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HomeMy WebLinkAboutCalahan, Lauren K Glenn Goldsmith,President ����� 40, Town Hall Annex A.Nicholas Krupski,Vice President < 54375 Route 25 0 Eric Sepenoski o ,? P.O.Box 1179 Liz Gillooly �y • 0�� Southold,NY 11971 Elizabeth Peeples l * '�a" Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: 5�A 2av Completed infield by: 4'. Site inspection for LAUREN K. CALAHAN regarding clearing violations on two properties. One property contains freshwater wetland vegetation that was cleared. The second property contains tidal wetland vegetation that was cleared and is within the Coastal Erosion Hazard Area. Located: Off Central Avenue, Fishers Island. SCTM#'s 1000-6-3-8.3 & 1000-6-4-7.2 Type of area to be impacted: -,�!Oaltwater Wetland `� Freshwater Wetland Sound Bay 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 Notice of Hearing card posted on property: Yes No o Not Applicable Info needed/Modifications/Conditions/Etc.: �z•� ' Present Were: G. Goldsmith N. Krupski E. Sepenoski L. Gillooly E. Peeple - -� 'Ide 44 or S.A..w eA1c rA.+4ER m6rt+ew I ` FISHERS ISLAND SOUND o�fNoaYarPme c a tmwc "°K ra[Irtvt tl'_t l- 1 � IF NNOCRW:NLEr Ar;O Ren_n-e£ �I / I _i MIC_Ei O--Er:IN(5 - \. uEtaik- psT.E� NDiTO st/u J �)-- T ---__ :_t ', 't 33 VAmu•Cmss YJry.nlsMeYJ,Ci06266 T. (2 FOR-) H1951N9DE� Y,"_ .� iD1 Ea4 RA•erOA.y.fy,Eycr \ - e /-E\�i i 1 -" til 660686.1O551 wwN.dlamcPvlPlmm b' SI1NG C p/tTEiy YA1N -� i 6,r .11 e E• J,D'L j !i^ I J I II_ 7F FYJ -jT-� N �U STANDARD D-ROX CAST FETE COtEP.s/ i'1 . --A� �1 �_.� '.,.�_.•_,1 PLAN II SILT FENCE \\ ?��'f`�.� _S_ sm..e.:E ,7 .�R = I I COVER LO'. G CASMC -- '�I 1 \ / anrw Nor io"scuc I-) c r-t Tc GRADE _ .{ WEST vgVEN ARE FENCE(NM.to - \� ❑ ��a ITo C",- LmT9!rn r.LDE_ ... ! ! ARBOR - GAUGE w/MAX 6'VESN '\. _ \ o I i .- CNIu.NEY - H SPA-G) PROVIDE WATER xo+Es: R LJ i ',x x1RE nIESHSERVICE- DJq,19(Y,s ENCM, Otte T-PE90ENRAL SITE DEVELOPMENT PLAN TO'YAM,CENTCR \ COOROMATE WITH ' MN5T MN.LARoER ANMEC a`R90AEEiDttNsKjrpupLO s 5�y.e I IT-6 -- ..._ -r a• / \t PREPARED FOR: ,.. .. M CEN FENC[DOST6GM \\ Fl WATER WORKS (T � +' _TOJ,I ET _ ` ITR '.0 GALLOCi/AA�.P..95 let 1'FMEDDAPD). I ET ......- DRIVEN rRN.16• n.f 2.p.PRAL MA7LRAL AND LIOJms A1sT BM REMOVED fRp, I UO_N:t:H� w,a GROUND \ AND FROPERT DIMMED M w E RT RElC<S 1 LAUREN CALAHAN 75a OF,TS C.A." LOT 1 A F•.