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HomeMy WebLinkAboutTR-868Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0542C Date: May 14, 2010 THIS CERTIFIES that the fixed 3'x54' catwalk with 3'x19' fixed "T" dock extension and tie-off pile off of seaward end At 1300 Strohson Road, Cutchogue, New York Suffolk County Tax Map # 103-10-27 Conforms to the applications for a Trustees Permit heretofore f'fled in this office Dated 5/4/00 pursuant to which Trustees Wetland Permit # 868 Dated 4/2/73 was issued and Amended on 6/22/01_, and Amended again on 2/25/04, and Amended again on 7/22/09 and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the fixed 3'x54' catwalk with 3'x19' fixed "T~' dock extension and tie-off pile off of seaward end. The certificate is issued to JERRY & LINDA MATEJKA owner of the aforesaid property. Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: J Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction. hay bale line/silt boom/silt curtain 1st day of construction % constructed Project complete, compliance inspection. INSPECTED BY: ~, COMMENTS: ~',~a ~'r'?~'~ J ~,~' .~,~l,o ~.~ ~ ~ CERTIFICATE OF COMPLIANCE: OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.) Southold, NY 11971 MAILING ADDRESS: P.O. Box 1179 Southold, NY 11971 Telephone: 631 765-1938 Fax: 631 765-3136 To: LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD _ .: Jim King, President Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: July 16, 2009 Re: Proposed Wetland Permit for JERRY & LINDA MATEJKA SCTM#1000-103-10-27 JERRY & LINDA MATEJKA request an Amendment to Permit #868 to add a 3'X 19' fixed "T" dock extension onto the seaward end of the existing dock. Located: 1300 Strohson Rd., Cutchogue. SCTM#103-10-27 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is CONSISTENT with the Policy Standards and therefore is CONSISTENT with the LWRP provided that the following recommendations to further the below listed policies are implemented. Pursuant to Chapter 266, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Lori Hulse, Assistant Town Attorney James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen John Holzapf¢l Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 APPLICATION FOR AN AMENDMENT TO A WETLAND PER_MIT'-'-~ ADDRESS PROPERTY LOCATION TAX MAP NO. //j' 6~ t) ' request an Amendment to Permit # ~'~, ,,~' Si James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall, 53095 Main Rd. P.O. Box I 179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of JERRY MATEJKA COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I~"~¢,a.'/ Y'//~TL:O"~ , residing at 2dba being duly sworn, depose and say: Sworn to before me this ]$,44, dayof~00 c~ That on the/,0 day ot~x~_ , 200'~, I personally posted the property,known as b/pCac~ng t~rus~t~s o~~wh~e ~t ~ e[tsi?yX'b; seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held Wed, July 22~ 2009 on or about 6:00 PM. Dated: · ) Notary Public CONNIE D. BUNCH Notary Public, State of New York No. 01BU6185050 Qua filed in Suffolk CountY C~mmission Exoires ADd 14, '~ PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Address: Soothhold Town , Board of Trustees · M~?4a.y /-qef~ , residing at _)~Y)~//~/.,. .. /".3, Z,-~/...~q...e~e-~" , being duly sworn, ~eposes anc~ says mat on me - ~-/.) day gt~ ~ ,200~, deponent mailed a true copy of the Notice ~et forth, inthe Boa{,d of Tqustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set oppo. site 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 ~./z-Tc:d-/O 6 1 ) ~ ,~otic~s were mailed to each of said persons by (certified) (registered) mail. y // ~ ~ Sworn to before me this J '~ __ Day of 5~___, 20_D (~ Notary Public Board of Trustees Application County of Suffolk State of New York ~"~ R ~ Y ft'//~7"~ ~ 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/HER 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 ^OREES TO.O~O ~HE TOW~ O~ SO~THO~O ~ THE ~OW~ T~STEES .~SS ~ ~REE ~O~ ~ ~ AL~ D~^~S ~ ~,~S ,~SIN~ Sig'~re ~ SWORN TO BEFORE ME THIS c-~,q'4~ DAYOF ~c_L)~ ~ Notary Public CONNIE D. BUN~ NO. 01BU§185050 (~ualifled in Suffolk County Commission Fex~ir~ ~ 14,~0 Town of Southold LWRP CONSISTENCW ~;SESSlVlENT FORM A. INSTRUCTIONS All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Water~ont Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area (which includes all of Southold Town). If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus~ each answer must be explained in detaii~ listing both supporting and non- suooorting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online/-~ website (southoldtown.northfork.net), the Board of Trustees Off, lc local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION / ._..~ ' ' ' L-.~oS~°rd of Trustees The Appbeation has been submitted to (check appropriate response): Category of Town of Southold agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital construction, planning activity, agency regulation, land transaction) (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action: Location of action: ~vBYJT_/ Site acreage: ~ ~ Present land use: ~9'~i~ Present zoning classification: If an application for the proposed action has been filed with the Town of Southold agenc);, the following information shall be provided: (d) Application number, if any: Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes [] No [~ If yes, which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III - Policies; Page 2 for evaluation criteria. ~Yes ~ No [~/Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section IlI- Policies Pages 3 through 6 for evaluation criteria ~ Yes ['~ No [-~N°tApplicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III - Polices Pages 6 through 7 for evaluation criteria ~ Yes ~ No~L~ Not Apphcable" Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III - Policies Pa~es 8 through 16 for evaluation criteria [-'] Yes [] No[~-J/I ~r ~ Not Apphcable- Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section HI - Policies Pages 16 through 21 for evaluation criteria [-~ Yes ~ No[~l v INot Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III - Policies; Pages 22 through 32 for evaluation criteria. Yes No Not Ap~able Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies Pages 32 through 34 fo~/evaluation criteria. [] Yes [] No IV[ Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria. ~ Yes [] No ~Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section IH - Policies; Pages 38 through 46 for evaluation criteria. ~ Ye~-~ No ~/Not Applicable Attach additional sheets if necessary WORKING COAST POLICI~ Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. S~e LWRP Section IH - Policies; Pages 47 through 56 for evaluation criteria. [] Yes [--] No~ Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. [] Yes ~-~ No ~/Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold, See LWRP Section III - Policies; Pages 62 through 65 for evaluation criteria. ~ Yes ~ No[~t-~ Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III - Policies; Pages 65 through 68 for evaluation criteria. TITLE. DATE 1300 Strohson Road Cutchogue NY 11935 Jerry W. Matejka May 31, 2009 Board of Town Trustees Town of Southold Greetings, I am writing this letter to request a pre-submission cenference at our property to obtain input from the Trustees on our desire to add a "T' extension to the existing fixed dock. The existing dock and tie-off pile was approved by the Trustees on 2/25/2004 and constructed. Subsequently, we had hoped to add a ramp to the existing fixed dock and add a floating dock, but were denied in April 2006 by DEC. We then appealed for a formal hearing scheduled in August. We have been working with DEC on a compromise and they have recently recommended the fixed "T" as a solution they would accept obviating the need for a hearing Enclosed is our check for $50., and a site plan and cross section of the proposed work. We grant permission to the Trustees to visit the property and we will plan on being there on 6/10/2009 to answer any questions. Should the plans change, please call me at 631-838-2900 to inform us of the date of the visit. We look forward to your thoughts about out plans Sincerely, CC: DEC- Ms Dawn McReynolds O :~. 