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HomeMy WebLinkAboutTR-5809 tea:. •� � �7 r�✓'`•.(y;N €� „a'&�;s. O�+�`�?`. 'a.='{gyp-. '�' y y �.�`. — �" r�ti -�• r " IVY ,mow a ou hold Town Trustees Board Of S SOUTHOLD, NEW YORK DATE: Sept 24, 2A03 j PERMIT NO. ... .......-. ... ...... ..... ..---•• � r' ISSUED TO ....JENNIFER .&...PHILIP_..ST..N.T.ON......................."---............... l a Y Pursuant to the provisions of Chapter 615 of the Laws of. r f the State of New York, 1893; and Chapter 404 of the Laws of the r� State of New York 1952; and the Southold Town Ordinance en- titled ."REGULATING AND THE PLACING OF OBSTRUCTIONS `;�. IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL"OR OTHER MATERIALS FROM LANDS UNDER TOWN'WATERS and in accordance with the 1T ( ' • Resolution of The Board adopted at a meeting held on Sept. 200,00 --............ paid by ,z. 2003-:_., and in consideration of the sum of k x, }c `. _ En.-"Coxlsllltants......Inc..-...on...behal�f...Of...Jennifer---&----P�ilipr-••5tanton .....-..-..."................................" N. Y. and• subject to the of �.o . . .--. ..n Terms an 0 1 ions listed on the reverse side hereof, _ of Southold Town Trustees authorizes and permits the following: ' Wetland Permit for removal of existing masonry walk and construct new walkway realign curb r1 1 of existing driveway as per survey dated September 23,2002 and revised August 6,2003 -prepared by John C.Ehlers Land Surveyor all in accordance with the detailed specifications as presented in the originating application. IN WITNESS WHEREOF, The said Board of Trustees here- , by causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this date. - Trusteesa I .•' f i'T _ _.ems / ... : TERMS and CONDITIONS The Permittee Jennifer & ?hili Stnntan residing at 720 Town N. Y., as part- of the consideration for the issuance of the Permit does understand and prescribe to the fol- lowing: 1. That the said Board of Trustees and the Town of Southold are released from nay.and an damages, or claims for damages, of suits arising directly or indirecdy as it result of any open- atroa performed pursuant to this permit, and the said Permittee will, at his or her awn defend any and all such suits'inidated by third .parties, and the said Permittee assumes fall liability with respect thereto, to the complete-exclusion of the Board of Trustees of the Town of Southold 24 2. That this Permit is valid for n-period of Enos. which is considered to be dhe estimated time.required to complete the work involved, but should_circumstances warrant, request, for an eXteasioa 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 orIproject involved, to provide evidence to anyone concerned that with orizatioo was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance-with.the provisions of the originating applieatioq.maybe cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southold require the.removal and/or alterations . in the locution of the work herein authorized, or if, in the opinion of the Board of Trustees the. work shall cause unreasonable obstrumon to free navigation, the said Petmittee will be required, upon due notice, to remove or alter this work or project herein stated without mpenses to the Tows . Of Southold. 8. That the said Board will be notified by the Permittee of the oompledon.of the work nth- orized 9. That the Permittee will obtain all other permits and consents brat array be required sap' plemental to this permit which may be subject to revoke upon failure to obtain same. SOFFO(,� Albert J.Krupski,President ��,� CD Town Hall James King,Vice-President _� G'y� 53095 Route 25 Artie Foster O P.O.Box 1179 y 2 Southold,New York 11971-0959 Ken Poliwoda Peggy A. Dickerson y ��� Telephone(631) 765-1892 ��j �►a Fax(631)765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD September 