---6 F'� 'sl rD u,msMreµ s=uJ1 J.'eA,w• - PRu1 To EACH Irg n+P,RE(bnTNMIT SINGLE FAMILY FH I I. same FiD 7�j /1 CENTRAL AVENUE C "i9i"•nR LEACHING POOL DETAIL FI I 2'pe,w \ \ / " RESIDENCE-MUNICIPAL WATER i ASPECT R+ NOT TO SCALE I �� ` SHERS ISLAND, NY .. HEIGHTPLTE \ _`b`u . \ ON SITE SEPTIC I,SYSTEM I ,•_ S-B _ \ M'WDF EASEMENT FOR I LOCATION MAP SCALE 1 N=400' o UTILITIES(SET SLBDIVISICN I PROVIDE 20M CAL DROSS SEl:T1DN _ _ r/ 0'4.y. 6'u.11. \ MAP MAPREFERENT t) / / I BOXTI AND2 LE.ACTN TIa I `/ � TO) PERSPECTIVE NEW CLEAN-OUT- z' I I 2000 GALLON 7 / MAP REFERENCES / FROM FOUNDATION WALL I I 2 COMPARTMENT CE \ SEPTTO TANK EXPANSION AREA I Or TO GCe1E vgVEN wRE FENCE(fRx.+6 PROVIDE 130!IF li 1Va}E �� \/ 1. MINOR SUSDIKNOWN:AS PLAN PROPERTY OF E TR AVENUE. EDSON, .,R cAUEE w/"Al 6'lrESH I' t� BOULDER WALL- / -�•I / �o /TO' / / StOCXPRE I FORMERLY KNOWN AS EDITH p88 DILLa,CENTRAL AVENUE, SP.CNC)wM DLtER actR 3 �pi�y, / `) / O.RRYY AREA I - FlSHERS ISLAND,NEW YORK.SCALE 1'-40'.DATE: DECEMBER If. 1992 REVISED THROUGH 2 24 1995,BY CHANDLER,PALMER&KING 36'ON.cElla Pest R ��W 2 �/ / .•dry _ VELLS P 3 DRY ROVIDE ROOF I I / /' I 1WY.sNRB_D N 490D.1 � 1� J / 34 ti T FLOw�. I (AOt1A0 W 9159 \ .,64 E / 37 y, 15 / /1A CHERRY DRAINAGE(TIP.) NOTES __ \ N• / / .p / i�16 1+e o 4Ay (SEE DETAIL) COYP.CTED sm E 99 PROVIDE / / /�' ( GS / /S \ / 1. THIS SURVEY WAS PREPARED FOR THE PARTIES AND PURPOSE 5 e LANDSCAPED 4F 1 / u 7Y EMBED FILER GLOM u, LOT 2 ISLAND -- 24 / /� Q+ �0/.F / / / INDICATED HEREON.ANY EXTENSION OF THE USE BEYOND THE _ A ON Q s'nr aeouxD m= \ yy+. ) /' - PURPOSED AGREED TO BETWEEN THE CLIENT AND THE SURVEYOR SINGLE FAMILY LOT 3A STAGING AREA EXCEEDS THE SCOPE OF'THE INGAGEMENT. %ti RESIDENCE-MUNICIPAL WATER PRovmE SD Lac x z'WmE STONE i I w- I ( / I / / j T1' 2, iT IS A VIOLATION OF THE STATE EDUCATION LAW FOR ANY /(f _SECTION MET'! EIllID 77iDNa FOR ORDEWAY 1 _ 1 i PERSON,UNLESS ACTING UNDER THE DIRECTION OF A LICENSED ON SITE SEPTIC SYSTEM \ IXU NAGS(SEE DETAEJ I ) Y ) N 4BNLII/ ) LAND SURVEYOR,TO AIJER µ ITEM IN ANY WAY. CONSTRUCTION ROMIFl.ATIONc ��. y.F I 1 "� 1 L � �mo W 2M.2 1' - 1.VAVEry wrLF FENCE i0 BE FASTENED SENRELY 10 FENCE 105T5 wM \ �\ ,1- LTT,L��/ ` \ / �� 1 , I / / 1% / 3. ONLY COPIES OF TE SURVEY i WITH THE LAND TRIM TES OR STAPLES.POSTS SHALL IS STEEL EITHER-r'OR V'-E �X RES .A.N l` 1 OR HARD 000. SURVEYOR'S SIGNATUREORIGINAL CZ ,!'/ AND AN EMBOSS©OR INK SEAL ARE THE PRODUCT OF THE LAND SURVEYOR. ••,��.�.