'LACE S 82'26'50,, N 84'54'20" W NOUs£ F/o/x 162.45" 138.94' SUFFOLK S.C. TAX V'V S;TUA TE NEAR PECONIC TOWN OF $OUTHOL.D COUNTY, NEW No. 1000-103- 1~ ~[~-C'ALE ~ "--'~0W JANUARY 5, 2000 AREA = 15.587.2~ sq. ft. BOARD, USTEES 'L OF TOWN OF SOUTHOLD NYSDEC APPROVED AS PER TERMS AND CONDITIONS OF PERMIT NO DAT~ ~'/,,s"/~, /~'/( ' Pa~7~ On/7-o Southhold Towe rd of Trusteee 6Y l S T/ I,O (, c os5 F~9~ /._9 /!T" O/V-TO NYSDEC APPROVED AS PER TERMS AND CONDITIONS OF PERMIT NO, [' '/7 3 J~ - ,'~'~o//00~ DATE ~/,,s"]o9 k"62~' James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghos±o, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE~ONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1st day of construction ¼ constructed Project complete, compliance inspection. James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD July 22, 2009 Mr. & Mrs. Jerry Matejka 1300 Strohson Rd. Cutchogue, NY 11935 RE: 1300 STROHSON RD., CUTCHOGUE SCTM#103-10-27 Dear Mr. & Mrs. Matejka: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wed., July 22, 2009: WHEREAS, JERRY & LINDA MATEJKA applied to the Southold Town Trustees for an Amendment to Wetland Permit #868 under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated June 29, 2009, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, the LWRP Coordinator issued a recommendation that the application be found Consistent with the Local Waterfront Revitalization Program policy standards, and, WHEREAS, the structure complies with the standards set forth in Chapter 275 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, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees have found the application to be Consistent with the Local Waterfront Revitalization Program, and, BE IT FURTHER RESOLVED, that the Southold Town Board of Trustees APPROVES the Amendment to Wetland Permit #868 to add a 3'X 19' fixed "T" dock extension onto the seaward end of the existing dock, and as depicted on the plan prepared by Jerry Matejka last dated June 1, 2009 and stamped approved on July 29, 2009. This is not a determination from any other agency. Sincerely, Jam F.~nK'ng, Presid~ Board of Trustees JFK:lms James F. King, President Jill M. Doher~y, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES .TOWN OF SOUTHOLD Please be advised that your application dated ~ f~5']~ has been reviewed by this Board at the regular meeting of ~) ~-~0 ~ and your application has been approved pending the completion of the following items checked off below. __ Revised Plans for proposed project __ Pre-Construction Hay Bale Line Inspection Fee ($50.00) __ 1st Day of Construction ($50.00) __ ¼ Constructed ($50.00) ,,/' Final InsPection Fee ($50.00) v"' Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: BY: James F. King, President Board of TrUstees James F. King, President Jill M. Doherty, Vice-President Pegg~ A. Dick~rson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Please be advised that your application dated ~ [o~q been reviewed by this Board at the regular meeting of and your application has been approved pending the completion of the following items checked off below, has __ Revised Plans for proposed project __ Pre-Construction Hay Bale Line Inspection Fee ($50.00) __ 1st Day of Construction ($50.00) __ ¼ Constructed ($50.00) V"/Final InsPection Fee ($50.00) __ Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF .PERMIT FEES: TOTAL FEES DUE:$ BY: James F. King, President Board of Trustees Donald Wilder, Chairman Lauren Standish, Secretary Town Hall, 53095 Main Rd. P.O. Box I 179 Southoid, NY 11971 Telephone (63 I) 765-1892 Fax (631) 765-6641 Conservation Advisory Council Town of Southoid At the meeting of the Southold Town Conservation Advisory Council held Wed., July 15, 2009, the following recommendation was made: Moved by James Eckert, seconded by Peter Young, it was RESOLVED to SUPPORT the Wetland Permit application of JERRY & LINDA MATEJKA to Amend Permit #868 to add a 3'X 19' fixed "T" dock extension onto the seaward end of the existing dock. Located: 1300 Strohson Rd., Cutchogue. SCTM#103-10-27 Inspected by: Peter Young, James Eckert The CAC Supports the application with the Condition of a 10' non-turf buffer and the dock is constructed using appropriate materials such as Thru-Flow Interlocking Panels. Vote of Council: Ayes: All Motion Carried James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. P,O. Box 1179 Southold, NY 11971 Telephone(631) 765-1892 Fax (631)765-6641 Southold Town Board of Trustees Field Inspection/VVorksession Report Date/Time: JERRY & LINDA MATEJKA request an Amendment to Permit #868 to add a 3'X 19' fixed "T" dock extension onto the seaward end of the existing dock. Located: 1300 Strohson Rd., Cutchogue. SCTM#103-10-27 Type of area to be impacted: __Saltwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: __Chapt.275 Chapt. 111 other Type of Application: Wetland __Coastal Erosion ._Amendment ._Administrative__Emergency __Pre-Submission Violation Info needed: Modifications: Conditions: Present Were: __J.King __J.Doherty __P.Dickerson __ D. Dzenkowski other Form filled out in the field by D. Bergen__ B.Ghosio, Mailed/Faxed to: Date: New York State Department of Environmental Conservation Division of Environmental Permits, Region One 50 Circle Road- SUNY, Stony Brook, New York 11790-3409 Phone: (631) 444-0365 · FAX: (631) 444-0360 Website: www,dec.state.ny, us PERMIT MODIFICATION Mr. Jerry Matejka 1300 Strohson Road Cutchogue, NY 11935 Re: Matejka property 1300 Strohson Rd., Cutchogue DEC# 1-4738-02701/00005 Dear Permittee; June 15, 2009 $outhhold 10wn Board of Trustees Your request to modify the above permit has been reviewed pursuant to 6NYCRR Part 621 (Uniform Procedures Regulations). It has been determined that the proposed modifications will not substantially change the scope of the permitted actions or the existing permit conditions. Therefore, the permit is modified to authorize: Construction of a 3' x 19' fixed "T" onto seaward end of existing dock, as shown on plans by Jerry Matejka, last revised 6/1/09, NYSDEC stamped approved on 6/15/09. This letter is a modification to the original permit, and as such, shall be available at the job site whenever authorized work is in progress. All terms and conditions remain as written in the original permit. rieland Deputy Permit Administrator cc: KPK MHP file James F King~ President Jill M. Dohel~ty. Vice-President Peggy A. Dickel~on Dave Beqgen Bob Ghosio, Jr. PO. Box 1179 Southold, NY 11971 Telephone (63 [ ) 765-1892 Fax (631 ) 765-6641 Southold Town Board of Trustees Field InspectionNVorksession Report Date/Time: JERRY MATEJKA requests a pre-submission inspection to discuss the possibility of adding a "T" extension to the existing fixed dock. Located: 1300 Strohson Rd., Cutchogue. SCTM#103-10-27 Typ&~alt~,f area to be impacted: ater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland _~haf Town Code proposed work falls under: pt.275 Cha, p~¥ other Type of Application: v Wetland __Coastal Erosion __Amendment ~Ad ministrative__Emergency __Pre-Submission Violation Info needed: Modifications: Conditions: Present Were: ~J.K~g jL~oDo herty P Dickerson ~D. Bergen B~.Ghosio, __ D. Dzenkowski Scott Hilary__other Form filled out in the field by Mailed/Faxed to: Date: uthold Town Trustees SOUTHOLD, NEW YORK PERMIT NO. ISSUED TO .............. Lg.;.is.. Po!esn~ ........ 