29, 2003 Mr. Rob Herrmann En-Consultants, Inc. 1329 North Sea Road Southampton,NY 11968 RE: SCTM#64-1-14.4 Jennifer&Philip Stanton 720 Town Creek Lane Southold,NY Dear Mr. Herrmann: The Board of Town Trustees took the following action during a Regular Meeting, held on September 24th, 2003 regarding the above matter. WHEREAS,En-Consultants,Inc. on behalf of JENNIFER&PHILIP STANTON applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated September 2, 2003 WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on September 24, 2003 at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, 2 WHEREAS,the structure complies with the standard set forth in Chapter 97-18 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 approved JENNIFER&PHILIP STANTON Wetland Permit for removal of existing masonry walk and construct new walkway realign curb of existing driveway as per survey dated September 23, 2002 and revised August 6,2003 prepared by John C. Ehlers Land Surveyor BE IT FURTHER RESOLVED that this determination should not be considered a determination made for any other Department or Agency,which may also have an application pending for the same or similar project. Fee must be paid, if applicable and permit issued within six months of the date of this notification. If inspections are required, at a fee of$5.00 per inspection(See attached schedule). FEES: $5.00 Very truly yours, Albert J. � ski Jr. p President,Board of Trustees AJK/cjc cc: DEC Albert J.Krupski,President ®��$QFFO(y��0 Town Hall James King,Vice-President G 53095 Main Road P.O.Box 1179 Henry Smith o Southold,New York 11971 Artie Foster y _ Ken Poliwoda O ® Telephone(516) 765-1892 y Q� Fax(516)765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: En-Consultants Inc on helialf ®i Jennifer & .Philip Stanton, Please be advised that your application, dated Sept. 2. 2003 has been reviewed by this Board, at the regular meeting of �:gtebe 34 — and the following action was taken: X) 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: One 'Inspection @$5.00 TOTAL FEES DUE: $ 5.00 { SIGNED: PRESIDENT, BOARD OF TRUSTEES r CLERK, BOARD OFT STEES 4/98 Via.;.;;�,�i..lfi„111; ,,.F,,,,.�6,frYi�, rnud. .. :,,,•r:.. ..�. - Town Hall Albert J.Krttpski,Presiden�. SOS MCO 53095 Main Road games King,Vice-Presidenl- �Q� �2 P.O.Box 1179 Henry Smith o= Southold,New York 11971 Artie Foster H T iwoda � Telephone(516) 765-1;892 Ken pol �ifi� a0�� Fax(516)765-1823 BOARD OF TOWN TRi]S'PES TOWN OF SOUTHOLD TO: En-Con,�ultants I Je i Please be advised that your application, dated Sept 2 2003 eting OE has been :reviewed by this Board, at ng: actthe gionawasetaken: and the following b48-r- -?r40r,- 3-&03- Application Approved (see below) ( _) ApplicEntion. Denied (see below) ( _) Arplica tion Tabled (see below) roved as noted above, a permit fee is If your application is approved payable to the Southold Town now due. Make check or money Trustees: Th(' fee is 'computed below according to the schedule; of rates as sr�t forth in the instruction sheet. The following fee must be paid within 90 days or re-app -application fees will be necessary. LOCATION OF PERMIT FEES: One Inspection @$5.00 5.00 TOTAL FEES DUE: $ r r SIGNED: PRESIDENT, BOARD OF TRUSTEEa BY! CLERK, BOARD OF T STEES Town Hall Al J i j ski,President SVFFO`� 53095 Route 25 Jajd6s�''kk�'' i Vice-President OHO c�G P.O.Box 1179 S Attie Foster outhold,New York 11971-0959 . 5 Kri poliwoda o Telephone(631)765-189,2 .i CO,.