= ` y ` 1$ ` \ 3 (N10N. J /N4B19/' �0 / ✓•/ 4. COORDINATE DISTANCES ARE MEASURED FROM U.S.COAST AND =`lei�' .7�- TI S S 0.0M TO BE FASTENED SECURE LY TI N.FEN YARN FENCE- \ ` n F / TIES SPAT)EVERY 2A'a,TOP TRIO .SECTION.FENCE SN.0 BE. UNE) ' / .. , � W ?37 / / ,1 � GEODETIC SURVEY TRIANGULATION STATION'PROS' I W WE.S NANNUN YF91 RRCLOTH -}. / TEST HOLE DATA- •Po•tei UN7T5 OF 29NRBANCE\ FJ� OO ° \ i )• xe oA°�'Ifrm feT Ae S NHEN av 5'ECOGS fB SIX"O<S NDi}N EACH FILTER WE' OBW 29,ti50E SF \\ PA / • I )) 5. SITE IS S THE T006,OF BLOCK 3,LOT COUNTY OF SUFFOLK TAX 1-;7SHALL BE Owl-LFI MR BY 9X FOIE'A T FLWA AV. GLOM - (S NO DtSTURBAN(E •Q •S'. TH xETM/ ) BY: R.STROUSE P.ELS.DATE: OS-19-1994 MAP 1000,SECTION 006,BLOO(3,LOT 8.3. 91ALL BE DTNER DTER%.YWADtODx,9TABLLrP(A TI.CN,OR APPROVED SE(DF' /� i I .) - - EOMVALDIT, yNI1H1W TLA S. VI / / / / (SUBDIN90N MAP).PEP' \ WElWIDS�\ \ W }� / 8 / / :' 0'-6"TOPSOIL6. TOTAL AREA=2.05f ACRES. rF WEFABRICA=-1.SHALL BE GEOFA9.ENV.ROFE-E.DN APPROVED \ \ \� / / / 1�% EOtRNMDIi. - TV PROVE 76 LONG X Y MADE$TONE PROVDE CS.LF .} 4 / 6 30'SANDY SUBSOIL . \ \ E4 S ))' 30 17 SAND AND GRAVEL-COARSE SAND SW 7. SIT[IS LOCATED IN ZONING DISTRICT R-80. S NAa1TETIMa SHALL BE r+ERFORMED AS NODDED AND MATERIAL '( FILLED TRENCH Fa DRIVEWAY \� - ra-BOULDER WAIL-Y/ `' // Qr / /J / EXPECTED HIGH GROUND WATER RE.OVED YMEN"BL40Es'(Mw,L N WE SLY FEXCE A'� DRAINAGE(SEE DETAIL)'\�-Y \ �, \ C- IQ�7aT5 VARIES �o/ / // ). / BELOW ELEVATION 5 8. PERCENT OF LOT COVERAGE PROPOSED-3.47 9LTFFNWDCE+\ \\ '0' _6 o k- 1 /'�- /j/ O// % )1/7.// DEVELOPMENTS NO WELLS YdTFGN 150'OF THE PROPOSED \ WXNTAG!DURa c. o 10.ELEVATIONS RASE ON NAVD88 `.11 .� v, .- v. W y N• \ \ PROVIDE DRIVE AND PARKING 11 '15�+' / - 6' / 2"RWNDEO )li SF f tom/ .+- ,V W W W r• W \ AREA \ 6 --YtY i�N \ /41 FWISHED STONE ¢nNC eY5T77.1 DISf9/FOR 4 ROIL:^^•'RE90E'x'- I'SW \ �y� \ 6 GRADE PROVIDE 4'Q PIPE TO SEPTIC TANK.LOCATE CLEAN-OUT 2'FROM FOUNDATION RLHLUD:G IIryT WETLANDS D FRESHWATER ( WALL INVERT AT FOUNDATION-71.5 wE1LAND5 IRONUVMFI N AL N• WASHOUT PIE `' >y''�J �¢+E N�� / PRO'Y1DE 2000 GALLON SEPTIC TANK-INLET INVERT=21.0 TOTVTE OF 50T:TTiOT.l1 JUST,MO ENVIRaYENTAL,,, r• y y \ WA41WT PIT I ,,.� s _ RAFT CONSULTING 03-25-2021 \ (SEE DETAIL) �' ptv /� F(LTFR FABPoC (PONBLE FUNRE ADDITIa) CUTLET INVERT 20.75 y- '" "" w N• N' W \ ,..• ,�'' i/ /r - PRO'Y1DE 1 DISTRIBUTION BO%-INLET ELEVATIa-20.50 N 4701 W W W •+. w• W W \-� y / �� PRO'ODE 2 LEACHING POOLS-INLET ELEVATION-20.25 - W 26Q.T v- W �'J , FLOOO ZaE VEt1 �• ,P , ,✓!"l/ �i /)• .