868 .... DATE:~p~il ~.L...~973 Pursuant 'to the provisions of Chapter 615 o{ the Laws of the State of New Yorl(, 1893; and Chapter 404 of the Laws of {'he State of New York 1952; and the Southold Town Ordinance en- titled "RESULATIN$ AND THE PLACIN$ OF OBSTRUCTIONS IN AND ON TOWN WATER5 AND PUBLIC LANDS and the REMOVAL OF 5AND, C=RAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;" and in accordance with the Resolution of The Board adopted at a meeting held on ~pr±l 2 ~97~... , and in consideration of the sum of $ 5.00 paid by Louis Polesny -Stronson Rd. Cutchogue, ot ....................... ' .... N. Y; and subiect to the Terms and Conditions I~sfed on the reverse side hereof, of Soufhold Town Trustees authorizes and permits the following: Place a fixed dock-catwalk 3 ft. by 24 ft. (10 ft. below high water mark) in front of his property at Mud Creek, off Stronson Road, Cutchogue, New York. all in accordance with the detailed specifications as presented rn the originaHng applcaflon. IN WITNESS WHEREOF, The said Board of Trustees here- by causes ifs Corporate Seal to be affixed, and these presents fo be subscribed by a majority of the said Board as of fh~s d~fe. TERMS end CONDITIONS The Permktee Louis Polesny residing at Stronson Road, Cutchoque N.Y., as parr of the consideration for the issuance of Ifie Permit does understand and prescn~ to the fol- lowhag: 1. That the-said Board of Trustees and the Town of Southold are released from any and all damages, or rialtos for dainages, of suks arising directly or indirectly as a result of any oper- at/on performed pursuant to this permit, and the said Permittae will, at his or her own expense, defend any and all such suits initiated by third pardes, and the said Permittee assumes full ~ity with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold 2. That this Permit is valid for a perio4 of 12 mos. which is considered to be the estimated time required ro complete the work involved, but should circumstances warrant, request for an extension may be made to the Board at a later date. 5. That this Permit should be reeaned indefinitely~ or as long as the said Pei'mittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that auth- orization was originall7 obtained. 4. _That the work involved will be subject to -the inspection and approval of the Board or its agents, and non-com~:liance With the provisions of the originating applimfion, may be cause for revocation of this Permit by resolution of the said Board. 5. That there win he no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the tight of the public to pass and repass along the beach between high and low water marks. 7. That if furore 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, the work shall cause unreasonable obstruction to fi'ee navigation, the said Permittee will be required, upon due notice, to rexnove 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 completion of the work anth- orized. 9. That the Permittee will obtain all other perm/rs and consents that may bc required sup- plemental m ~is permit which may be subject to revoke upon failure to olXaln same. BOARD OF TOWN TRUSTEES Town of Southold Main Road Southold, New York 11971 James ti. Rambo, Inc., T. E. Samuels, Pres., Wunneweta Rd. , Cutchogue,NY To: .... t~E '.;" ' "L'6ii'f ~' "p~5'~ ~'~'fi~' ~' ' "S ~'f6 h'~ ~5'ff ' ' K6 ~'c~ ;' '"C U'~ h'~ ~'t~ ~';" ' I¢ 7 ~: ........................... I Your application, doted ..... ~.a..r...q.~....3..0.,.....1.~.7.~. ................................. has been reviewed by this Board, at a meeting of the Trustees held on ...... ..A.p..z:.i..:~ .2..,.....]:.?..7..3. ................................................ and resulting in the action, as indicated below (.~,~ ...... ) Application approved. ) Application denied. ) Application tabled. 2 Comments ane remarks: 3. [f your application is approvea above, A Permit Fee ~s now due, and should De made payable to the order of the Board of Southold Town Trustees. This fee is computed below according to ,the Schedule of Rates as set forth in the Instruction Sheet (Form I/i). it the Permit Fee ~s ~aid in person to the Secretary of the Board, The Permit will be obtainable at the same time. ~f }he fee is paid by mail, the permit will be mailed in reply. Computation of Permit Fee: fixed dock-catwalk 3 ft. by 10 ft. ~ 10¢ sq. ft. = $3.00 Minimum fe9 $5.00 Total Fee for this application ........................................................... $ .5...aD .............................. Signed ......... . .A..~...V...~..,., .B,, :... ,G.o..~...c1.. ~, .m. ~ ?...h. ............... Chrr Board of Southold Town Trustee.~ ~// Secretary, BOARD OF TOWN TRUSTEES Town Of Southold Main l~oad Southold, New York 11971 APPLICATION FOR FIXED and/or FLOATING DOCKS 2. Contractor's name and address: 3. Briefly explain the purpose of this application: 4. After issuance of a Permit, I expect to: (mark by an//X) (a) Commence work -- AT ONCE ......... .,.; ASAP ..~ ......... ; UNKNOWN ............. (b) Complete work in- 1 DAY ............ ; 1 MO ............. ; 1 YR ............. ; FUTURE ............. Secure the correct Area Map from the Secretary of this Board, gnd by using an X WITHIN A CIRCLE indicate as closely as possible the location 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 supplemental pilings which are needed to hold a floati.ng dock or tie-up a boat. Give oll 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 i.nto Town Waters beyond aFr-i~aginary line or boundary formed by other similar structures a ong the area's shoreline? ~E~or NO ..... ~,T~ / i ' If it does extend beyond th~s so-called dock line ~nd,cate by how far, approx~mately,....'..C?...ft. Provide the following documents: (a) A Licensed Engineer's Survey of the property involved. (b) A copy of the Contractor's Plans and Specifications. 8. Will this construction require the Filling of any land offshore of the Ordinopf--kJi_gh Water Mark or the Dredging of any material from Town La,nds under water? YES o~NO.~f it does, Form A/4 (Application for Dredging/Filling) must be completed and attached a-'~l~rt of this application. In requesting approval of this application, I submit that: the information presented herein is true and correct to the best of my kno~vledge 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. Accepted by: fz Dated: ;oye ~ef Board Of Southold Town Trustees SOUTHOLD, NEW YORK PERMIT NO. 86 8 DATE:A~ril 2, 1973 ISSUED TO .. LQu.is.....~Qles.ny.. Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1893; and Chapter 404 of the Laws of the State of New York t952; and the Southold Town Ordinance en- rifled "REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and fha REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS:" and in accordance with the Resolution of The Board adopted at a meeting held on ~pril .2 1973., end in consideration of the sum of $. 5.00 paid by .Louis Po. lesny ofS~.~°~.s~n...R~.~..,., cu.tch°que' . N. Y. and subject fo the Terms and Conditions listed on the reverse side hereof, of Soufhold Town Trustees authorizes and permits the following: Place a fixed dock-catwalk 3 ft. by 24 ft. (10 ft. below high water mark) in front of his property at Mud Creek, off Stronson Road, Cutchogue, New York. all in accordance with the detailed specifications as presented in the originating applcafion. IN WITNESS WHEREOF, The said Board of Trustees here- by causes ifs Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. '- . ' '. Trustees BOARD OF TOWN TRUSTEES Town of Sonthold Main Road Southold, New York 11971 James H. Rambo, Inc. , T. E. Samuels, Pres. , k;ur~n(-=weta Rd. , Cutchogue,N To: 1. Your application, doted ..... ~.Qb...