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HomeMy WebLinkAboutTR-9333A l Michael J. Domino, President coo Town Hall Annex John M. Bredemeyer, III, Vice-President how y<'•• 54375 Route 25 Glenn Goldsmith t N x P.O. Box 1179 A Nicholas Krupski �y • o���y Southold, NY 11971 Greg Williams �.A'01 , �� Telephone (631) 765-1892 Z Fax (631) 765-6641 SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITIES CHECKED OFF BELOW INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction % constructed Whenjroect complete, call for compliance inspection; p 1 �O��fit SU(/ryO1 Town Hall Annex Michael J.Domino,President John M.Bred emeyer III,Vice-President 54375 Route 25 P.O. Box 1179 Glenn Goldsmith CAP Southold,New York 11971 A.Nicholas Krupski �pQ Telephone(631) 765-1892 Greg Williams41r, ' Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9333A Date of Receipt of Application: October 1, 2018 Applicant: Paul & Margaret Poster SCTM#: 1000-137-4-35' Project Location: 1615 Fleetwood Road, Cutchogue Date of Resolution/Issuance: November 14, 2018 Date of Expiration: November 14, 2020 Reviewed by: Board of Trustees Project Description: Remove the invasive plants from bluff area and re- vegetate in same location using native plants. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the landscape plan prepared by Creative Environmental Design, dated September 28, 2018 and stamped approved on November 14, 2018. Special Conditions: None. Inspections: Final Inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. Michael J. Domino, President Board of Trustees Michael J. Domino,Prf; It � C ` ` Town Hall Annex John M. Bredemeyer III,Vice-President may` �,�„� - . 54375 Route 25 Glenn Goldsmithro P.O.Box 1179 A.Nicholas Krupski 0 � Southold,NY 11971 Greg Williams Telephone(631)765-1892 Bola Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time:�` 1 B Completed in field by: Aj, Creative Environmental Design on behalf of PAUL & MARGARET POSTER request an Administrative Permit,to remove the invasive plants from bluff area and re-vegetate in same location using native plants. 'Located: 1615 Fleetwood Road, Cutchogue. SCTM# 1000-137-4-35 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 V1 Ch. 111 SEQRA Type I 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: I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M.:Domino G. Goldsmith N. Krupski G. 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A, RAN -A- iv, _ ■ ■w ' ■ Z ■ X ■ W Mm i J, ■ ■fi 4' ja W m A I AC ■ 11�J i OUT R v _ ----- --------------- 105x _ - }' 105x 2 WALL#1 ` n � � x2 WALL#2 Dwm r r ti° w i � � ;,ter 8%1M , it r X t W '. —� • ■ X LAWN AREA '�• UJ ■ 3200 sa.FT. .�■ ,- 24 ■ °'�' I OAK TREE _■ / / TO VE i iR k odic TR661, X ■. ■r". IL NO ■ r ■ ■- ■ r ■ j i24 ■i- i- ""'■ OAK TREE � r ■ \ TO i .•,� �` WALL#2 -45'LONG x 2'HGH r M WALL# 1 = 105' LOR,x 2'HG+� minn r �®'■.� �,�, D'\ 0 0 0 00 o '9 0 0 NEW ` \'c, r o o o `oo ALL 24 r\ �' ■r ■ 00 c o o i O O,j o0 00 O _ a.. I. � J� i— r ■ 664 r . �, � k txy■ ��. c DV `'., ■ ■ 3. =so it ° 4 b ■ OZ 1 u.■i' rfr , APPROVED BY ° �° o ��° 'o � � ■� h�� BOARD OF TRUSTEES ° ° " , _. TOWN OF SOUTHOLD ° - � , L, G,�� LrJ� DATE , ° � �� � � �''� � ■ - �. � �� .. i.. Ns OCT - 1 2018 � ,( � � � -.� .� o o ` ■ Plan :NOW L n ca e ^MA Dow 1. Revision a s ■ 3' 61 j r Imo. ''T �, I R 0A Date: 9/2Q1')01 8 Poster 7.1.1 sGaie. Mir Design LandscapeDaveCichanowicz ■ 1 10 reati've Environmen al esi n r. f S r c r .- �. ._t f a����-. ♦ x` ,T. .. � ;,� -�- rte_• s+r_a AA It I� J .� ti �, �,. � � •.�d .. � � r��� .Y ���� ya. ids*'ice �A�� a, ±j t' �• it I� ` v '•'' "tom"' ��; �ie,a�.• ��"' t f ch- \ ` a t u(d N O r?> as tSNp t � 66 lIOU1H01D 32 16 n Z4 28 s y RD. r�(p p � � P •' N ,r A tP 1!� ` , 11 � � r• 1 � NOrICE COUNTY OF SUFFOLK © E °� aountan .. PropertyPTAgency Real ax Sernce r ,5 1 OFFICE LOCATION: �o��OF MAILING ADDRESS: Town Hall Annex ® P.O.Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) N Southold,NY 11971 Q Telephone: 631765-1938 C4UNTY,� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President Town of Southold Board of Trustees From: Mark Terry, Assistant Town Planning Director LWRP Coordinator Date: November 13, 2018 Re: Local Waterfront Coastal Consistency Review for PAUL & MARGARET POSTER SCTM# 1000-137-4-35 Creative Environmental Design on behalf of PAUL & MARGARET POSTER request an Administrative Permit to remove the invasive plants from bluff area and re-vegetate in same location using native plants. Located: 1615 Fleetwood Road, Cutchogue. SCTM# 1000-137-4- 35 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 action is CONSISTENT with the Policy Standards and therefore is CONSISTENT with the LWRP based on the following: 6.3 Protect and restore tidal and freshwater wetlands. " E. Maintain buffers to ensure that adverse effects of adjacent or nearby development are avoided. 