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HomeMy WebLinkAboutTR-5758 i yT_i-frC•'�r_ �'.� :..tn!�J�`Piv�v/.�'�..c..�_.�rr_:��.:b'-`_' a�_?f.J__ _-:_ .. �v - ' � ._fir_ •-_---'— � � •' '. Board Of Southold Town Trustees - SOUTHOL D NEW YORK a �` ,: ' DATE ` PERMIT NO = M y 2 20"03 _ - �, ISSUED TO ..................RAUL...S.GH��-�tELLER.................... ............._............ a Pursuant to the provisions of Chapter 615 of the Laws of. the State of New York, 1893; and Chapter 404 of the Laws of the t� ' State of New York 1952; and the Southold Town Ordinance en- `` w titled ."REGULATING AND THE PLACING OF OBSTRUCTIONS � IN AND ON TOWN WATERS AND PUBLIC LANDS and the fi yY. REMOVAL OF SAND, GRAVEL-OR OTHER MATERIALS FROM l` LANDS UNDER TOWN"WATERS;'...': and in. accordance with the -r: Resolution of The Board adopted at a meeting held on ....May..."2•i,- 2003 and consideration of the sum, of $.....2.0-0-0.0--" pai by s Paul....Scilirreiler...................... >' subject to th > ............. N. Y. and• of ........Pew©pie............................................. / Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the following• 30 deciduous trees located within 100 feet of .1 Wetland Permit to cut down approximately thirty( ) `s Jt: 1 tidal wetlands—plant evergreens and shrubs of local variety such as Cedar,Spruce,Bayberry, a « from Tidal Wetlands—use only pervious ground cover such etc.—keep turf at least 50 feet away f\ 'g as wood chips, an esented in with the detailed specifications as pr all n accordance c4 iy the originating application. h The said Board of Trustees ere- 4 " IN WITNESS WHEREOF, � �� • . by causes its Corporate Seal to be affixed, and these presents to 1 be subscribed by a majority of the said Board as of this date. /$ O ! PC .1 l" Trustees � .1� �. - - s: � � � ���'�,i��7���.r�Y+air/ �J' • lop .. l l�C• .M. � •. � � {f � .'f.'y/,'Y O pi� � �'�i, �i_f'-.. CCS` yG,'5g��,yj�'_ .nf�•� !,_�1 ,• � l"i.l{*` � G tqx;�, �`-R�', ,..., ,��r�PT41 TERMS and CONDITIONS The Permittee residing at 1435 Well; N. Y., as part- of the consideration for the issuance of she Permit does understand and prescribe to the fol- lowing.: 1. That the said Board of Trustees and the Town of Southold are released from any and on damages, or claims for damages, of suits arising directly or indirectly as a result of any oper- ation performed pursuant to this permit, and the said Permittee will, at his of her own expense, defend any and all such suits.-inidated by third parties, and the said Permittee assumes full liabil t9 with respect thereto, to the complete-exclusion of the Board of Trustees of the Town of Southold 2. That this Permit is'valid for a period of 2 4 mos. which is considered to be the estimated time•required to complete the work involved, but-should circes warrant, inquest for an extension may be made to the Board at a later date. IThat this Permit should be retained indefinitely, or as long as the said Petmittee wishes to-maintain the structure or project involved, to provide evidence to anyone concerned that auth- orization. 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 applicatioq:may be 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 location of the work herein authorized, or if, in the opinion of the Board of Trustees, the- work shall cause unreasonable obstruction to free navigation, the said Permittee will be rehired, r.alter this work or project herein stated without expenses to the Town upon due notice, to remove o . of Southold. 