~.Q,....~.7.~ ................................. has been reviewed by this 8oord, at ~ meeting of the Trustees held on ....... ~P.~.~..~.,....~.~.~ ...................................................... and resulting in the action, os indicated bela.v: ( ............ ( ............ Application approved Application denied. Application tabled Comments and remarks: 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 the Schedule of Rates as set forth in the Instruction Sheet (Form If the Permit Fee is paid in person to the Secretary of the Board, The Permit ,viii be obloir, cbic at the same time. If the fee is paid by mail, the permit will be mailed in reply. Computation of Permit Fee: fixed dock-catwalk - 3 ft. biz 10 ft. ~ 10¢ sq. ft. = $3.00 Minimum fee $5.00 Total Fee for this application ............................................................ $ 5, 1~)...l(.,sr/..'....i ............ James H. Rambo, Inc. , T. E. Samuels, Pres., Wunneweta Rd., Cutchogue,5 To: .... R']~ '~ '-" · L'~ ~'i'§ ' · 'p~']~ ~'~'i~? ~' ' "S t~'i"~6 ~'~ ~'~ ' ' R~ ~i h~ ',' ' ' 'C b.'~Z ~ b'~ ~ ~'~' ' ' ~ Y T ~' .......................... 1. Your application, dated ..... ~;C..c.b...3.O.,.....1.~..7.~ ................................. has been reviewed by this Bo~rd, at a meeting of the Trustees held on ....... ..A.R'~.i.~...~.,....~.?.~ ..................................................... and resulting in the action, as indicated below: (.F-J{ ...... ) ( ............ ) Application approved. Application denJed. Application tabled. 2. Comments and remarks: 3. If your application is approved above, A Permit Fee is now due, and shculd be made payable to the order of the Board of Southold Town Trustees. This fee is computed below according to the 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?ainoblz at the same time. ff the fee is paid by mail, the permit will be mailed in reply. Computation of Permit Fee: fixed dock-catwalk - 3 ft. by 10 ft. ~ 10¢ sq. ~t.. = $3.00 Minimum fee $5.00 Total Fee for this application ............................................................ $ .~.,.C~)...,;...; ....... : ............. Chm. Board of Southold Town Trustees. Secretary. TERMS and CONDITIONS Louis Polesny residing at Stronson Road, Cutchoque N.Y., as part of the consideration for the issuance of ~Iae Permit does understand and prescribe to the fol- lowing: 1. That the said Board of Trustees and the Town of Southold are rehrased from any and all damages, or claims for damages, of suits arising directly o£ indirectly as a result of any oper- ation performed pursuant to this permit, and the said Permirtee will, at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee ;rssumes full liability with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold 2. That this Permit is valid for a period of 12 mos. which is coasidet~ to be the estimated time required to complete the work involved, but should drcumstances 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. T&at the work involved wi/l be subject to the inspection and approval of the Board or its agents, and non-com?liance with the provisions of the originating application, may be cause for revocation of this Pernfit by resolution of the said Board. 5. That there wiU 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 the beach between high and low water marks. 7. That if future operations of the Town of Southold require the removai and. or alterations in the location of the work herein authorized, or if, in the opinion of the Bo~trd of Trustees, the work shall cause unreasonable obstruction to free navigation, the said Pernfittee will be required, upon due notice, to remove or alter this work or project herein stated without expenses t,~ the Town of Southold. 8. That the said Board will be notified by the Permittee of the completion of the work auth- orized. 9. That the Permktee will obtain all other permits and consent~ that amy be required sup- plemearal ro this permit which may be subject to revoke uF, on failure to obtain same. Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (6311 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1st day of construction constructed Project complete, compliance inspection. Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD February 25, 2004 Mr. Jerry Matejka 1300 Strohson Rd. Cutchogue, NY 11935 RE: 1300 STROHSON RD., CUTCHOGUE SCTM#103-10-27 Dear Mr. Matejka: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, February 25, 2004: RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to Permit #868 to construct a 3'X 10' extension to the existing dock and install a tie-off pile 20' past the end of the dock, and as depicted on the plan prepared by Jerry Matejka last dated June 15, 2003. This is not a determination from any other agency. If you have any questions, please call our office at (631) 765-1892. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK:lms Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Please be advised that your application, dated//~7/O~ has been reviewed by this Board, at the regular--meeting of ~/~./OV and the following action was taken: ( ~'/) 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: TOT EES DUE: $ 93,00 SIGNED: PRESIDENT, BOARD OF TRUSTEES BY: CL~RK, BOARD OF TRUSTEES 4~98 Telephone (631) 765-1892 Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD At the meeting of the Southold Town Conservation Advisory Council held Monday, February 23, 2004, the following recommendation was made: Moved by William Cook, seconded by Don Wilder, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH CONDITIONS of the Amendment application of JERRY MATEJKA to Amend Permit #868 to construct a 3'X 10' extension to the existing dock and install a tie-off pile 20' past the end of the dock. Located: 1300 Strohson Rd., Cutchogue. SCTM#103-10-27 The CAC recommends Approval of the application with the Condition of a 10' non-turf buffer and ne treated lumber is used. Vote of Council: Ayes: All Motion Carried 1300 Strohson Road Cutchogue N3t 11935 Jerry W. Matejka Board of Town trustees Town of South'old Mr Krupski, I am in receipt of )'our letter dated June 18,2003relative to the disapproval of my request to add 15 feet to my existing dock. I did not want to get into a debate on the night of the hearing, but I was totally shocked at the arbitrary and capricious nature of the denial. The reasons cited are: 1- The shallow water depth in the creek. This is ludicrous. There are 25-30 foot boats in the creek and I have a 19' fishing boat. While the creek is shallow, my sounding data as performed by En Consultants was that adding 15 feet onto the existing dock will put my boat into about I0" of deeper water 2- ]'he physical intrusion into the creek. This is equally baffling and one of the Trustees indicated in the hearing that I would protrude beyond my neighbor if the)' approved the 15 feet. I beg to disagree by this is not true. My neighbor on the left has the same shoreline as our property and their fixed dock at present already is 15 pas1 my existing dock. Add their yearround floating dock and they are out anotherlS-20 feet. The unnecessao' damage 1o underwater lands. How is this possible if the boat would be moored 15 feet beyond where it presently is as shown in the consultants report that I paid $500 to obtain ? The location in the creek would be inappropriate. 