1. Maintain buffers to achieve a high filtration efficiency of surface runoff. 2. Avoid permanent or unnecessary disturbance within buffer areas. 3. Maintain existing indigenous vegetation within buffer areas. The existing indigenous vegetation provides important nutrient filtering, erosion control and storm surge protection and is recommended to be preserved and integrated within the planting plan to further this policy to the greatest extent practicable. f Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Damon Hagan, Assistant Town Attorney Michael J.Domino,President Qv SI?v ® '�, Town Ball Annex 54375 Route 25 John M.Bredemeyer III,Vice-President `� � � 'IL 6 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski Telephone(631) 765-1892 Greg Williams t',f/ Fax(631) 765-6641 Ulm BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only _ ' ; ' !t Coastal Erosion Permit Application ';{ � E Wetland Permit Application Administrative Permit--/ —Received OCT – 1 2018 Received Applica ion: Received Fee: $ 00,0 —� Com P Pp leted A lication: 0 Southold 7oovu J Incomplete: SEQRA Classification: TypeI Typc II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent):_ LWRP Consistency Assessment Form Sent: CAC Referral Sent: Date of Inspection: Receipt of CAC Report: Technical Review: V—Public Hearing Held: < < < Resolution: Owner(s) Legal Name of Property (as shown on Deed): Mailing Address: is WA f\a�oy1 AL, fl�l Phone Number: Suffolk County Tax Map Number: 1000 e Property Location: /) 5 (If necessary,provide LILCO Pole #, distance to cross streets, and location) AGENT(If applicable): Mailing Address: Creative Environmental Doi— &3 FO Box 160 Phone Number: Pecomc,NY 11958 ___ Board of Trustees lappl ition GENERAL DATA Land Area(in square feet): 1 5�1 Area Zoning: Q\- ` o Previous use of property: �, Intended use of property: Ae�,;b I'V 14 Covenants and Restrictions on property? Yes t/ No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? Yes v`�No If"Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes No If"Yes", please provide copy of decision. Will this project require,my demolition as per Town Code or as determined by the Building Dept.? Yes iv No Does the structure(s) on property have a valid Certificate of Occupancy? V Yes No Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. Has any permit/approval ver been revoked or suspended by a governmental agency? / Yes If yes,provide explanation: Project Description (use attachments if necessary): Remove invasive plants from bluff area and replant in same location native plants as per plan submitted Board of Trustees Appl ition WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: VLJMi�t- 18-VA51ve-L D64N.�S 4- 46 Area of wetlands on lot: (1, square feet Percent coverage of lot: % J P� Closest distance between nearest existing structure and upland edge of wetlands: _�feet Closest distance between nearest proposed structure and upland edge of wetlands: Ilk feet 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 Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: f%V OL4� Manner in which material will be removed or deposited: ICU -6L 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): Wl�C'i9U ��. U \!�9��1(14 1�GQ� vi-- �� 617.20 Appendix B Short Environmental Assessment Form Instructions for Comnletintl Part I -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part I based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1 -Project and Sponsor Information Name of Action or Project: % k dam Project Location(describ nd attach a location map): •1 (o I S 1�7\td_�Wo06, Brief Description of Proposed Action: Remove invasive plants from bluff area and replant in same location native plants ' as per plan submitted Name of Applicant or Sponsor: Telephone: E-Mail:c-va G/ft 1t Address: PQ BOX 160 Pecolnic,NY 11958 City/PO: State: Zip Code: 1.Does the proposed action only involve the legislative adoption of a plan, local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that F] may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes, list agency(s)name and permit or approval: ❑ 3.a.Total acreage of the site of the proposed action? ams- b. ctb.Total acreage to be physically disturbed? — acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban []Rural(non-agriculture) []Industrial ❑Commercial residential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland Page I of 4 5. Is the proposed action, NO YES I N/A a.A permitted use under the zoning regulations? ❑ K 1:1b.Consistent with the adopted comprehensive plan? 1:1lJ ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: ® ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES C F-1- b.Are public transportation service(s)available at or near the site of the proposed action? ❑ c. Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? ❑ 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: 010 ❑ 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: 0 ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? ❑ b. Is the proposed action located in an archeological sensitive area? ❑ 13.a. Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? ❑ If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Idabtify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: ®Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional ❑ Wetland ❑Urban ❑Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats, listed NO YES by the State or Federal government as threatened or endangered? ff ❑ 16.Is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, ❑ a.Will storm water discharges flow to adjacent properties? �]NO ❑YES b.Will storm water discharges be directed to established conveyance systems(rurtbff and storm drains)? If Yes,briefly describe: UNO ❑YES Page 2 of 4 18. Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: 19. Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE nay 1 Applicant/spo e: Date: �Jd,O�l4 Signature: Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur I. Will the proposed action create a material conflict with an adopted land use plan or zoning ❑ regulations? Ef 2. Will the proposed action result in a change in the use or intensity of use of land? 3. Will the proposed action impair the character or quality of the existing community? ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the ❑ establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or ❑ affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ❑ reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: a.public/private water supplies? b.public/private wastewater treatment utilities? ❑ 8. Will the proposed action impair the character or quality of important historic,archaeological, ❑ architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage 1:1problems? 11. Will the proposed action create a hazard to environmental resources or human health? LLJ Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration, irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impactV. Town of Southold-Board of Trustees f G Michael Name of Lead Agency Date �► ichael J■ Domino President Print or Type Nam of Responsible,.Officer in Lead Agency Title of Responsible Officer Signature of Responoble Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM Tlie To of Soptfold's Codc of Ethics nrohibitti coitllicts of interest on ilic_nnrl of town iiff icers and cnmloyice&'llrr;aurin•e of this form is In provide inforinntion which can atert the town of nnssible conflicts of interusl and allow it to take wlintever action is neemqury to avoid salTle, YOURNAME• (Last name,firs e,griddle initial,unless you are applying to the name of someone else or other entity,such as a company.If so,indicate lie other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance �._ Building -X Variance Trustee x 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 coutpirny,spouse,sibling,parent,or child)have a relationship with any officer or cngiloyce of the fawn of Southold? "Relationship"includes by blood,marriage,or business prlteresL"Business interest"means n business, including a partnership,in which ilia town officer or employee has even n partial ownership of(orantployment by)a corporation in which the town officer or employee owns more than 5%of the shales. YES NO X If ydu answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yoursclf(the applicant/a$ent/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 Ilia corporate stock of the applicpvt (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(whoa[lie applicant is not a corporation); C)an officer,director,partner,or employee of the applicant or D)the actual applicant. DESCRIPTION OF RELATIONSHIP ` Submitted thdayo o4s Signature P• Print Name / — a�r Form TS 1 Board of Trustees Application .AFFIDAVIT b P \ BEING DULY SWORN y 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 A.GENT(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 DIKING THE TERM OF THE PERMIT. Signature of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF ,.20 Notary Public Board of Trustees Application AUTHORIZATION (Where the applicant is not the owner) Uwe, �C�� �' 1M,��•ec�— �'�� - - - - - - r owners of the property identified as SCTM# 1000- ,1 3� in the town of 1615 E&� JVA. ,.New York,hereby authorizes David Cichanowicz, Pres. Creative