959 Artie Foster y � Ken Poliwoda �y • Telephone(631) 765-1892 Fax(631)765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD ----------------------------------- In the Matter of the Application of -- _to ---------------- COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I, Patricia C. Moore , residing at 370 Terry Lane, Southold, NY being duly sworn, depose and say: That on the Iq4� day of February, 200 3, I personally posted the property known as 2835 Shipyard(�Lane, East Marion, NY by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of t-h� � �6 � public_hearin . D(a��e� shearing noted thereon to be held c � a Dated: February 14, 2003 ('signature) Patricia C. Moore Sworn to before me this 114'1. day of February 200 3 ' 7"l_. �UA 71 I u Notary Public MELISSA McGOWAN Notary Public,State of New York N0.4995913 Oualified in Suffolk County Commission Expires May 4,2b.& Board of Trustees Application County of Suffolk State of New York i `� A� ( � Yc.�ca oo I BEING DULY SWORN DEPOSES AND AFFIRMS 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/BER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN 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(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. I'-�4-- Signature SWORN TO BEFORE ME THIS o DAY OF Cvv�v� ,200-3 otary ublic MARGARET C. RUTKOWSKI Notaiy Public,State of New York No. 4982528 Qualified in Suffolk CountV Commission Expires June 3, GI .rr-roz� 4UYJ Iuui. •v +.- -. - l AUTHORIZATION LETTER New York State Department of Environmental Conservation Suilding 40-SUNY Stony gook, New York 11790-2356 At:t : Regulatory Permits OWNER: OKI-DO LTJ. Tatsur�ura Hi11�'er Ph.D, President name: Dr.. Kazu7�a addre8s: 1 Lincoln Plaza, Apt . 24E New York, NY 10023 telephone number;2?2-"799-9711 PROVERTY : 2835 Shipyard Lane, East Marion SCTM##: 1000-36-07-7 . AGENT: Patricianame: C. Moore Esq. address : 51020 Main Road , snuthol:1 NY 11971 teiephonc number: 631-76S-,1330 Dear Sir or Madam; z Dr . Kazuko TatsUMUl'a Hi l lyer Ph.D auth(::)ri ze my attorney, Patricia C. Moore as my agent for all to the DEC, Southold Tawr, Trustees, and any submissions property . other agency 1:aving jur-1.sd ct ion regarding the Very truly yours DrKa Iko Ta:sumura IHillyer Ph.D 14-1.6.4(2/87)—Text 12 PROJECT I.D. NUMBER 617.21 SEC Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I—PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT/SPONSOR 2. PROJECT NAME -moo L+A 3. PROJECT LOCATION: 3 L ( � - / /LvJ�'e �CC ///�l 6 111) IL r Municipality ✓ y �– County 4. PRECISE LOCATION (Street address and road intersections,prominent landmarks, etc., or provide map) tom, S S � /ate© 3e-v-I - 7. 5. IS PROPOSED ACTION: ❑New ❑Expansion ❑Modificationialteration S. DESCRIBE PROJECT BRIEFLY: t��/-"0/1-/70Y7 oz- 7. F7. AMOUNT OF LAND AFF�CT D: Initially acres Ultimately 4, 0 acres a. WILY PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? YN'Yes ❑No If No,describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECTI ❑Residential ❑,'ndustrial Kcommercial U Agricuiture U ParK/ForestlOoen space Ell Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL, STATE OR LOCAL)? XYes t__1 No If yes, list agency(s)and permit/approvals a�� r 11. DOES ANY ASPECT OF THE ACTIOI4 HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Yes' ❑No If yes,list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REOUIRE MODIFICATION? ❑Yes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor nanre: make."A " DB1� Date: Signature: K If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER ' i ' PART II--14VIR0t,1MENTA' 'SS MENTgoohecortpreteoCy ,-`.genc iA. DOES ACTICN EXCE-ED ANY • r=E3i:OLD IN 8 N CRF. SART 5.7. _ It yes. docralnate :he review .rocess and use 'he Yes !No B. WILL ACTION RECc:VE, GFICINATED RE/IEN AS,PROVIDED UDJL:STED ACTIONS iN S NYCE:R, =4RT 5,,7.37 f No. a negative ::ec:ara may be superseded zy anctr,er.nvolved agency. I L Yes `:No C. CCULD ACT-,CN =ESUL-:N ANY ADVEnSE E==_CTS ASSOc:ATEC WITH -=E FOLLOWING.'Answers may ce nanCwnRen. f ;eglclel I C1. E,,sung air duality, surraca or groundwater euallty or duantity, noise revels, ex:sting :,attic patterns, solid .vaste oroduc-:on or dlsdc aotentiai for erosion,drainage or Goading oroblems'?