- leggy A.Dickerson W Fax(631)765-1366 1 BOARD OF TOWN TRUSTE]GS TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF TI�SPECTKONOFA�ILURE TO DKE AN O SO APPOINTMENT FOR A PRE,•CONSTRUCTION :SHALL BE CC'NSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. STANTON INSPECTION SCHEDULE Pre-construction, hay bale line Ist day of Construction constructed " X Project connplete, compliance inspection. i t a is A. sa, i Albert J.Krupski,President _. Town Hall James King, ® u�F®� C 53095ute 25 Vice-President ®� S OG P.O.B 1179 Artie Foster o~� y� Southold,New York 11971-0959 Ken Poliwoda Peggy A.Dickerson H = Telephone(631)765-1892 _ ® Fax(631)765-1366 �01 Sao BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT ENETO MAKE AN BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMT OF THE WORK APPOINTMENT FOR A PRE-CONSTRUCTION N AND POSSEBLEON.REVOCILURE TOAT ON O F THE SHALL BE CONSIDERED A VIOLA PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1st day of construction % constructed ✓ Project complete, compliance inspection. . oSUF�o��o Tower Hall. 53095 Main Road P.O. Box 1179 Telephone Off. O Southold, New York 11971 (631) 765-1892. _ SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold.Town Conservation Advisory Council held Tuesday, September 23, 2003, the following recommendation was made: Moved by Bob Ghosio, seconded by Nicholas Dickerson, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH A CONDITION of the Wetland Permit application of JENNIFER & PHILIP STANTON to remove existing masonry walk and construct new walkway; realign curb on existing driveway; and replace existing asphalt driveway with pervious stone. All proposed work (including new parking areas) located more than 100' from tidal wetlands boundary is beyond Trustees jurisdiction. Located: 720 Town Creek Lane, Southold. SCTM#64-1-14.4 The CAC recommends Approval with the Condition that hay bales are placed down along the creek during construction. Vote of Council: Ayes: All Motion Carried f. :> 1329 North Sea Road Southampton, New York 11968 631-283-6360 A Fax: 631-283-6136 encon�l EN-CONSULTANTS, INC. E_ wwwwencconnssultantscom ENVIRONMENTAL SERVICES August 28,2003 Town of Southold Board of Trustees Post Office Box 1179 Southold,New York 11971 Attn.: Charlotte Cunningham Re: Jennifer&Philip Stanton 720 Town Creek Lane, Southold SCTM#1000-64-1-14.4 Dear Ms. Cunningham: In regard to the above referenced property, enclosed are the following for the Boa d of Tnl.-,teeq p� 2 L5 l� V E I. Three(3)Wetland Permit Applications, (including Notice and Proof of Mailing to adjacent owners). 2. Three(3) Short Environmental Assessment Forms. 8EP " 2 2003 3. Three(3)copies of authorization&disclosure forms. 4. Three(3)work plans: d Town 5. Three(3)copies of survey. Board of l Trustees 6. One(1)set of site photographs. 7. Application fee of$200.00. I trust this information shall allow you to process our permit request. Should any additional information be required, please do not hesitate to contact our office. Sincere �, Robert errmann Coastal Management Specialist /khs Enc. Albert J. Krupski, President Town Hall James King, Vice-President �OSUFF�eI¢'C 53095 Route 25 P.O. Box 1179 Henry Smith =�� l/ Southold,New York 11971-0959 Artie Foster Ken Poliwoda _ y Z Telephone(631)765-1892 �y • �� Fex(631)765-1366 �o! Sao BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application Wetland Permit Application Major Minor Waiver/Amendment/Changes Received Applicafon: I b.! Received Fee:$ OV Completed Application D Incomplete SEQRA Classification: Type I Type II Unlisted Coordination:(date sent CAC Referral Sent: o Date of Inspection: r (? Pv E Receipt of CAC Report: lh L� Lead Agency Determination: �- -� Technical Review: Str 2 LUUJ Public Hearing Held: Resolution: Southold wn RoArd stees Name of ApplicantJENNIFER&PHILIP STANTON Address 18 ORCHARD STREET,NO.5,NEW YORK,NY 10002 Phone Number:212-941-6101 Suff County Tax Map Number: 1000 - 64-1-14.4 xolkr Property Location:720 TOWN CREEK LANE,SOUTHOLD , Cr (provide LILCO Pole#, distance to cross streets, and location) AGENT:EN-CONSULTANTS,INC. (If applicable) Address: 1329 NORTH SEA ROAD,SOUTHAMPTON,NY 11968 Phone:631-283-6360 Board of