'fh~s reason makes no sense whatsoever. Inappropriate to what.? A neighbor on the other side of the creek, a neighbor.etc ? There is well over 400 feet to the opposite shoreline The whole nature of this hearing was unfair and as a taxpayer in the Town, I want to pursue this case. I am willing to meet the Trustees at my house or meet at Town Hall at your convenience. I can be reached at work at 631-563-6800 x398 ~.--~g~ncerely, .Mbe~t J. Krupski, President James King, Vice-President Artie ~oster Ken Poliwoda Peggsz A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone ,1631) 765-1892 Fax (1631) 765-1366 June 18,2003 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. JerW Matejka 1300 Strohson Rd. Cutchogue, NY 1!935 RE: 1300 STROHSON RD. CUTCHOGUE SCTM#103-10~27 Dear Mr. MatQka: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday. Jtme ~8, 2003: RESOLVED. :hat thc Southold Town Board cf Trustees DISAPPROVE the Amendment to Pem~it :t868 ro const~.ct a 3'X ;5' ..:xrenslon to the existing dock '~nd instal! ,:ne pile for a piling pulley system because .,f the ~bi!owmg reasons: ,) the shalio,v ,'.'2ter ~lepth in the creek. 2) t~e physical intms:on into tl:e cree~, 3) the urmecessary damage to the underwater lands, and z) the location in the creek ~* onid be inappropriate. This is not a ~letermination from any other agency. If you have any questions, please call our office at (631 ) 765-I 892. Sincerely, Albert J. Krupski, Jr. President. Board of Trustees AJK:lms Telephone (631) 765-1892 Town H',fll. 53095 Ma~n[oad P.O. Box 1179 Southold, New York 11971 $OUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Monday, June'16, 2003, the following recommendation was made: Moved by Bill McDermott, seconded by Meivyn Morris, it was RESOLVED to recommend to the Southold Town Board of Trustees DISAPPROVAL of the Amendment application of JI::RRY MATEJKA to Amend Permit #868 to construct a 3'X 15' extension to the existing dock and install one pile for a piling pulley system. Located: 1300 Shrohson Rd., Cutchogue. SCTM#103-10-27 The CAC recommends Disapproval of the application because there was no need shown for the extension. There would still be inadequate water depths with an additional extension. ~/ote of Council: Ayes: All Motion Carried A~bert J. Krupsld, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 ~OARD OF TOWN Ti%USTEE,~ TOWN OF SoTYrHOLD Please be advised that your application, dated has been reviewed by this Board, at the regular .T, ee~xnq cf ~/~//C/ and the following act. io~. %-.'as taken; Application Approved {see below) ) Application Denied ~s=~ below) Application Tabled (see below) If your application is apprcve~ 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 %c~crding to the schedule of rat~s as set forth in ~he instruct~cn sheet. The fo].lowinq fee must be pa&d wzLhi:; 90 ,iays or re-applicAtion tees will be necessazTf.. COMPUTATION OF PE~IT FEES: TOT FE S DUE: SIGNED: PRESIDENT, BOARD OF TRUSTEES BY: CL~RK, BOARD OF TRUSTEES Telephone (631) 765-1892 Tov~ -l-,hdl. 5.'1095 ~,.in Road P.O. Box 11"/9 Soc, thold. New Yo~k 11971 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Tuesday, Jun_e 12, 2001, the following recommendation was made: JERRY MATEJKA & MILDRED POLESNY 103-10-27 to Amend Permit #868 to construct a 3'X 15' extension to the existing dock and install one pile for piling pulley system. 1300 Strohson Rd., Cutchogue The CAC did not make an inspection, therefore no recommendation was made. 115, 30,01 0§:00 F.~X 631 $63 6882 LOCICON LC[$ ~062 PERMIT r~ P£RNI[ ISSUED TO ~_~jldred ~otesny Jerry Natejka, 9~ Futten Bt~d., ¢_oea~c~r N? DESCRIP~ON OF AUTHOrIZeD 1172~ 65,30'~1 0~:00 FAX 631 563 6882 LOGICON LCIS ~001 LOGICON A Noc~rop Grumman Company FACSZMZLE TRANSMITTAL LEAD SHEET TO: COMPANY: TELEPHONE: FAX #; FROM: TELEPHONE #: Number of pages + Lead DATE: Eastern Permits Section DEPARTMENT OF THE ARMY NEW YORK DISTRICT, CORPS OF ENGINEERS J,~COB K, JAVITS FEDERAL BUILDING NEW YORK, N.Y. 10278-0090 August 31, 2000 SUBJECT: Application Number 2000-00914-L2 by Mildred Polesny To Whom It May Concern: The New York District, U.S. Army Corps of Engineers, has received a request for Department of the Army authorization for the following activity: APPLICANT: Mildred Polesny 1300 Strohson Road Cutchogue, NY 11935 ACTIVITY: Add to an existing pier, a 4-foot by 12-foot ramp leading to a 6-foot by 20-foot float secured to two-pile dolphins. The purpose of this project is to provide a mooring facility for a vessel. WATERWAY: Mud Creek, Little Peconic Bay LOCATION: Cutchogue, Town of Southold, Suffolk County, NY As this is minor in nature, authorization may be by Letter of Permission. This is in accordance with current Federal Regulations governing work in navigable waters of the United States. To accomplish the coordination required, prior to the issuance of a Letter of Permission, your review of the enclosed drawings is requested. Pursuant to Section 307 (c) of the Coastal Zone Management Act of 1972 as amended (16 U.S.C. 1465 (c) (3) (A)), the applicant has certified that the activity complies with and will be conducted in a manner that is consistent with the approved state coastal zone management program. To allow for the timely processing of the subject application, your comments are requested within 15 days of the date of this letter. Enclosures Sincerely, Eastern Permits Section h~p://v,'ww.malxiUeXLcom/cgi )oin/ia.~li...%290201%3a% 10F%3d w229wT_% 29zaSg02_ 1.1, ~- l'",~i~,f'",.~'~-'-=',?".'",',8'.,,'. ~'%,;'k- '""':--': ~ R ,~.~.~gl ~'""~.~ ..... ~., ~- ~,~-~.~-'%.,r ~?',~,~:;,...~ ~i --I ~'"'1~'~! !~.:~[~:~.~~- g;:',~c ~ n ~. ~: ....... ~ · . . , ......... '~,,.,~,~ ,. .%...,~.....,.~, ~...~.. . .. ~ r ·, ..~.~ · . . . ~,,,,_,,;~,,,~,..,,.~,,., ..................................................................... . ................. , ....................................................................................... ,~,~ .......................................... / I .~' ~" .... ", '. ..... '~.. '~':~"~"~"~;'~:~';'"~.'..~T (, .~ ', %~ ~ :~.~; ....% ~ ...... ~ ....... ~,.....~...~ ........ , .............. ~ ..., .: ..... : ......~ .......... ~ ............ ~,,..,.~......,~ ........ .. ,..~ ...... ~~ Map Search Result 1300 ~ROHSON RD, CUTCHOGUE, NY, 11935-2162, US Save this Address ADDENDUM TQ.~PPLICATION #1-4738-02701/0001 I) Requested depths in mooring areas at 10 foot intervals 2) Depths,or soundings referenced to Iow water at the same spots as above 3)_AHW and ALW lines are shown ou the diagram and taken on August 20, 2000 at 10:15 AM for Iow tid~ readings a~nd at 4:IOPM on the same for the high water readings. We hereby subm/t specifications and estimates for: Floating Dock, Ramp, Mooring Piles 6' x 20' Floating dock 4' x 12' Ramp with hand rails on both sides. (R) T~o pile dolphins 30' in length. We believe that after this winter's l~e damage in the local that double bolted mooring piles ar~ ~e~essary. All lumb~r and piling $outhez-~ yellow pine CCA pressure treated to 1.5 lbs/cu, ft. maxlJ~u~ :~'~t~tion. June 25, 2000 To:Board of Trustees, Town of Southold From: Jerry Matejka & Mildred Polesny Subject: Application for a permit amendment to allow a floating dock added to a fixed dock catwalk (permit #868 ) At the meeting on June 21, my application was tabled pending the DEC approval. Since this process has just started, it will take several months. At the meeting, Mr Ke.