Em4onmental Design to act as my agent and handle all necessary work involved with the application process for permit(s) from the Southold Town Board of Trustees for this property. Pro erty Owner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS DAY OF ,;20 Notary'Public 4 APP]LICANVAGENT/REPRESENTATIW TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of sown officers and employees.The pu[Rose 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: )AA 1 (Last name,first name,jpiddle initial,unless you are applying hi 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,r4arriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or'employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO V 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 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 applic*nt (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 ay o 206 g Signature Print Name U; etre c�FG Form TS l ------ ------- - ------ ---- - ------------ -------- - -- ------------- APPLICANT/AGENT//ItEPRESENTATIV TRANSACTIONAL DISCLOSURE,FORM 'T11c Town,o£Soutliold's."Code of Ethics nLc hibitg conaiets of interest on=the part•ortown officers Arid"emolgy s.The Mu-'Mie-dr, this fnt•tri+s•tta jirnvide"uitiaririadan which"Cali alert the t0�rt of�SSih)te eonfhlct5 of intern5t'an'ti.gl,(o`,w'it ttl l�t<e:'SVItatCVC!•5lCtloll I�' nkc,q5sarY ti)avoid same. YOURNAME: (Last name,fist name,ipiddle initial,unless you are applying iti 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 . L Variance Trustee _. Change of Zone _ ____r Coastal Erosion Approval of plat _ Mooring Exemption from plat or official map Planning Other (If"Other,name the activity.) 60 you personally(of througlryour eonip`any,spouse,sibling,parent;orchild)'have a relationship with,any officer or•cmirloyee of thc'Townof Southolii?-`"Relationship"includes by blood;njan•iage,or business.irttet est `•'Busipcss urtc"resf'-mcans,a business, including a partnership,in whicli the town officer ac employeG.hos even a partial ownership qor empIoymen#liy)a corporation' in which'tlie town ofiacecoremployee=ot4ns"marc titau5°fu:oftlic shares. YES NO X 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 Title or position of that person Describe the relationship between yourself(the appiicantlagent(representative)and the town officer or employee.Either check the approFiaie lint A)through D)andlor 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 3%of,ihe shdrres of the corporate-stock bf ttie applic*ttt (when the applicant is n coipotntionx ' B)the legal or bencMial owner of any interest in anon-cnrpqrate,entii (%A6h tire; applicant is nota corporation); C)an officer,director,partner,or employee of the applicant;or 17)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this ay of 20Q signature Print Name Form TS I i Board of Trustees Application AUTHORIZATION (Where the applicant is not the owner) I/We, (�_ � owners of the property identified as SCTM# 1000- 3-7— 3 5 in the town of New York,hereby authorizes David Cichanowicz, Pres. Creative Envionmental Design to act as my agent and handle all necessary work involved with the application process for permit(s)from the Southold Town Board of Trustees for this property. Property Owner's Signature Property ner's Signature SWORN TO BEFORE ME THIS DAY OF 20 l� otary Public MARGUERITE POUPAKIS Notary Public,State of New York No.01 P06203276 Qualified In New York County Commission Expires April 6,2021 r Board of Trustees Application AFFIDAVIT BEING DULY SWORN DEPOSES AN FIRMS©HAT HE/SHE IS THE APPLICANT OR THE ABOVE DESCRIBED PERMITS)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. Signature of Property Owner Signature of perty Owner SWORN TO BEFORE ME THIS DAY OF S i �'�� ;20 I ary Public MARGUERITE POUPAKIS Notary Public,State of New York No.01 P06203276 Qualtfled in New York County Commission Expires April 6,2021 APPLICANT TAGMTfRKFRESJMTA7TVU1 TRANSkC-Tj()NAL DISCLOSURE FORM Tla "lotcntsf c+tnllc�i3'sl'erileeafl�Itir��uliitsitc•cofill iag" finte-e isanlhutrirt,tiE,u�cyniifEic r;;:cntEet vloYlcss,tT uu. crzt tliis.Cramr is lra atr`r�snrIe3rafcir'iia�tiwtn~s>��Iirch can alezl��zr��-��`ctrl€tea:ortillacas-o�tizetcs�,azad ali�su,�a3°tc�,t a��v1:n .a�acrCicna�„ asi rranae,tirsc naane,.gza A-RaLess you are appiytng in the itaazte of someone else or other entity,such as a company.If so,indicate'We-other peison;sor'csaangaanyss�name.