Trustees Applica - :>n GENERAL DATA Land Area(in square feet):120,874 Area Zoning: Previous use of property:RESIDENTIAL Intended use of property:NO CHANGE. Prior permits/approvals for site improvements: Agency Date X No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? X No Yes If yes, provide explanation: Project Description(use attachments if necessary): REMOVE EXISTING MASONRY WALK AND CONSTRUCT NEW WALKWAY;REALIGN CURB OF EXISTING DRIVEWAY;AND REPLACE EXISTING ASPHALT DRIVEWAY WITH PERVIOUS STONE,ALL AS DEPICTED ON THE SITE PLAN PREPARED BY JOHN C.EHLERS,LAND SURVEYOR,LAST DATED 8-6-03. ALL PROPOSED WORK(INCLUDING NEW PARKING AREAS)LOCATED MORE THAN 100 FEET FROM TIDAL WETLANDS BOUNDARY IS BEYOND TRUSTEES JURISDICTION PURSUANT TO SOUTHOLD TOWN CODE CHAPTER 97. 'toard of Trustees Applica- n WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: REPLACE WALKWAY AND IMPROVE CONDITION,CONFIGURATION,AND MAKE UP OF DRIVEWAY AND PARKING AREAS. Area of wetlands on lot: +/-1400 square feet Percent coverage of lot:+/-I Closest distance between nearest existing structure and upland edge of wetlands:+/-60 feet (MASONRY WALK) CIosest distance between nearest proposed structure and upland edge of wetlands:+/-62 feet (PROPOSED WALK) Does the project involve excavation or filling? X No Yes If yes, how much material will be excavated?N/A cubic yards How much material will be filled? N/A cubic yards Depth of which material will be removed or deposited: N/A feet Proposed slope throughout the area of operations: N/A Manner in which material,will be removed or deposited: N/A 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): THE PROJECT,WHICH INCLUDES THE REPLACEMENT OF AN ASPHALT DRIVEWAY WITH PERVIOUS STONE,WILL HAVE A POSITIVE IMPACT ON ADJACENT TIDAL WETLANDS AND WATERS,AS IT WILL REDUCE COVERAGE BY IMPERVIOUS SURFACES AND REDUCE POTENTIAL RUNOFF. 14-16-4(2/B7)—Texlt2 PROJECT I.D. NUMBER 617.21 S E Q R Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I—PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1 APPLICANTISPONSOR: 2.PROJECT NAME JENNIFER&PHILIP STANTON BY EN-CONSULTANTS,INC. 3 PROJECT LOCATION: Municipality SOUTHOLD county SUFFOLK 4 PRECISE LOCATION(Street address and road intersections,prominent landmarks,etc,or provide map) 720 TOWN CREEK LANE,SOUTHOLD,SCTM#1000-64-1-14.4;MAP PROVIDED 5.IS PROPOSED ACTION ® New ❑ Expansion ❑ Modification/alteration 6 DESCRIBE PROJECT BRIEFLY: MOVE EXISTING MASONRY WALK AND CONSTRUCT NEW WALKWAY;REALIGN CURB OF EXISTING DRIVEWAY; AND REPLACE EXISTING ASPHALT DRIVEWAY WITH PERVIOUS STONE,ALL AS DEPICTED ON THE SITE PLAN PREPARED BY JOHN C.EHLERS,LAND SURVEYOR,LAST DATED 8-6-03. ALL PROPOSED WORK(INCLUDING NEW PARKING AREAS)LOCATED MORE THAN 100 FEET FROM TIDAL WETLANDS BOUNDARY IS BEYOND TRUSTEES JURISDICTION PURSUANT TO SOUTHOLD TOWN CODE CHAPTER 97. 7. AMOUNT OF LAND AFFECTED Initially 2.77 acres Ultimately 2.77 acres B. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ®Yes ❑No If No,describe briefly 9.WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ®Residential ❑Industrial ❑Commercial ❑Agriculture ❑Park Forest/Open space ❑Other Describe: to. DOES ACTION INVOLVE PERMIT APPROVAL,OR FUNDING,NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL, STATE OR LOCAL)? ❑No If yes,list agency(s)and permit/approvals ®Yes DEC 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Dyes ®No If yes, list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? ❑Yes ®No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicantfsponsor name ROBERT E41ERRMANN,COASTAL MANAGEMENT SPECIALIST t7ATE:AUGUST 28, 2003 Signature: If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) I, d I � . � I ✓ � residing .at (print owner of property) mailing address) A440 ,Z'CIZ—.., % . `�j do hereby authorize�j-- ©( �--- (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. Owner' s