_:plain briefly: C2. Aesthetic, agricultural, archaeological,nrswric, or other natural or cultural resources: or community ar neignbernood criaracter'? Exolairi p. CO. Vegetation or :auna. *isn, snelifisn or•Nildlife saec:es, significant`iaoitats,or threatened or endangered spec:es? =:plain nrlaily: C-1. A community's existing pfans or goals as otfic:aliv adopted,or a criange in use or intensity or use of land or other natural resources?Explain pr C5. Growth,suoseauent ,eveloornent.or related activities likely to oe induced oy the proposed action? Exotain pr:efly. CS. !cng term, snort term,pnmuiative,or other effects not identified in C.-05? =xdiain,brieriy. Other imoac:s inc:,ic:ng changes In use of a,ther cuannty or:vpe or energy)? 1-otain Zmetly. I - - DR :S-n ERE _:Kc Y TC BE. CONTROVE?SY RELATED 70 =OTENTIAL A,-VE?SE ENVIROMAENTAL :P4C-S1 i — i _ Yes =No :f"es, exclain anefly I ?ART III—DEI cRMINATION OF SIGNIFiCANCE (To be completed by agency) INSTRUCTIONS: For eac:t adverse erfect identified at:ove,determine wnettler it Is substantial,large, Imoortant or otherwise slgnific Each effect should be assessed In connection with Its (a) setting (i.e. urban or rural); (b) prooaoility of occa..-ing; (c) duration- irreversibility: (e) geograonic score; and (f) magnitude_ If necessary, add attachments or reference supporting materials. Ensure explanations contain surfic:ent detail to snow that ail relevant adverse Impacts nave been identified and adequately addressee. i Check this box If you nave identified one or more potentially large or significant adverse imoac,s which MAY occur. Tien oroceea directly to the FULL EAF andlor precare a positive-declaration. i Ciec:< this pox :f you have determined, based an the information and analysis above and any sucoort;nc documentation, :hat the orocosea action ';PILL NOT result In�r1y significant adverse environmental imoac:�- AND orovide on attachments as necessary, the reasons supcorung this determination: i i I `i.,me nr _e,u Agency i i 'nn(Or .vpe Name Ji {eicon%iole�;lilc_r•O .cap �,gencl we Oi •le:Qon5i0le UtliQef I ' ;ign.][L'r.^ N 1e�COnSr pie i:iCer�n -eau Agency i,vna:ure,Jf f.'.')drer tit err:e•enr ,rpm rCSp On HOie Jitic 2rl ' JJ(C APPUCANT TRANSACTIONAL DISCLOSURE FORH � The Town of Southold ' s Code of Ethics ' rohibits conflicts of nterest on the part of town officers and em loo ees . The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same . . YOUR NAME! ��d - �o �`-�! � +,&C, 1�a tri ®C -'6 Last name , first name , m d •le inial , unless you are applying in the name of someone else or other entity , such as a company. If so, indicate the other person ' s or company ' s name. ) NATURE OP APPLICATION: (Check all that apply. ) Tax grievance Variance Change of zone App wai of plat r4 Exe ption fromlat or official map other Zr U 5�s ( if 110ther, " name the activity. ) Do you personally (or through your counpanyt npoone, sibling, parent, or child) have a relationship with any officer or employee of the 'Town of Southold? "Relationship" includes by blood, marriage, or business interest. "Business interest" means a business, including a partnership► in which Ehe town officer or employee has even a partial ownership of (or employment by) a corporation in which the town ofri,cer or employee owns more than 5% of the shares. YES NO if you answered "VES, ". complete the balance of thim form and date and sign where indicated. Name of person employed by the mown of Southold Title or position of that person _ Describe the relationship between yourself ( the applicant) and the town officer or employee. Either check tho appropriate line n) through D) and/or, describe in the space provided. The town officer or employee or his or her spousst sibling, parent , or child is (check all that apply) t A) the owner of greater than 5% of the shares of the corporate stock of the applicant (when the applicant is a corporation) ] b) the legal or bbneficial owner or any interest in a noncorporaterentity (when the applicant in not a corporation) = C) an officer, director► partner, or empibyae of the applicantt or D) the actual applicant . DESCRIPTION OF RELATIONSItIP �rfts ' ,t• 751'.(,'p`i. 1•�"'r'1'ir �',al�.""} • 'J X,,1<d Submitted this sig'na lure r •.i`-, .. , print name ', 'Jrp?)�' ' t y .t.' I r'\i� �• +N�^' G 1'F('i ,P If{lr.:.l• ty 1't,�s,^`.f/i7 .)) (�ryJ��• +��'cj l�., pt.,Ar��•S'rr!.�� ��' > ';S�>