+ AS&I aFOCI - - I /il PANEL 3"MM000I9H �A EFF.9/25/2009 Q - - _ ap-s10NE 10 RECEIVED fv'L /�)�' PROIME EXTEND TO S'MLKCOU:)1YDEPART0.1PNfOFFMALTHSRVICES Comm 6cna FINISHED GRADE L^ttzTFar, f JUN T 0 2D21 ,)�1 /)... -�..•: ARCS - Af:'[•OVAL OrCoT,-. :UCE70N FORA (SEE OETArQ SO"GLE FAATD.V RL`_•p{¢q\'!.V SUFF.CO.HEALTH SFAV6� /�1)'••• CE OAT3.ZL J7C:?.! I OFFICE OFV•'iSTL'NlATERIM . -J-=r«.. HF EFF.HD. r 1'I-Ik• OP-LDFD.^.DOT(' LOT/3 Jr �E / 2t_ ]ENT ES TnPSP TnE MFROMDATEOFAPPROVAL I ry RJR t a B pxA 41\ NowaG ' Roo EwR TRENCH DRAIN CROSS SECTION -- j HIS .A rs vK� 1 •)ry R o�t LEGEND )1 n) P9 l � <RaR�w rATa VN� PROPERTY UNE - ) rrnL o ill Mmw R-tita-F)aR Ewa • Rrm rAex ABUTTERS ONE o MERC9ITJN ; N 457MM J ) EDGE OF PAVEMENT -- HOUND) W 139.01 >)) Va en+OJ a e 0 EDGE OF GRAVEL -----------_----- rt.il - . ') R O O e 6 M_. A T UQS11NG CCMUR O ---28--- RUAW O WALL CONTOUR • m e<P o BOOF AREA-Z805 SF (-- i REWIRED-2,805 SF SF X 2/12 a 467 OF uNInG FALL PROPOSED 4 BEDROOM }. RESIDENCE / W �*r3, W 13570 '), DRY WFl I R PROPOSED SILT FENCE ,` )Y/ STIX2MWATER DRYWEL IIETAt 467 CF/28.27 CF/VF=16.5 V, PROPOSED TREE LINE USE THREE(3)-6'e%6'-DEEP DRY WELLS. TREE UNC �� ')/)/ NOW OR FORMERLY AIIF Designed By. D.•awn By. Checked By: DIM' I AM FAMILIAR WITH THE STANDARDS FOR APPROVAL NEW DRIVEWAY AREA-4.900 SF BOUNDARY POINT,(I )y /:• O FIRS �C CBRr HS ate•' L• AND CONSTRUCTION OF SUBSURFACE SEWAGE REOUIRED Z.4.900 SF%1.0 X 2/12-817 CIF FlLT "}.\` •) MERFSTONE S W F ,,,Y•„- )- DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCE B17 CF/6.0 CF/LF=135 LF ■ Issue Dale: Prgect NO: Scale: �t71C ') AND WILL ABIDE BY THE CONDITIONS SET FORTH PROVIDE 178 FEET OF STONE FILLED TRENCH WATER VALVE 0607-2021 067028 1'=30 ma`s THEREIN AND ON THE PERMIT TO CONSTRUCT. w a' CONSTRUCTION ENTRANCE SOIL f1A�SagGATI0N5 Drawl g No.: j NOT TO SCALE APPLICANT MfC-M-t-k 11-sandy loom 8-157.Dlopen 30 t5 D 3o SHEET 1 OF 1 ID GRAPHIC SCALE IN FEET FISHERS ISLAND SOUND TEST HOLE DATA BY: R.STROUSE P.E.L.S.DATE: 05-19-1994 i(SUBDIVISION MAP) 0'-fi'TOPSOIL / 6'-30.SANDY SUBSOIL _ li as cpcc Way.manniea GT—Oft IT SAND AND GRAVEL-COARSE SAND SW `,i ) W�i61 Ean RrverOme,tcl Flp EXPECTED HIGH GROUND WATER �^ �/ Eact Namprd.CT os IOB BELOW ELEVATION 5 ��_ 860.8BSIo551 wxw.cAammpanlez.com /Y uE ... -WATER MArN FOX \ . EXISTING° — SITE / \ — I _ \ WEST \ \\\ HARBOR \\ ELECTRIC I --- SITE DEVELOPMENT PLAN SERVICE I .r ✓ PREPARED FOR: WATER A\ I J LAUREN CALAHAN SERVICE i ( CENTRAL AVENUE r\' ^ FISHERS ISLAND, NY I � J �10'WIDE UTLITY EASEMENT LOCATION MAP SCALE 1"=400' \\\ (SEE MAP REFERENCE 1) SOOT GAL _ SEPTIC TANK DISTRIBUTION BOX iTWO a DEEP LEACHING G POOLS OLS I MAP RFPFRFNCES \1 EXPANSION AREA 1. MINOR SUBDIVISION PLAN PROPERTY OF EDITH DILLON EDSON. FORMERLY KNOWN AS EDITH GIBB DILL N,CENTRAL AVENUE, P, FISHERS ISLAND,NEW YORK.SCALE: 1'=40',DATE: DECEMBER 11, \_\ 1992 REVISED THROUGH 2/24/1995.BY CHANDLER,PALMER k KING E�� W 91391 i�W NOTES 1. THIS SURVEY WAS PREPARED FOR THE PARTIES AND PURPOSE _y F >12' I I INDICATED HEREON.ANY EXTENSION OF THE USE BEYOND THE 6 -- PURPOSED AGREED TO BETWEEN THE CLIENT AND THE SURVEYOR EXCEEDS THE SCOPE OF THE ENGAGEMENT. F NElyy \\T" 1 A TH 2 3 2. IT IS A VIOLATION OF E STATE EDUCATION LAW FOR ANY �9-j- / PERSON,UNLESS ACTING UNDER THE'DIRECTION OF A UCENSED 4 _ N 184B.1f LAND SURVEYOR,TO ALTER AN ITEM IN ANY WAY. 2 glDRy- = 3. ONLY COPIES OF THIS SURVEY MARKED WITH THE LAND 4 BEDROOM SURVEYOR'S SIGNATURE AND AN ORIGINAL EMBOSSED OR INK SEAL u, Cgp3nr. �2C SINGLE FAMILY ___ ARE THE PRODUCT OF THE LAND SURVEYOR. RESIOdCE xf yY� - FOPEG510NP \ N 4BiB.02 4. COORDINATE DISTANCES ARE MEASURED FROM U.S.COAST AND IW 25704 GEODETIC SURVEY TRIANGULATION STATION"PROS 5. SITE IS IN THE TOWN OF SOUTHOLD,COUNTY OF SUFFOLK TAX MAP 1000.SECTION OOfi,BLOCK 3,LOT 8.3. 2 / - o.n o aor ®.m •\ i S. TOTAL AREA=2.052 ACRES. 7. SITE IS LOCATED IN ZONING DISTRICT R-80. lit B. PERCENT OF LOT COVERAGE PROPOSED-3.4R 9. THERE ARE NO WELLS WITHIN 150'OF THE PROPOSED DEVELOPMENT 10.ELEVATIONS BASE ON NAVD88 / PR, GAS L,. P. W 268.7 TIES FOR SEPTIC SYSTEM / TO POINT FROM POINT "A" FROM POINT "B" DESCRIPTION 1 58' 13, SEPTIC TANK INLET COVER \ 2 50" 15.5' SEPTIC TANK OUTLET COVER / 3 40' 23.5' DISTRIBUTION BOX 4 29' 35'1.5 LEACHING POOL COVER Y✓ SuttnmalrRe�ss�m AXd er oa¢ s 5 15' S1.5' LEACHING PDOL COVER I REY16E0 DR 6E 5 PNP O1N1YNt6 9� -- - Li - / LEGEND j PROPERTY LINE 7)8i2025 R-21-1675 EDGE ABUTTERS E -- EDGE OF GRAVEL PAVEMENT N 1139.07 = - - — EDGE OF GRAVEL ___________________ w f39.Df -- E%ISIINC CONTOUR —28--- PROPOSED CONTOUR RETANNG WALL SEPTIC SYSTEM -i. FENCE x .E x FINAL LOCATION PLAN PROPOSED SILT FENCE PROPOSED TREE UNE WX. 4 -- _ TREE UNE NOW OR FORMERLY NSF - Designed By. Dawn By. C hecked By' BOUNDARY POINT O RHS ZBC CB/RHS MMERESTONE Issue Date. Project N. 