~ P~l_~ved_a ~'~commended a pile or stake. He said that the bo:~t could be pullied into the dock At the meeting, I was so preoccupied with trying to get the Board to go ahead with my application that I was not thinking about what I would do tiffs summer with my recently purchased 19' boat. I would like to go ahead with Ken's recommendation and have something temporary for this summer which will at least allow me to me to tie up my own small boat on our property. It doesn't even need tr, be a permanent piling. A stake or ball mooring will be ok. In the meantime. I am moving fo~'ward with the DEC. Thanl~ou for all your wisdont June 12, 2000 To: Board of trustees, Town of Southold From: M Polesny and J Matejka Subject: Application for a permit amendment to allow a floating dock- Sounding data requested Our application was reviewed and tabled at the last meeting on May 24, 2000 because of inadequate sounding data. These had been gathered based on neighbors estimates. We have now done a thorough reading at several locations Date of readings June 9, 2000 · Low tide readings at 12:45PM · High tide readings at 7:15PM The table below shows precise measurements taken at the same spots and at various locations from the end of the existing fixed catwalk. Since the floating dock will start 12 feet from the end of the existing dock, it will always be floating in water and will not need to be pulled out. Feet from catwalk end TIDE 3 feet 12 feet 25 feet 30 feet Low 0" 10" 19" 24" High 33" 40" 55" 59.2" We thank you in advance for your consideration at the next Board meeting. Respectfully, ~ Noreast Salt~vater [Tide Chart~ Page I of I Tide Charts Tide location New Suffolk Starting date June 9, 2000 Ending date June 23, 2000 Caution: Although every effor~ has been made to ensure the accuracy of the tide predictions below, Noreast Saltwater assumes no liability due to the use of this information in any way. Weather and other conditions may affect the actual tide levels. i:I9AM Low 0.4 2:20AM Low 0.4 3:17AM Low 0.3 7:36 AM High 2.7 8:40 AM High 2.5 9:37AM High 2.5 1:39 PM Low 0.3 2:32 PM Low 0.3 3:21 PrVl Low 0.4 8:14 PM High 3 9:09 PM High 3.1 9:57 PM High 3.1 4:08AM Low 0.2 4:54 AM Low 0.2 5:37 AM Low 0.2 10:26 AM High 2.4 11:09 AM High 2.4 11:49 AM High 2.4 4:08 PM Low 0.4 4:51 PM Low 0.4 5:34 PM Low 0,5 10:40 PM High 3.2 11:19 PM High 3.2 11:56 PM High 3.2 6:lgAM Low 0.2 12:33AM High 3.2 1:lOAM High 3.2 12:27 PM High 2.4 7:00 AM Low 0.2 7:42 AM Low 0.2 6:16 PM Low 0.5 i:OSPM High 2.4 1:45 PM High 2.4 6:58 PM Low 0.5 7:41 PM Low 0.6 1:47 AM High 3.I 2:26 AH High 3 3:07 AM High 2.9 8:24AM Low 0.2 9:08AH Low 0.3 9:53AM Low 0.4 2:26 PM High 2.4 3:09 PM High 2.4 3:55 PM High 2.5 8:27 PM Low 0.7 9:15 PM Low 0.8 10:05 PM Low 0.8 3:51AM High 2.8 4:39AM High 2.7 12:14AM Low 0.4 10:40 AM Low 0.4 1I:27 AM Low 0.5 6:28 AH High 2.8 4:42 PM High 2.5 5:32 PM High 2.5 12:43 PM Low 0.2 10:58 PM Low 0.9 11:53PH Low 0.8 7:14 PM High 2.9 // this page to a friend... . [Home] iLatest Issue! ~ [ride CharM 2000 ~.'~4~" t~d.,j For technical ~roblems concernlng t~is ~e~site contact our Copyright ~ 2000 New Med~a Publishing, Inc. All rights rese~ed. Use of this site signifies your agreement to the '[erm~ http:, noreast.com tidesnew, SelectDateSubmit.cfm 6/6/00 Telephone (516) 765-t~Z Town Hall, 53095 Main Road P.O. Box 1179 Southold. New York t1971 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Monday, May 22, 2000, the following recommendation was made: Moved by Melvyn Morris, seconded by Richard Smith, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL of the Amendment Request of MILDRED POLESNY & JERRY MATEJKA 103-10-27 to Amend Permit//868 to add a 4'X 12' ramp and a 6'X 20' floating dock to an existing fixed dock. 1300 Strohson Rd., Cutchogue Vote of Council: Ayes: All Motion Carried May 18, 2000 To:Sothhold Town Board of Trustees Subject: Soundings In response to your request for additional information following your ste visit on Wednesday May 17, I am providing the following information. At Iow tide, the area of the proposed floating dock will be at 3-3.5 feet of water. At normal high tide, the water the dock ~vill be in 5.5-6.5 feet of water. As you are aware, we are requesting a modification to the existing fixed dock- catwalk permit from the town in order to add a floating dock. This dock will be similar in design to what the neighbors currently have. Thank you kindly for your consideration M Polesny & J Matejka ~ ' '~ '~l][} ~e be=eby eubmit spe=i~io&tions an~ esti~tes ~or: ~ioating Doc~, Ramp, ~ooring ~iies 6' x 20' Floating dock 4' x 12' Ra~p with hand rails on both sides. (2) Two pile dolphins 30' in length. We believe that after this winter's ice damage in the local that double bolted mooring piles are necessary. All lumber and piling Southern yellow pine CCA pressure treated to 1.5 lbs/cu.ft, max£m~m retention. Permits are not included. Please call Eh-COnsultants, Inc. for an estimate of costs at 283-6360 or others. All hardware hot dipped galvanized. Or.FO .5: c.y/o rv 01/21:04 ~%~D 0g:l? FAX 6317651366 Southold Town Accounrlns .-- ~001 Albert J. I<rupski, President James King, Vice-President Arkie FosS;er Ken Po~woda Peggy A, Dickerson Town Hall 63095 P~ute 2§ P.O. Box 1179 Southo]d, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWi~ OF SOUTHOLD APPLICATION FOR AN AIVIEND1VHgNT TO A PER1VIIT AGENT PHONE ADDKBSS PROPERTY LOCATION T~X ~ NO. /f 3 -/~ - 3 T 01121/2004 WED 09:16 [TX/'RX NO 58211 ~001 Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OFTOWNTRUSTEES TOWN OFSOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of COUNTY OF SUFFOLK) STATE 0]7 NEW YORK) AFFIDAVIT OF POSTING //7 being duly sworr~epose and say: That on the/~ day of~" ,200~, I personally posted the property knosvn as _ by placing the Bo~d of Trustees official poster where it c~ e~ily be seen, ~d that I have checked to be s~e the poster has remained in place for ei~t da~ prior to the date of the public hemng. Dale ofhemng noted thereon to be held ~.. ~h. ~, ~- · Dated: Sworn to before me this day of Iz---g 200'( Notary lSublic V~RGINIA G. GREEN No~Y Public. Stste a( New York No. 01GR~O66656 Quslified in Suffolk Coun~lf Commission Ex,aires Sept. 30, ~ 01./2.1/04 WED 09:17 FAX 6317651366 Southold Town Accounting ~003 PROOF OF 1VLA ri JN'G OF NOTICE Al'TACH CERT[VllC_,D MAIL RECEIPTS STATE OF NEW YORK COUNTY OF SL1YFOLK (~9~.~.7r~~ , being duly sworn, deposes and says that on thc -- ~ d;afo f -7~v,.r--~ ,20~_~.,~ deponent mailed a tree copy of the Notice - ~eet forth, in'the Board ofTrust6es Appliealdon, directed to each of the abo~e 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 assessmentjoll o, ftho Town of Southold; that said Nolices wore mailed at the United States Post Offive at ~~ ~ ~. _, that said Notices were mailed to each of said persons by (certified) (registered) mail. x-T Sworn to before me tlaig I 7 Dayof ~el0~.~ , 20_o~-i t '~Notaty PulJlic VIRGINIA G. GREEN Notary Public, Stere of New York No. 01GR50~6656 _(~ualifled in Suffolk County Commismon Expires Sept. 30,, ~b[~ 01/21/2004 WED 09:16 [TX/~I NO 5821] ~003 0i/21,'04 ~ED 09:17 F.4~ 63176.~&66 Southold ;own Accou~[~ng Boar~ of Trustees Application County of Suffolk State of New York DEPOSES AND AFFIRMs T~tAT ~E/F~F, IS THE A~PLICAN~ FOR 1-~. ABOVE DES~B~ P~IT{S) ~ ~T ~5 STAT~S ~AIND ~EIN ~ TR~ TO ~hm BEST OF HIS/~ ~GE.~D B~IEF, ~ ~AT ~L WO~ WILL BE ~ IN ~E ~ER S~ FOR~ IN ~S ~PSICATION ~D AS ~Y BE ~PRO~ BY ~E ~O~OLD ~ BO~ OF ~US~ES. ~ ApPLIC~T A~ES ~ HO~ ~ ~ OF $ODTHOLD ~ '~ ~ ~US~S ~.ESM ~ F~E ~OM ~ ~ ~L D~GES ~D C~IMS ~SIN~ ~ OR BY ~R~ OF S~ID P~T(S}f, IF ~'fEO. IN CO~LETING ~I-S ~PLICATION, I ~BY A~O~ZE ~ ~RUS~ES, TO INSPE~ T~ P~SES IN CON~ION WI~ ~I~ OF' APPLICATION. Notary Public . VIRGINIA G. GREEN Notary Public, State of New York No. OIGR5066656 Qualified in Suffolk County Commission Expires Sept. 30, ~ 7 01/21/2004 WED 09:16 [TX/~K NO 5821! ~004 0i/21/04 ~,~D 09:17 F.'L~ 6317651 Southold Town Accounting OO5 APPLI CANT/AGE NTflLE PRE S ENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold'~ Code of Ethics l:~oin'bit~ conflicts of interest on the part ofWWn officerg and emvloyees. The vuroosc of this forrp is to !