�- TWC San= _ BuVXM Change of Zone Coastal Erosion .Approval,of plat Mooring T--emptmfttnplater nfEicWmap Fl ni Ott � ee2:6* ) y ra rsfaaralEy Cor tltrYrrtgta t�cscrrc ztap i}. rsnsc.s#slizag,P=X!l 0.or C1Iitji 11w c.a rejadonsitip%%inIz<arry oWicc:r oreni iIT,9-c of tlrc TtsiK�ir of Sar[tlaoltE? "ReI:ztisansitip"i:acluzi�!?y laloocl,utarri:rgc,or bzrsinc�s interest'`l3i>sinc�ss ivturc$i"rnc:uLc a t?using inctuciirrga partnership,iea ut:icli the town oClicxr or esnplaycc ices rtfcn a lrrrtiat rnvia�rsitija oC(or c�aa�afaynacnt by)fa coapor:riioza in which the town 61licer6r employee owns rnarethan 5°C of'ilae shmm _ YES _ I x Ifyeu answered"YES%completa the balance ofthis font and slate and.sign where indicated Name of person employed by the Town of Southold Titleiarposition ofthatperson De=ft the a�lat'sot�aipbetweeAyourseif(the applicardwnt/representstive)and tate town offoeror employee.Eitlaerchacic tip �Ike A)tf rough I ) �� the spice praim-k& lie town officer or employee or bis or her spouse,sibling,parent;or child is(check all that apply): A)the owner ofgreater than 5%o£the shares of the corporate stock orilae applic�at (whcir the applicant is a c6rlaorati6n);- B)the legal orbencficial owner of any interest in a non-corporate entity(wl e-a the- applimm is not:Y C)an officer,dtredor,paatnei,or enpbYee of the applicartt;or D)the actual applicant DESCRIPTION OF RBLATiONSW Submitted this 44 Aay of 2045 'Signature _ print I`onn TS 1 Board of Trustees Appl,, 'iLts.on AFFIDAVIT BEING DULY SWORN DEMOS AND AFFIIUM THATHE/SHE IS TIDE APPLICANT FOR THE ABOVE DESCRIBED PE (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 E4ENTER 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. Sign fore of Property Owner Signature of Progeny Owner SWORN TO BEFORE ME THIS -9-e DAY OF 2C RESA L.WILLIAMS No.01 WI6160000 -Notary Public,State of N@w Y®fh I'�Io rY Public Commission Expires►,x - 9 Board of Trustees Appl &tion A O 'MONY (Where the applicant is not the owner) owners of the property identified as SCTM# 1000- in the town of New York-,hereby authorizes David Cichanowicz, Pres. Creative Envionmental Design to act as my agent and handle all neccssary work involved with the application process for permit(s)from the Southold Town Board of Trustees for this property. Property 6 ner's tignature Property Owner's Signature SWORN TO BEFORE ME THIS DAY OF 20=Lj_ ' Public RESA L. WILLIAMS No.01 W1616060,9 Nota ry Public,State of New York Qualified in Bron oun Commission Expires �� 7 Town of Southold LWRP CONSISTENCY ASSESSMENT FORINT A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront 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 manor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. 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 significantL beneficial and adverse effects upon the coastal area(which includes all of Southold Town). 3. 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 detail, listing both supporting and non- supporting 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 at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM#� �- ! - 3� PROJECT NAMEThe Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees 1. 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: , Remove invasive plants from bluff area and replant in same location native plants as per plan submitted i Location of action: Site acreage: Present land use: `"4t4 Present zoning classification: AAD 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: Pklk� + 4iLti� Payr (b) Mailing address:_' qa-,RbMtQ in j2A, Ili (c) Telephone number: Area Code ( (d) Application number,if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ No P 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, Foyes ❑ No ❑ Not Applicable flt4 1 r\Q 'I ndld v1— �I"A Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III--Policies Pages 3 through 6 for evaluation criteria El Yes ❑ No VNot Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Se tion III—Policies Pages 6 through 7 for evaluation criteria Yes ❑ No ❑ Not Applicable 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 II—Policies Pages 8 through 16 for evaluation criteria Vyes ❑ No ❑ Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III —Polici s Pages 16 through 21 for evaluation criteria Yes ❑ No ❑Not 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 .,.,Applicable 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 for evaluation criteria. Yes [:] No F] 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 III—Policies; Pages 38 through 46 for evaluation criteria. ❑ YesD No 12/Not Applicable Attach additional sheets if necessary WORKING COAST PGjL zCIES ' Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III--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 Estua and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. L2Yes ❑ 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 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. ❑ Yes ❑ No ❑ Not Applicable PREPARED BY Ic , TITLE DATE