8. That the said Board will be notified by the Permittee of the oompletion.of the work with - That 9. That the Permittee will obtain all other permits and consents that may be required sup- plemental to this permit which may be subject to revoke upon failure to obtain same. I� ii i 1 ' I 1 i i i Albert J.Krupski,President 0�� C� Town Hall James King,Vice-President �`t` G.f, 53095 Route 25 \ Artie Foster co P.O.Box 1179 Ken Poliwoda = Southold,New York 11971-0959 Peggy A.Dickerson _.f� Telephone(631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD May 27, 2003 Mr. Paul A. Schineller PO Box 511 Sagaponack,NY 11962-0611 RE: SCTM#75-06=13.2 1435 Wells Road Peconic,NY Dear Mr. Schineller: The Board of Town Trustees took the following action during a Regular Meeting,held on May 21, 2003 regarding the above matter WHEREAS,Paul Schineller applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold,application dated April 23, 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 May 21, 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, 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. 2 NOW THEREFORE BE IT, RESOLVED,that the Board of Trustees approved the application of Paul Schineller for a Wetland Permit to cut down approximately thirty(30) deciduous trees located within 100 feet of tidal wetlands—plant evergreens and,shrubs of local variety such as Cedar, Spruce,Bayberry, etc.—keep turf at least 50 feet away from Tidal Wetlands—use only pervious ground cover such as wood chips, etc. as per plans submitted. 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. Inspections are required at a fee of$5.00 per inspection. (See attached schedule). FEES: None Very truly yours, d �. * le"I"- )� - Albert J. Krupski, Jr. President,Board of Trustees AJK/cjc cc DEC c Townt Hall. 53095 Main Road cn 'T P.O. Box 1179 Telephone 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, May 13, 2003, the following recommendation was made: Moved by Don Wilder, seconded by Bill Cook, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH A CONDITION of the Wetland Permit application of PAUL A. SCHINELLER to cut down approx. 30 deciduous, garbage trees located within 100' of the tidal wetlands. Plant evergreens and shrubs of local variety such as cedar, spruce, and bayberry. Keep turf at least 50' away from tidal wetlands. Use only pervious ground cover such as wood chips, etc. Located: 1435 Wells Rd., Peconic. SCTM#75-6-13.2 The CAC recommends Approval with the Condition that a 50' non-disturbance buffer is maintained and recommend that the trees marked with maroon ribbons be pruned low to the ground rather than being completely removed. Vote of Council: Ayes: All Motion Carried 5/19/2003 2:44 P" "-,OM: Paul Schineller TO: 7651366 PAGEi -"- OF 002 .r Paul Schineller PO Box 511 Sagaponack, NY 11962-0511 Telephone: 631-838-5050 Fax: 631-614-7922 Email: paschin@optonline.net May 19, 2003 Board of Trustees - Town Of Southold PO Box 1179 Southold, NY 1 1 971-0959 Re: 1435 Wells Road, Peconic, NY Hello Charlotte: Just to confirm our conversation today: 1 . Rob Herman Flagged the wetland area on my property on 5/8/03. 2. Joe Ingegno staked the 50 foot from the wetlands line on 5/19/03. 3. 1 received the new survey today showing the new wetlands bounday and the line 50 feet upland of the wetlands line. I will bring copies of this new survey with me to give them to the Board of Trustees at the hearing on May 21 . Thanks, Paul Schineller Paul Schineller PO Box 511 Sagaponack, NY 11962-0511 Telephone: 631-838-5050 Fax: 631-614-7922 Email: paschin@optonline.net May 21, 2003 Board of Trustees - Town Of Southold PO Box 1179 Southold, NY 11971-0959 Attn: Mr. Albert J. Krupsk, President Re: 1436 Wells Road, Pe conic, NY Dear Mr. Krupski: During the last two weeks, Erg-Consultants has flagged the tidal wetlands line and Joseph; Ingegno has produced a new survey based on that line. The new survey (copies attached) also shows the 50 foot buffer- zone line which was staked a f:,w days ago. am requesting that you approve my application for a permit to cut down trees on my proper'.y, upland of the 50 foot buffer zone line. Respectfully, Paul Schineller Paul Schineller PO Box 511 Sagaponack, NY 11962-0511 Telephone: 631-838-5050 �- Fax: 631-614-7922 Email: paschin@optonline.net May 12, 2003 Board of Trustees - Town Of Southold PO Box 1179 + Southold, NY 11971-0959 Re: 1435 Wells Road Peconic NY V ` MAY 12 2003 Hello Charlotte: Southold Town FYI: Board of Trustees 1. On 5/7/03, Rob Herman flagged the wetland area on my property. 