~rovidc ilfforrnation which ainu alva the town of possible. ~:gnfliciz of inter~: ~al~ow !t ro take whatever action necesaapt' to avoid samc. (Last uarnc, fir'st name, mlddlc initial, unless you are applying in the namc of someone ¢].~a or other cutity, such a~ a company. If so, indicate thc other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Variance Change of Zone Approval ofpha E~i~mption from pl~t or oflqcial nmp. Oth~ (If'OUher" namethc ~:tivity_) Do you l~SOnally (or through your company, slx, usc, s~lin$, pareat, or child) have a rclafio~hip with any ofilcc~ or employee of thc To'~ of Sou~old7 "Rala~innship" include~ by blood, marriage, or busin~ int~cst. "Business interest" mca~ ~ bu.~ness, including a par~ership, in which the town officer or employee has twcn a partial ownership of(or croploymem by) a in which the town officer or employee owns more th~n 5% of the shares. YBS NO If you answered "Y'~S", complete the balance of this form and date aud sign where indicate, d, Name of person .mlpl oyed by thc Town of Southold Title or position of that person Describe the rc.lalionship be~-een your~If 0hr applicant/agent/rcpre~mtive) and thc town o~]cer or employea Either check thc appropriate line A) through D) a~d/or describc in thc space provldcd. Thc town officer or enkoloyc= or hi: or her spousc, s~ol/ng, parent, or child is (check all that apply); __A) the ¢,wn~' of gtealm- ~n 5% of the ~haxes of thc corporate stock of~c ~li~t (whc~ ~ ~pli~t ~ a c~on); B) ~c l~g~ or ~c~ o~ of~y int~ ~ a aoa~o~e enfi~ (wh~ ~e applier is not ~ ~r~on); _ ~ ~ m~c~, ~r, pa~er, or ~plo~ of ~e applic~g or ~) ~e ~ appli~at D~SCPdPTION OF F~LA~ONSHIP 01/21/2004 WED 09:16 [TX/RX NO 5821] ~005 Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggs' A. Dickerson BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD APPLICATION FOR AN AMENDI~ AGENT ADDRESS PHON] PROPERTY LOCATION Town Hall 53095 Route 25 P.O. Box 1179 Southold, NewYork 11971-0959 'T'~lephOne (631) 765-1892 Fax t631) 765-1366 ~J MAY 2 8 Z(~03 Beard ef Tmstee~ TAX MAP NO. UVCe request an Amendment to Permit ~.O,v.sw&tc, c_.r- ~ ~/y/,5-'/ cex'/--~--wS/zp,v, ~ 7-trw May 28, 2003 To: Southhold Town Trustees From: Jer~' Matejka Subject: Amendment I am requesting the Trustees to kindly consider my request to add a 3x15 foot dock extension to the existing structure and to add a piling mooring post. The original permit #868 is dated 4/2/1973, and was last modified in June 2001 when the trustees allowed a previous extension of 15 feet. This request is being made since it will result in less turbidity, as my boat ~4ll be in deeper water. Please schedule me for the next meeting. Respectfully, Cutchogue NY 11935 Tel 631-838-2900 (cell) Work 631-563-6800 x398 I A'f 29 2O03 Southotd Town Board of Trustees Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggs' A. Dickerson Town Hall 53095 Route 25 P.O. Box 1!.79 Southold, New York 11971_-0959 Telephone 1631i 765-1_892 Fax 11631-) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of ............................ COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFDAVIT OF POSTING residing at /..~o~2 .~7'-~O/'F5~> ~. ' ~ Y~tTO~o~ *~W //03 )~- being duly sworn, depose and say: That on the (':' day ofU~ o,~r ,200 3, I personally posted the property knox~vn as 13oo s,wuoOso,~ Ao,,~, oa)z47o6vC- wy//~ 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 the public hearing. Date of hearing noted thereon to be held (.0 !} g }0~ ~r'~ Of' aB(XI-~' "/',IX} Om.. Dated: ~/c~/0 '~ .... J /(jff'gnature)-~---'"'"'~ Sworn to before me this day o¢~ 200~ JUN 1 2 3X~ PROOF OF MAILING OF NOTICE ATTACIt CERTIFIED 5IAIL RECEIPTS Name: Address: STATE OF NEW YORK COUNTY OF SUFFOLK ,J'~=r~___,/ h., ,'-/a-~'-~J'/~.~ , residing at/2~ _~-~ /rz~ O,..c~C~o~ ~ ¥ r/q.*~"' , being duly sworn, deposes and says that on the ~' day of Cru,o~ ,20 0), deponent mailed a true copy of the Notice set tbrth 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 sa/d persons are the address ofsa/d persons as shown on the current assessment roll of the Town of Southold; that said Notices were ma/led at the United States Post Office at al.O-/" C./.-~O~U~- , that said Notices were mailed to each of said persons by (certified) (registered) mail. Sworn to before me this Day of ~== ,20--0.5 ,,.S. Postal Service .... ~ CERTIFIED MAIL~,., RECEIPT nj (Domestic Mail Only; No Insurance Coverage Provided) rtl (~omemem Requ~d) m U.S. Postal Service CERTIFIED MAIL:,,, RECEIPT (Domestic Mail Only; No Insurance Coverage Provided) .~!~a~.t (~ A L USE '$ 0.3/ Postage ~: ~o ~- ....... ..._...;[,,. -- ~=,;~ ............ ~,~,~. U.S. Postal Service,., CERTIFIED MAIL,,, RECEIPT (Domestic Mail Only; No Insurance Coverage Provided) $ 0.37 2.~0 $ 4.42 UNIT I[m: 09~ Postmark 'e~97/03 May25,2001 To: Southold Trustees From: Jerry Matejka & Mildred Polesny Suhject: Amendments/waivers/changes On 6/27/00, we presented our request for a floating dock to the Town Trustees. Subsequently, the DEC did not want to permit me for this project as proposed. Instead, they have approved a fixed dock extension. 1 am enclosing a set of the approved plans which are dated 5/5/01. Mr Chris Arfsten of DEC called me on May 23rd to vverbally inform me of the approval of the plans and that Ms Farkas will be sending the letter shortly. We are therefore changing the original proposal to indicate that we; Request an Amendment to permit #868 dated April 2, 1973 in order to add a 3' X 15' extension to the existing dock and one (1) mooring post. Located at 1300 Strohson Road, Cutchogue. SCTM #103-10-27. As soon as I hear from your office when we can schedule for a meeting, I will again notify the neighbors by registered letter, i can be reached during the day at work at 631-563-6800 ext 398 Thank you for your kind patience and understanding Jerry Matejka June 8. 2001 To: Southold Trustees From: Jerry Matejka & Mildred Polesny Subject: Amendments/~vaivers/changes Enclosed please find the following in support for our application to modify Southold trustees permit #868 dated April 2, 1973. The hearing is scheduled fi~r June 21, 2001 !. DEC permit #1-4738-02701/001 dated May 23, 21}01 2. NYDEC stamp approved Cross Section Plan and Site Plan 3. Notarized proof of mailing to neighbors 4. Notarized affidavit of posting 5. A cop)' of the original Trustee permit The scope of new work encompasses adding YxlS' to lhe existing fixed dock and adding 1 mooring post. I hope that this covers all the materials requested. If there are any questions, please call me at work (631-563-6800 x398) ~l~ank you Jerry Matejka ~ Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York [1971-0959 Telephone(631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OFSOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I~J--~z~ /~k~ , residing at being duly 'swor~, depose and say: That on the ~ day of~-uf;~ , 2001, I personally posted the property known as 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 the public ~earing. Date of hearing noted thereon to be held'~~-~ Dated: ~/~/~l Sworn to before me this 9 day of-~¢'¥~ 200/ PROOF OF MKILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: STATE OF NEW YORK CO[5~TY OF SUFFOLK ~3-~¥ _~JT-~ , residing at ~ ~71~ ~u',b ___ , being duly sworn, deposes and say~- that cn the ~ d~y.?f ~ ,~, deponen% maJ!ed a tt-u.e copy r ,_ne Not~ce~et forth ~n the Board of Trustees Application, directed to each of the ~ove named persians at the 5ddresses set opposite there respective n~es: that the ad~3res~es s~c opposite the n~es of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that ~~re mailed at tb~ United States Post Office at that said Notices were mailed to ' mail. each of ~aid per__certified) (registered) 6 U.S. Postal Service CERTIFIED MAIL il=l.