signature) 8 " and of Trustees Applicati , County of Suffolk State of New York /l•(•� 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 TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION, Signature SWORN TO BEFORE ME THIS Z,�� DAY OF $&j?k0L&V,20 ()'L, LYDIA CHEUK Notary Public,State of New York No. 02CH6063678 Qualified In New York County Commis Evires Septembc, 4,2005 N ary Public APPLICAI • TRANSACTIONAL DISCLOSURE PORN The Town of Southold 's Code of Ebttic•s rohibibs conflicts of interest on bile art of town officers and employees. The ur ose of this form is to rovide information which can alert Ltte town of posa ble confl cts of interest and allow it to take whatever action is necesearV to avoid same. YOUR NAHB: C::Z '��j"/A /`f'7`) I / Last name, first name, m dd•le nit al, unless You are applying in the name of someone else or other entity, such as a company. If so, indicate . bile other person's or company's name. ) NATURE OF APPLICATION: (Check all that apply. ) Tax grievance Variance Change of zone Approva•1 of plat _ Exemption from pla or official map Other (If "Other, " name the activity. ) �� S Do you personally (br 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, 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 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) 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 596 of the shares of the corporate stock or bhe applies►tit ('when the applicant is a corporation) l B) the legal or beneficial owner of any interest in a noncorporabe 'entiby (when the applicant is not a corporation h C) an officer, director, partner, or employee of the applicant! or D) bile actual applicant. DESCRIPTION OF RELATIONSHIP submitted bhi d y Signature -Print name . `Pw(/j,�, s V NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant:JENNIFER&PHILIP STANTON SCTM#1000- 64-1-14.4 YOU ARE HEREBY GIVEN NOTICE: 1 . That it is the intention of the undersigned to request a Permit from the Board of Trustees to: REMOVE EXISTING MASONRY WALK AND CONSTRUCT NEW WALKWAY;REALIGN CURB OF EXISTING DRIVEWAY;AND REPLACE EXISTING ASPHALT DRIVEWAY WITH PERVIOUS STONE,ALL AS DEPICTED ON THE SITE PLAN PREPARED BY JOHN C.EHLERS,LAND SURVEYOR,LAST DATED 8-6-03. ALL PROPOSED WORK(INCLUDING NEW PARKING AREAS)LOCATED MORE THAN 100 FEET FROM TIDAL WETLANDS BOUNDARY IS BEYOND TRUSTEES JURISDICTION PURSUANT TO SOUTHOLD TOWN CODE CHAPTER 97. 2 . That the property which is the subject of Environmental Review-is located adjacent to your property and is described as follows : 720 TOWN CREEK LANE,SOUTHOLD 3. That the project which is subject to Environmental Review under Chapters 32, 37, or 97 of the Town Code is open to public comment on:SEPT.24,2003 @ 7:00 pm You may contact the Trustees Office at 765-1892 or in writing. The above referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal . OWNERS NAME: JENNIFER&PHILIP STANTON MAILING ADDRESS: 18 ORCHARD STREET,NO.5 NEW YORK,NY 10002 PHONE # : 212-941-6101 Enc. : Copy of sketch or plan showing proposal for your convenience . S APPLICANT/AGENUREPRESENTATIVE 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 provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. �" ` S` Tu lA 10 YOURNAME: 4_J X LA . (Last name,first name,middle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Variance Change of Zone Approval of plat Exemption from plat or official map Other (If"Other",name the activity.) w e 11 tkIJ D S 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, 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. X YES NO If you answered"YE",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 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 X -� ay of ��' 200 Signature ->�— Print Name 4 .rr --i, - SVfF�(�Albert J.Krupski,President Town Hall��� C� James King,Vice-President �`Z` Gy 53095 Route 25 co . P.O.Box 1179 Artie Foster = Southold,New York 11971-0959 Ken Poliwoda y Peggy A.Dickerson �1i �� Telephone(631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of -------- ------ - ------------- ----------------------- OUNT OF SUF OLK) STATE OF NEW ORK) AFFIDAVIT OF POSTING A EN-CONSULTANTS INC. I, � e�'► Cf A;r,5! idiRg at 1329 NORTH SEA RD SOUTFIAMPTON,N.Y. 11�68 631-283-6360 being duly sworn, depose and say: - - That on th% day of �''' , 2003,I ersonally osted the property known as �a � . r 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 thedate the ublic hearing. Date of hearing noted thereon to be held 6 d Dated: (signature) Sworn to before me this If_k day of� 2003 N ublic NdaryP�t• oIN�iYak romHs.ka1�11 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: ELISABETH TODD MAPLE LANE SOUTHOLD,NY 11971 JENWER&PHILIP STANTON 18 ORCHARD STREET,NO.5 NEW YORY,NY 10002 STATE OF NEW YORK COUNTY OF SUFFOLK ROBERT E.HERRMANN doing business a t EN-CONSULTANTS,INC. 1329 NORTH SEA ROAD SOUTHAMPTON,NY 11968 being duly sworn, deposes and says that on the 28TH day of AUGUST 120 03 , deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at ��t5ek -^�2761 , that said Notices were mailed to each of said persons by (certified) mail . Sworn to efore me this day of-- 206 Notary Public �-U SEP 2 2003 ----------------- KNH.SiEPItfAS Southold Town HdaryPuaic SaiedN�l�tt Board of Trustees Cammis�a�No,�01�931 :. Q��ANSn9o�Cduq 6ia�tiolE�rollVo�l�, L ® SURVEY OF PROPERTY N ®AD 51TUATE: 5OUTHOLD TOWN: 5OUTHOLD W E 5UFFOLK COUNTY, NY SURVEYED OG-23-02 s SUFFOLK COUNTY TAX u 1000-64-1-114.4 CMT=TO: ]f?hihilip B Stan" pennifer]Lamberts Stanton Feconic Abstract,Inc. t�, Fndehty National Title.Insairanc e ® Conparay of�Tew York (;itibank,RT.A. RFo rot R/ \ O� mOn ?/ 'os �rF Naw a$ ¢or eet`� yam 3 9r s ? C� ` �a�amm00 �Q 0 hand NO of <�L orry �O� forme y, 8 e,?ee / or Gorrler Gq Of \ 9 0 WIllrcmd Noyle � 9 3 ° 7A O O + t oyy. t oR _ _ 3 �Zo e � I I � \ 5 rl► O� Bd�rc�of T--�O t I � O w o S0I 8 E zd t � 1 rrjt,�" 0 v a bZ�Q _ ' 1 ' vt o e VJ'�OD FEMVGE $ YWw Q �1 N86°42'00"W 169.61' o \b, � 1 +\ Qrt " yO N S1 E ►586 51'00"E 91.70, \ , 20-06 � ZAR C� os ow 5b5 6AR "AO r POO e�OUlS S1 Ramp 2 Story z / \ f�e � w airy o \ \ Lot — — proposedVol E \ D >_ E (5Hr —`_o �S�vL- r q \ \ 0 0 3 stay pro 47,5 LgnC noto Qc Fermerl g e �r \ BOres y Of o�P�Rlr O2 \e u 44j4�C' 2nd flr.over' \ \ CD O Olt grILOF star \,p \ screen porch O re I \ 1, TOPO ADDED 03-Ic[-03 9 aHi1 PROP05ED ACTION 05-OG-03 yJ AMENDED 0-T-14-03, PROPOSED ACTIONS 08-06-03 •� age or \ \ \ \ \ \ \ \ \ ® h/A/ \ (tie \1 \ NOTES: 9 �Nw ■ MONUMENT FOUND O r7,rn� PIPE FOUND K7 1 PARCEL ALSO APPEARS A5 LOTS 3, 4 d 5 ON A MAPS. J Q� OF PROP05ED SUBDIVISION FOR HELEN M. LAT50N BY R. VANTUYL. APPROVED BY THE THE SOUTHOLD 0 �- } '.,, 4- TOWN PLANNING BOARD, MAY 13, IG-7I. f fillJ4Y Kha t,t/v YP C7 ELEVATIONS REFERENCED TO NGVD '2q DATUM 'IFw.thor:eo oit.r°tlon or.00, n to°aurv°y mop bea'In9°Ilcene9tl 1°M wrveyorb tool le o D REFERENCE L. 10528 e.p. 4�4 °ollon of sec E—,Ip,eW- °„,,°r the VVe 4 �ry cork Slote Edeotlon Law" 'Only copies from the or q—of lhls su-wy ntho °—t °fthe��W,t.yae JO C. EHLERS LA SURVEYOR slanpeo seal shop lx conaldered to be v°IfG true AREA = 120,8�4 s.f. or 2.7� acres espies• 'certy onons ma—-hereon elq�lry!hd mB ey ry°e prepor°°I„'Or L�—„flh the e,- 6 EAST MAIN STREET letlt `o.°f ="w for`°"'surreys°mpt°° N.Y.S.LIC.N0.50202 6R PH I G SCALE I"=40' the a wk xate AIt,lots°f Prof°•°, 5 ey°re, a"Ifk°l°ro shoN ra° y RIVERHEAI),N.Y. 11901 to!ha person for whom the e�rvey is prepa-ed. antl on hls°eMif to the Ill ie corrp°ry,9°" 369-8288 Fax 369-8287 "°°°"�°°°°'`h°'°°'n9'ro`"""° `°r°"ko- REF:\\Hp serverld\PROS\02-290b.pro Norm ore nct lroroferoble!o odditlon°i bietltullone bi8l]P�3 i,�AFM\Vp wwr\NPFr05b�-XWpo