2. On 5/7/03, 1 mailed notification of the hearing to my neighbors. 3. On 5110/03, 1 posted the sign on the property. 4. Joe Ignegno will provide a new survey showing the new wetlands line as well as a line 50 feet upland of the wetlands line. This will be done in time for the 5/21/03 hearing. 5. 1 have enclosed the notorized "proof of mailing of notice" and the associated certified mail receipts. Also enclosed is the notorized "affidavit of posting". Thanks for all your help. Paul Schineller Paul Schineller PO Box 511 Sagaponack, NY 11962-0511 Telephone: 631-838-5050 Fax: 631-614-7922 Email: paschin@optonline.net April 22, 2003 Board of Town Trustees Town of Southold Town Hall PO Box 1179 53095 Route 25 Southold, NY 11971-0959 Attn: Mr Albert Krupski, President — Dear Mr. Krupski: As per your request, I have taken the following action: Today, I spoke with both Joe Ingegno (Surveyor) and Rob Herman (EnConsultants). 1. Rob will have the wetland boundary Flagged prior to May 14, 2003. Actually, it may be done much sooner than that and in any event, I will advise you as soon as it is done. 2. Joe will then produce a new survey showing the new wetlands boundry line as well as a line 50 feet upland of the wetlands boundry line. Yours Truly, Paul Schineller VSOPe :::3' Ix-0/•v6 SEE SEC IEl.069 x-01-VI � isiia to a I� G♦ z9 � e.oz• ]oam�v xzA y. e•iao� 1•oA I �• saAm , ..21 01.0o-0i Lt a •♦ fNE1cl w w OPEN 000t 1LIU B 9 1E.1 tl4U M1O♦ GM1 S - .S S P I i U♦ e G 1•G a -0 ♦ � GaG y Po tir s o x 14, • ,ry a 11 N ud N , J ! Oho n.aia b 10 a "00 9♦ y v x w J p2o G°� • 0♦ 1 ^ !C +\ ` —A. xix v'a tiye s 'o/ w a a s m 1 1'Om 6 Stl—D 7 �vomwl a el a F9 '' ftll PIRCFL N6 Wy 9 y N y0/ G - d u WA b d ISA Y IdA 45 Y S0J]x0.D I� 3 17 ,1 n u ia�ralr sar� — QO cz Lw i 9.l ]SAA x40A 1l1Yown wnPs< COUX]Y OF SO]iLLE `++ I.IUU e! Onnm.al mOP 6y StlL RSi.]D.E M1 d 3SR I zsu u isz iam w sartxnD I v a+msioa u iosx sDvi '' zsum � zw Pe M1ud fdl PIPEEL SEE SEGN0. —y, ♦ M1 G O11.OS-010 'Iry a M1 M, i 0 14 ],lAlcl 4 a d • = a e 14 A � 1 M1 � ♦ u � siva G�8 4$ n I.LIU uzua •@ av rom m sammn POR PARCEL 172 1.2 a SCE YL�In� pd Cae N6ro�aec�-a] °j �o Ew va.rn i¢sLi�a a a azA mR Pa.ws sum aec-atroos ��,P a9 '00v h �ry uE SEL xa oscroiroim auE EEc rm. e. _�_ -�— e 0)Eroi-oos.i WT. wiO1 IM luou a W1O1 SE 5¢SELN60e6 sEE L e K m 101 SOUTHOLD w _ c Nor Red Propertyy DTmc Serv� SECTION NO e A een r e,. 907 , n... .�.,, .. _ a.0 mnoi cm�o� nc....- .'iw1 T �u L Albert J.Krupski,President ®�oSV�Fo(��O Town Hall James King,Vice-President 53095 Route 25 �s� Gy P.O.Box 1179 Henry Smith � ? Southold,New York 11971-0959 Artie Foster w Ken Poliwoda • `F Telephone(631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Applicatio Wetland Permit Application Major Minor _Waiver/Amendme t/C a ges _Received Application: b _Received Fee:$ _Completed Application ��`1 Q _ _Incomplete _SEQRA Classification: Type I Type I1 Unlisted _Coordination:(date ' t i _CAC Referral Sent: _Date of Inspection: _Receipt of CAC Report: _Lead Agency Determination: _Technical Review: i _Public Hearing Held: � r` `63 y Y Resolution: Name of Applicant I A'ylL, A A/PV��—'L /� Address p® 0®>C l V Y Phone Number:( ) 6 3/ — S Zg S U ��0 Suffolk County Tax Map Number: 1000 - 75-494 — 13 Property Location: /*3,5— /V ` 160'7b S 5 (provide LILCO Pole#, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: r Board of Trustees Application GENERAL