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't� r"�� 1,�r .* �ai K Aa? a� j"y:. 4 ''.� � !' �• #,�f�"S All 11/ _ .r r A: i. orb `J!r •♦ jam. i.: _ � �.. ��. s sor r �. 4 •� Lss 'L�tl 1*' . fW •AIM,' "4 .. � :►.. f ° ,A� _; � nro vcu�ivn�-r-rvrvncr vNuc�c,�ivuFr- `iy, inarorc- urc�acrry� • Fife Edit View Toolbar Window Her'p - WI2 ® � � . ■a 6. 3-8-3 1473089 Southold Active R/S:1 School: Fishers Island� ICalahan.Lauren K --Roll Year: 20 55ICurr Yr 1 Family Res Land AV: 3,100 TBD Land Size:2-05 acres Total AV: 8.100 Ll Parcel 6.-3-8.3 Tax Bill M _.,.-----___.. Owner ailing Address '3rd Party Address Bank a History d ' a0 L' AssessmentL uren.K Calahan Owner Type:Primary' Q Status: I Cl Spec Dist(s) esi• CU Description . .....� Owner's) ', i Li Images Cj Gis Last Name!Company: First Name: MI: Jr.,Sr.,etc: % �] Site[1 J Res Calahan _ _ E E Lauren { I ---— jp d Sale06/29/21 Attention To 1 In Care Of Additional Address: :.....Li Site[1)Res Street No: Prefix Dir: Street!Rural Route: St Suffix: . Post Dir UnitName: -Unit No: �' S67 Middlesex Rd r - Po Box No: City/Town: State: Zip Code: - Country:enter if not"USA' Bd: Ownership e.g.Life Use Owner Type: n ! ,Owner's Primary Residence i Click on foider to open Window } Search ' M? nra vice211Vn-r- w-,vncr vNuaLr=r vivup - uy, rvarurc- 11miurryi {File Edit View Toolbar Window Herp 0 I t / 11 0 V2( 0 o Q T 6_-4-7.2 ,473889 Southold Active RfS:1 School: Fishers Island 1 Calahan.Lauren K _ — Roll Year. 2025 Curr Yr Res vac land/Wtrft Land AV: 1,000 1 TBD Land Size:0-49 acres Total AV: 1-000 { L Parcel 6.4-7.2 i Owner Tax Bill Mailing Address 3rd Party Address Bank I - _ - L History --- -- --_-- -—-- - .R...F1 Assessment Li Dist(s)[ i L-1 Description {? 111 Images (� Gis ';'Last Name f Company: First Name: MI: Jr.,Sr.,etc: •••••Ci Site(1)Res :..... Sale06f29f21 {;Attention To f In Care Of: Additional Address: Street No: Prefix Dir: Street f Rural Route: St Suffix Past Dir: UnitName: _Unit No: j561 -{ T Middlesex _ Rd i T Po Box No: City/Town: State: Zip Code: { Darien. c CT I 06820- 'Country: enter if not"USA" Bar Cd: Ownership.e.g.Life Use Owner Type: P Primary__ !Owner's Primary Residence j 1 i f I If { i Click on folder to Open Window ,�j M1.,s sUfFQI�''r. TOWN OF SOUTHOLD—BUILDING DEPARTMENT 1Y� Town Hall Annex 54375 Main Road P. O.Box 1179 Southold NY 11971-0959 Telephone 631 765-1802 Fax 631 765-9502 