~ LMJ (Domestic Mail Only: No tiT.~Wlfl U.S. Postal Service CERTIFIED MAIL RECEIPT (Domestic Mail Only; No Insurance Coverage Provided) ~ ~ HICKSVILLE, NY 11801 U.S. Postal Service CERTIFIED MAIL RECEIPT (Domestic Mail Only: No I~$ur,3r~co Coverage Provided) Postage 16 Albert J. Kruv :ki, !'('esi.~e~,t ,[ames King, \'ice P;esident Henr3 Smith Artie Ken Foliwoda Town Hall 53095 Mein Road P.O. Box 1179 Sou thold, New York 11971 Teiephone (516) 765-18.T2 Fax (516) 765-1823 BOARD I)F TOWN 'rRus'rEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application WeUland Pgrmit Application Grandfatb~r Permit Application · ~./~Wa ive r / Ame ndme n t / C h~3).~ Rece.---~ved Application: Received Fee:$ ~0~ ' Comp keted Application ~7~/ Incomplete __SEQ~A Classification: Type £ ........ Type Ir Unlisted coor'din;~tion: {date sent) ~CAC 9efez.,.r,! Sent:_ ~ _~_~Date of Im;pection:_ ~/[]~_ i~ev J.ew: ___Technic3 1 ~_/ _~---~Public [:lc.a [ J. nq Held: Rose] ~lt J.o~: Name of ApFllcant Addres:~_ 3_7_ t--t, Fhon~ N,~ber: Suffolk .~ouJ,t5 Tax Map Number: 10tH) -~-~ovi~L~L~;~ Bole' ~ ~s~'e ~ cross streW'ts. and location) AGENt.: ( If applic,M)ie) Address: Phone: FAX9: Board~ Trustees A]~plication GF~ERAL DATA Land Area (in square feet): Area Zoning: Previous use of property: Intended use of property: Prior permits/approvals for site improvements: Agency Date No prior Has any permit/approval ever been revoked or gover~nental agency? No If yes, provide explanation: permits/approvals for site improvements. suspended by a Yes P~oject Oescrip~ion (use attachments if necessary): Board~ Trustees Applicati~3)n WETT~%ND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area of wetlands on lot: .square feet Percent coverage of lot: % Closest distance between nearest existing structure edge of wetlands: feet Closest distance between nearest proposed structure edge of wetlands: feet Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? How much material will be filled? Depth of wh].ch material will be removed or deposited: feet Proposed s]o~ th.~oughout the area of operations: ~4anner in which material will be removed or deposited: and upland and upland cubic yards cubic yards 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 ].f approf~riat.e}: Albert J. Kmpski, Pce~idc,,t James King, Vice-Pre'.:id',nt Henry Smith. Artie F.-,stvr Ken Town Hall 53095 Main Road F'.O. Box 1179 '3c, uthold. New York 11971 'felephone 1516) 765-18~/2 Fax (51.6} 765-1823 BO~P,D OF TOIVN 'I]{US'rEE$ TOW OF SOUTHOLD BOARD OF TRUSTEES: TO~ OF SOUTHOLD fn the Mattec of the Application COUNTY OP SUFFOLK) ~ STATE OF NEW YORK) AFFIDAVIT OF POSTING I, ,f , residing at being duly ~;,,~orn~ depose, and say: That o,~ t:h~" day o~ ' ' 197 , /. p.e,_,~ol]ally po~ted the p?yoC, ertj' kno~;i] as ,- by placing the Board of.' Trustees oificJal poster where it can easily be seer,, dDd 'that I have checked to be sure the poster has remained in F.[ace for seven days prior to thr3 date of Lhe p~l,bl~lg. (date of hearing noted thereon to be held~~ (sSgnature) Sworn to before? me this /? day oF /~gy 1~9~.. AUTHORIZATION twhere t.h~.: applicant i'~ res i.d }.,~g .'~ t (print owner . ~ _ o~. property} (m~:iiidg address) do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. ( Owner ' '~' sJ gnature ) BoaOof Tr~;st:ees App;icatio'n County of Suffolk State of New Ycrk BEING DULY SWORN DEPOSES AND AFFI~4S 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 FORTH iN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGR!~ES TO HOLD THE TOWN OF SOUTHOL9 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 PR~%~ISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature ~ TC, BEf'C. RE ME THIS NOTARY 4963140, Ex~lrea June ~4 Notary Public ,19 OF NOTICE \t L PF, CE] STATE OF NEW YORK COUNTY OF SUFFOLK '~"~-~. ;: ........ , residing at ~b~,,?..~_~ - _ , being duly sworn, deposes and says thlat on the day of . _,19__~, deponent mailed a true copy o~ the tq~tice s~t 'fort~' in th~ Board of Trustees Application, dir~-~ct~.d to each of the above n~med persons at the addresses set opposite there respective names; that the addresses set o~:,?osJ_te the names of said persons are the address of said persons ~,.s shown on the current assessment roll of the Town of Sout.~.o):~: t~nt sai~ Mc.t'~.ces were ~aiied at the ~nited States Post O£ffice ?t , that said Notices were mailed to r"a.?h of said persons by (certified) (registered) mail. 6 May 1, 2000 Town of Southhold Main Road Southold NY 11971 Dear Board of Town Trustees: We are submitting this application for a permit to add a 'floating dock' onto the existing fixed dock-catwalk. As per the attached specification, a ramp and 2 piles would be added to accommodate the floating dock. Neighbors throughout the area including next door have recent floating docks. The following is being submitted for your consideration 1. A propen~y survey completed within the last 6 months 2. The original permit/authorization from the Town to construct the fixed portion 3. A sketch of the proposed work 4. A copy of my Power of Attomey for presenting this request on behalf of my aunt. 5. A picture of the existing dock. If possible, I would like to request a modification to the existing permit. Thank you for your kind consideration Sincerely, M Polesny 1300 Strohson Road Cutchogue NY 11935 Please respond to: Jerry Metejka 94 Fulton Blvd Commack NY 11725 Board Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity: Are wetlands present within 75 feet of the proposed activity? No Yes Does the project involve excavation or filling? 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 enviror~ental impacts reasonablv anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) APPLICANT The Town of Southold's Code o£ Ethics prohtbite c0n~llcts or interest on the part of town officers .~ em~!~_~y0es. The purpose of this form is to provide information which can alert the town of ~o~s~i~- conflicts of [~-~-rest and allow it to take whatever action is necessar~ to avold same. YOUR you ar~ applying Jn the name of someone else or other entity, gucb ns a company. I2 ~o, indicate the other person'~ or company's name.) NATURB OF APPLICATION{ (check ali that apply.) Tax grievance Variance Change of zone App~tal of plat Exemption from pl~t or official map other (If "Other," name the activity.) . parent, or ~hild) have a relat[onehip with any oEfi.~er or empl. oyee or the To=n of 5outhold7 'Relationehip* lncludee hf blood, marriag~, or buninene interent. interest" mean~ a bueinen., ineluding a partnernhip~ in which the town officer or employe~ ha. ~ven a ownerehip of (~r employment by) a corporation in Mhich HO ....... Name of person employed by the ToW~ of Southold ~[.t3g or po~i~ion of that person ~egcrib~ th~ relati, o~lahtp between yourmel/~ (th~ applicant) and the town offic!er ~r employee. Either check the ~pproprLato line h) through D) and/et describe t.n the space The parent, town officer or employee or his or her spouse, ~{bling, or child ia {check all that apply}t the owner of greater than 5% of the share~ of the corpoLats stock of the appl[c~nt (when tho applicant ia a eorporatlon)~ B) the legal or b~neficiaL owner o~ a~y ~t~re~t ~n a noncorporate~entity (when the appl~ant ia not a C) an ofricer~ ~irsctor, partner, or ~mpioy~s of the applt{:ant! or __D) the ~ctual applicant. DP,:3CRIPTION "'