DATA Land Area (in square feet): 5—Z 7-4, Area Zoning: $f Previous use of property: Rj5-5,( IV i/A L Intended use of property: WSJ lei/'V % Prior permits/approvals for site improvements: Agency Date Al3MY GoKPs oc- L_V6,1Nr--;9/?S APR � •Z� / 8 J�393 �rz Doc Ny a 4, 1 q g A ( io-,91 0,5 .5r 7-0 1301-v H o vs F) No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? _ _X—No Y-es -- If yes, provide explanation: 'Project Description(use attachments if necessary): Project Description: 1. Cut down approx 30 decidious, garbage trees located within 100 feet of Tidal-Wetlands. 2. Plant evergreens and shrubs of local variety such as cedar, spruce, bayberry, etc. 3. Keep turf at least 50 feet away from Tidal-Wetlands. 4. Use only pervious ground cover such as wood chips, etc. Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: The purpose of the project is to let sunlight into my house and into the area around it which is very dark due to tall trees. 1. Cut down approx 30 decidious, garbage trees located within 100 feet of Tidal-Wetlands. 2. Plant evergreens and shrubs of local variety such as cedar, spruce, bayberry, etc. 3. Keep turf at least 50 feet away from Tidal-Wetlands. 4. Use only pervious ground cover such as wood chips, etc. Area of wetlands on lot: 31 square feet Percent coverage of lot: c33 % Closest distance between nearest existing structure and upland edge of wetlands: C'90 feet Closest distance between nearest proposed structure and upland edge of wetlands: 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: Manner in which material will be removed or deposited: 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): a& TYE_ W4 �A4b_5 -A&D `4,44, WWTERs o= �t r__ _7z"Jpq N Albert J.Krupski,President oS �C► Town Hall James King,Vice-President ��� �l/ .53095 Route 25 Henry Smith yet P.O.Box 1179 cz vz Southold,New York 11971-0959 Artie Foster W Ken Poliwoda ® 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 --------- --- - ------ COUNTY OF SUFFOLK) STATE OF NEW YORK) n AFFIDAVIT OF POSTING I&va. residing at )PO 00)J 1 being duly sworn, de ose and say: That on the /V day of AIA), , 2003, I personally posted the property known as Z*35' W,64 :!�, XQAb p E6W & 6✓X //%59 by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date o the public h aring. Date of hearing noted thereon to be held02�� � Dated: (signature Sworn to before me this day of/1,f- 200_3 Nota Public MAAY C.FEHRENMCH. Notary Pubfic,State of New York No.451768 tua!Med In Suf ok County��l3d�� CommlWon Exp me PROOF OF MAILING OF NOTICE ATTACH-CERTIFIED MAIL RECEIPTS Name: Address: STATE OF NEW YORK COUNTY OF SUFFOLK residing at I n3rr x FARM Coup- 6,-APPAIAGK N y /! —�being duly sworn, deposes and says that on the 7 day of /IA �' ,2003 , 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,5A&AP6' (' a�"Il/�',that said Notices ailed to h of said persons by ce i e (registered)mail. ' Sworn to before me this Jr Day of/'1 , 20 0-3 C. (_)Notary Public NARY C.FEHRENBACH N�l9ty PW)k Skate of New foils No.07660 QualVW In Suffolk W(nty . . r 5 t 1.4-16-4(2167)-Text 12 PROJECT I.D.NUMBER 617.21 SEC 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. APPLICANTISPONSORegf !�_ /l I 2. PROJECT NAME 4. 3. PROJECT LOCATION: l�3JL' W'644' y /ZbA-li:5 Municipality _7 EC,0 -'V14, // J_Y County L5 4. PRECISE LOCATION (Street address and road intersections,prominent landmarks, etc., or proviae map) 5. IS PROPOSED ACTION: rr----11 XNew ❑Expansion LJ Modificationialteration 6. DESCRIBE PROJECT BRIEFLY: 1. Cut down approx 30 decidious, garbage trees located within:100 feet of Tidal-Wetlands. 2. Plant evergreens and shrubs of local variety such as cedar, spruce, bayberry, etc. 3.- — Keep turf at least 50 feet away from Tidal-Wetlands. 