htt s//w'A w.southoldtownnv.P-ov Date Received APPLICATION FOR BUILDING PERMIT �,f� p�/-q For Office Use Only _P SEP 04 902 C1 i',fi' PERMIT NO. I Vlp 1 Building Inspector. � J " Applications and forms must be filled out in their entirety.Incomplete TO1NN OFSOU LD applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. Date: 2 OWNER(S)6F PROPERTY: Name: Ua rce) L SCTM#1000- 3 Project Address: &dra..P 4ke J�i5kA k4w4 N 6(P r_) Phone#: Email: Mailing Address: CONTACT PERSON: -t� Name: �Ke_ d I o clo . Mailing Address: U &Y, `t [-764�1:5 1 [� / AJ Phone#: & 1. G #2- Email: 7ts�G'�O G°(��p 70�c iG CUl+ti DESIGN PROFESSIONAL INFORMATION: Name: A as MD Mailing Address: / Iva Phone#: b- Email: I d-n _Ce_ CUey___ CONTRACTOR INFORMATION: Name: &- d- i'c,10 Mailing Address: O �� ��� �iS s �� A l6'va Phone#: A t IV I - U q't'�L Email: -Ag e Vu /c6 . cmv— DESCRIPTION OF PROPOSED CONSTRUCTION dWew Structure ❑Addition ❑Alteration [I Repair ❑Demolition Estimated Cost of Project: ❑Other $ Will the lot be re-graded? ❑Yes 1�10 Will excess fill be removed from premises? ❑Yes to PROPERTY INFORMATION Existing use of property: � Intended use of property: Zone or use district in which premises is situated: Are there any covenants and rest fictions with res ect to _ 0 this property? E]YeskNo IF YES,PROVIDE A COPY. Check Box After Reading: The owner/contractor/design professional is responsible for all drainage and storm water Issues as provided by Chapter 236 of the Town Code.APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,Suffolk,County,New York and other applicable Laws,Ordinances or Regulations,for the construction of buildings, additions,alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code, housing code and regulations and to admit authorized inspectors on premises and in building(s)for necessary inspections.False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210AS of the New York State Penal Law. Application Submitted By(print name): Jq-,'. S. /O Mo Muthorized Agent ❑Owner Signature of Applicant: �� ,,d Gr Date: f_ 21 _Z 2___ STATE OF NEW YORK) SS: COUNTY OF Jam" r, J c, being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, ,M�e is the r®~rX-A-GTa 2 4 ete nij (Contractor,Agent,Corporate Officer,etc.) of said owner or owners,and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of his/berknowledge and belief;and that the work will be performed in the manner set forth in the application