HomeMy WebLinkAboutZupicich, Atilio r
t / SURVEY OF
LOT 10
MAP OF
WEST CREEK ESTATES
FILE No 3848 FILED AUGUST 19.1963
SITUATE
CUTCHOGUE
j) �+ TOWN OF SOUTHOLD
f SUFFOLK COUNTY, NEW YORK
J s S.C. TAX No. 1000-78-02-26
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NYS Lk No.50467
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4 Nathan 'Waft Corwin III
NOTES Land Surveyor
1 ELEVATIONS ARE REFERENCED TO N.G V D 1929 DATUM /
1 EXISTING ELEVATIONS ARE SHOWN THUS'= /
EXISTING CONTOUR LINES ARE SHOWN THUS' ————xx———— SN<ttsaor To Slonle7 J IboksN m LS
F7L- FUtsr RODR _px A Ing<gno LS
G£L- FMT BOOR iN<Sum7s-SudCnicrona- SI<Pons- Cmst—tan LOyoul
i PHONE(631)727-2090 Fox(631)727-1727
OF m LO TFO AT NAVNG ADORE55
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JA_Fort.N<n Yoh 11917 Jomuport.N°"Yoh 11947
1 -
Michael J. Domino,Pre t �Q `,� Town Hall Annex
John M.Bredemeyer III,Vice-President a Gam_ Y 54375 Route 25"
Glenn Goldsmith P.O.Box 1179 _
A.Nicholas Krupski 07 Southold,NY 11971
Greg Williams 4,,0� p� Telephone(631)765-1892
Fax(631)765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Date/Time: �'v�' 7 Completed infield by:
East End Pool King on behalf of ATILIO ZUPICICH requests a Pre-Submission Inspection to discuss
tree removal and a proposed swimming pool. Located: 800 Glenn Road, Southold. SCTM# 1000-78-
2-26
CH.-275-3 - SETBACKS
WETLAND BOUNDARY: Actual Footage or OK=4 Setback Waiver Required
1. Residence: 100 feet
2'. Driveway: 50 feet
3. Sanitary Leaching Pool (cesspool): 100 feet
4. Septic Tank: 75 feet
5. Swimming Pool and related structures: 50 feet
6. Landscaping or gardening: 50 feet
7. Placement of C&D material: 100 feet
TOP OF BLUFF:
1. Residence: 100 feet
2. Driveway: 100 feet
3. Sanitary leaching pool (cesspool) 100 feet:
4.,-Swimming pool and related structures: 100 feet
Public Notice of Hearing Card Posted: Y / N
Ch. 275 ✓ Ch. 111 SEORA Type: 1 II Unlisted Action
Type of Application: Pre-Submission Administrative Amendment Wetland
Coastal Erosion Emergency Violation Non-Jurisdiction
Survey <_ 5 years: Y/N- Wetland Line by: C.E.H.A. Line
Additional information/suggested modifications/conditions/need for outside
review/consultant/application`completeness/comments/standards:
44
I have read & acknowledged the foregoing Trustees comments:
Agent/Owner: ¢
Present were: Bredemeyer —IzM. Domino G. Goidsm'ith N. Krupski
G. Williams Other
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Board of Trustees Ap]J' cation
rozl� 3 vo -
AFFIDAVIT
BEING DULY SWORN
DEPOS AND AFFIRMS T T HE/SHE IS THE APPLICANT FOR THE ABOVE
-DE SCRIgG 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 AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE
BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES
AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF
GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE
TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES, INCLUDING THE
CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO
INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION,
INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF
TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE
COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL
EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM
OF THE PERMIT.
Signa a of Property OwneU Signature of Property Owner
SWORN TO BEFORE ME THIS 3fJ1 DAY OF 7y"1 , 20 f g
r A/r
Notary Public
DIANE DISAWO
NOTARY PUBLIC-STATE Of NEW YORK
No. O1 D1475593
Qualified In Suffolk County
My Commission Expires April 30, 20 �
14'
AM 19
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SEE SM NO
L NOTICE omvy, COUNTY OF SUFFOLK EK SOUTHOLD SECTION NO
Er Oz Real Property Tax Service Agency y
G owew. _^ County center Wre.0ee4,NY 111101 M 078
E670
A 1000 PROPERTY MAP
'AvB P
21 No
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6�1- �-75-
10)6,45-1 C-90 fooLAW—OYO
E cl ,
OCT 1 6 2018
So ahold Town jj
�o a r cLLf Tr 11s,t
East End Pool King September 12tn2018 =
A
P.O Box 369
Peconic, NY 11958
I hear by grant Jennifer Del Vaglio and her husband as property agents for all Swimming Pool installation
and related activity and all tree removal and related activity for my property at 800 Glenn Road
Southold, NY 11971.
Sincerely,
. pagn
Marc Zupicich, Property Owner Pfau ,Sbh®tXete;ed
No aIPIA I18a104
Air&=aid=WX*n Jane 02XW
800 Glenn Road
Southold', NY 11971 i
917-566-3824 /� ��
_�, Board of Trustees Applicl- ,on
AFFIDAVIT
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 AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE
BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES
AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF
GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE
TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES, INCLUDING THE
CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO
INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION,
INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF
TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE
COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL
EROSION PERMIT ISUED BY THE BOARD OF TRUSTEES DURING THE TERM
OF THE PERMIT.
Signature of Property O ne Signature of Property Owner
SWORN TO BEFORE ME THIS DAY OF 20-14K
Notary Pub
jV@aI PA,6100194
c���xpirls Daae II2.xD3Q
LiC
AIPFAN T/AO]EN T/RE'LD RESI+Cl`TA`?IVE
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of
this form is to vrovide 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: ITA f C
(Last name,first name,middle initial,unless you are applying rn the name of
'someone else or other entity,such as a company.If so,indicate the other
person's or company's name.)
NAME OF APPLICATION: (Check all that apply.)
Tax grievance Building
Variance Trustee
Change of Zone Coastal Erosion
Approval of plat Mooring
Exemption from plat or official map Planning
Other
(If"Other-',name the activity.)
Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee
of the Town of Southold? "Relationship"includes by blood, marriage,or business'interest."Business interest"means a business,
cer or employee has even a partial ownership of(or employment by)a corporation
including a partnership,in which the town offi
in which the town-officer or employee owns more than 5%of the shares.
YES NO
If you answered"YES",complete the balance of this form and date and sign where indicated.
Name of person employed by the Town of Southold I ��
Title or position of that person
Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check
the appropriate line A)through D)and/or describe in the space provided.
The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply):
A)the owner of greater than 5%of the shares of the corporate stock of the applicant
(when the applicant is a corporation);
B)the legal or beneficial owner of any interest in a non-corporate entity(when the
applicant is not a corporation);
C)an officer,director,partner,or employee of the applicant;or
D)the actual applicant.
DESCRIPTION OF RELATIONSHIP
Submitted this day of 200
Signature
Print Name
Form TS 1 �-PG� C
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