4. Use only pervious ground cover such as wood chips, etc. 7. AMOUNT OF LAND AFFECTED: Initially a o acres Ultimately t 19 acres a. VJILL 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? i XResidential E!,!ndustrial ❑Commercial I Agriculture L ;Park/Forest/open space Ell Other . Describe: ----10—DOES--AC-TION-INVOLVE A-PERlAIT-APP90VAL.OR-FUNDING,-NOW-OR-UL-TIMA-TEL--Y-FROM-ANY-OTHER-GOVERNMENTAL-AGENC-Y-(FEDERAL, STATE OR LOCAL)? ❑Yes NNo If yes, list agency(s)and permit/approvals 11. DOES ANYS, P_ECT OF THE ACTIO14 HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes' ; No If yes, list agency name and permitlapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MOOIFICATION? - ❑Yes Nb I CEiITIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNCWLEDGE 413 Applicant/sponsor name: �� ��- NE�L G Date: �'f Signature: Q°e 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 i, Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) I, 14JRMu9 A, L3 0R IV AIV P residing at /yl_35 (print owner of property) (mailing address) do hereby authorize (Agent) PQUl, A /�, to apply for permit(s) from the Southold Board of Town Trustees on my behalf. a (Owner's signature) 8 ' AI�pLtCANT • ` TRANSACTIONAL DISCLOSURE PORN i • ti The Town of SoAhold's Code of Ethics Ofohibibe conflicts of interest on the part of town off icere and employees. The purpose of this form is to provide information which can alert the town of possible conflicts of inberest and allow it to take whatever action is necessary to avoid same. YOUR NAHB: r Last name, first name, m dd•le itilbial, 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. ) NATURE OP APPLICATION: (Check all that apply. ) Tax grievance Variance Change of zone - App pval of plat ;h Exemption from plat or official map Other (If "Other," name the activity. ) 47- Do you personally (or through your cbMpany, speuse, 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 Che 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 thib Corm 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) i A) the owner of greater than 5c6 of the shares of the corporate stock of the applicant (when the applicant is a corporation)l b) the legal or beneficial owner of any interest in a noncorporate entity (when the applicant is not a corporation)t c) an officer, director, partner► or employee. of the applicants or D) the actual- applicant. DESCRIPTION OF RELATIONSHIP submitted this dny d lgg 0 signature.... 'Print name. :. Srf i a^:�E._ -2 I'..; 4 :I•: r1S.ISK 3 SURVEY 0V PROPERTY j, SITUATED AT c, I PECONIC c TOWN OF SOUtHOLD �1 I SUFFOLK COUNTY, PIEW' YORK S.C. TAX No. 1000-75-06-13.2l'' _ SCALE 1"=201 r I MARCA',17, 1497 " AREA 95,S9A,9A AR.1t. 2.195 ac. All, IIIL UYIC S'FRTIFIFO T0: FIDESr LITY NATIONAL TITLE INSURANCE CDY9ANY Or N[W YORK ..1..., .. .. .._ .. .,..5�. AW �—_... .. ..:.. XA YANK TIAN BANK... •. _._ .. . - AL 'ST0 ASSOCIATES AL 8 YIR[ILLE A.BURNAND 2g7• W AL' II $ AW AL y` IW IL l�Q � •A rr •• IL IL . 5 y, IL IL Ak A. � � N 1 y' r✓v ' ^ ".,�• Q�A'OaYa IL IL :L +,� 7 .N,j H,',.•9. lk AL AL All Ak W D f IYLL JK OAlk I-- IL / �F. p N / 1 .,•. r+YN• L 3• dI P.&7u -- --- -------- AL 6 1 ,s�"Po s 'I'• ,�, IL �ti -1— - ALA Al t /yro _` '� Ak r,\\ IT IL AL IL AL I IWv Q� ".DSo hill AL II . �y AL W y lk-t L I lk AL i L s .. Ac VA-Z.. All AL All • •.••''I' AL � o9iiTiq rol e��imlq I - IYL IktAl I IW 16 ..'Is C' �` ' 94•4'30"W AL »ur IL y' ! Q I n ,•t!c.'.R/ -. - .. .-_... —_._.___. 14 AL ory AL m.. IL H£NRY��IfR�. 26o,91' I.� Joseph A.'.Ingegl ,L s I Lanii Survejrol l il4 ;� I rxoxt ou),n-29Ao n.��U»p ,r Mt papa.M Nun nAwi x�n Board of Trustees Application County of Suffolk State of New York FAvt— A , BEING DULY SWORN DEPOSES AND AFFIRMS THAT 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 APPL ATION. Signature SWORN TO BEFORE ME THIS DAY OF �— ,20 P3 No ry ublic MARY C.MHMBACH N*Y 8t b of New York No.469080 i°sf` 4, c =1M3d/(