file therewith. Sworn before me this ,S�_day of ALoly� 20 Z Z N tary Public.oxA oS Z .Z{o bb,4g Z 2Z673 PROPERTY OWNED AUTHORIZATION (Where the applicant is not the owner) I, residing at do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. Owner's Signature Date Print Owner's Name PROM'"rAFORMAITWU exaszIP4 use a(:propemy- uar of pmVp-rT.,,.' Zonr or use disirict in 4i+ha0f grerm AS s4curt Are caw-t-a s aed rssttl[tlond tir"mmnec-,to DYts LjNo W VM PRW0E A Copy. Apokrt�an suhtwued by(oft, - hmd�+a�a a�taz.+�atuir�tr. +�: �a �� J`3�� r�esse�s�ap, ias�e 4'0 S , %ago Agent E]Owf*r fir&at AP Wm- 9,,, ,4 -��/�r- "a STATE Of NEW rORK) COUNTY OF oV—2 Z, �q Dip S Oise: 'sr , artd sus that�s{t+e is thespi, nc { ;of indvidual s gNrl,wntr+N above rAwn d, is the nvT1L-4 C Tb of said o r4v£or c e^s wW it d* or ln cm#4',taw_said w3fk and:p m4W and fk this a rpbxv,ic'n.41w e.vmtefrerfa Wf' Ai-wd in the aps'�i see t na to Ie bast of hi~kr wled; and b~;and the t1+e work watt be vptonr--ed in the manew feR ftr'.tl 0%Lne ae^ it,�s file there + i' Sworn t r*t Me this day of Uv T 2�Zl E VpuWVIC �s a5S2-cf hire the . K ma the o ner) I'.i.�.+�,.���+°"�..'Laaeri' ": .:o�, ��.�nE:•'d'--'` ...,,,. P�iR'd� .+''� �,2'• ;i'`. y�+ ,�"._ '�dXr ��r ��� 'jjr� �`"°""� � . r MY Town of S P ituAdme - ' r fte eppm� as d qi� f �! Print Chww 's.k i. f, NCVf910° - tYiafb iai F�Sy�RS 07 211 .42 tlfStr ' I 0 0 xr ;± SEE SEC.NC.130 / 1 •\� ~ 3fA J'. �ti 'b1 ;..- nl u, CRESCENT _I AA `` ^1C d"1Jl 14 UN� (2) r as C A I - u r r• 1— \ a o \` 1 tt'• it,� + rrss, r fnonl=1 12p •rat\ 119 .�� 1µ eF I ]a v� A I IA 4 r `4 3JN 1" 10 J � 2 1�Y ➢ .l - -- —w I/ 1` -t a3 n �oRA"E L - ° I I CRES�ENf ,y 6A S1 1,� nE ` /j" qt ri'S.e,°Fu} _ >. \ iaMq\I z -J]z"A zsp s•-I—rya��l_ y+r .. (/^ �'S,� �' I 9]A °, ,- I-1\ \ �'• 1 _r.. `�;�• J9AJ k 114A \ 11 x 3 ] zoe y1� °� ��� �r 1 i z0 I .<_ 1 z°n ]'JA \:� tip i A OA feOPC\�1! > i 9 Y_`a''. 4 EI dr SIt p � 1 �— P. W '� 0 f 1r.1 J I hin r x5 4 \ 305 ) :S • uo i3Nc1 :.,0 >',:. ( y ° t fan t 2AA s p ISA 08 z xaa ,y am mf I°Alclfl I If rs .r 4 1 nr ! k Al 1 R 5 �.>v rw.,,,e,k.,o=.,..pu�.> .,.�>.::�.<��m.srro,>w ,.,, — :.. — ..�, _, COUNTY OF SUFFOL _ .x wn.W,K.w...�.a ,,... N, Qu.n,y — -— ... rz taa.. g O NOTICE E �—zL__,—_ ��awn_--.—_ O .,,,,,,, ______ r=rua� R°W YrapenyTxSerrice Agency v 100° a 1-1 N IxarR�nntl.=d AwvaR.oa or t�w NAN Na�.a Ra.aPn sl „o. sour oEn 006 IM NIX -" —___— 3 purr rex sveru rooav