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` Southold Town Trustees -
H Board Of S
SOUTHOLD, NEW YORK <..•-
August 20, 2003
(�q E
PERMIT NO DATE. ._.:...................:.........
........ '
RITA HOLOBIGIAN ---------------' -......._
�..
ISSUED TO 2 ya
,t 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 �«
;z
' State of New York 1952; and the Southold Town Ordinance eti-
titled ."REGULATING AND THE PLACING OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS and the
i' REMOVAL OF SAND, GRAVEL-OR OTHER MATERIALS FROM -x
_W LANDS UNDER TOWN-WATERS;!' and in accordance with the
August 20,
�.
Resolution of The Board adopted at a meeting held on ........................... . . �
2003 � and rn consideration of the sum of ._............................. paid by s F
1 L Rita Holobigian.......................................................................................................
........................................................
_> Southold N. Y. and subject to the
Terms and Conditions listed on the reverse side hereof, . .
y� of Southold Town Trustees authorizes and permits the following:
Wetland Permit to fill in low spots in back garden with 40 cy.
^s of clean fill and 20 cy. of screened top fill, to seed for lawn,
F„` a with the condition of a 50' non-disturbance buffer and a hay bale'
line placed down at 50' before the project begins. >r.
all in accordance with the detailed specifications as presented in
? •the originating application.
The said Board of Trustees here- �y
IN WITNESS WHEREOF, 4
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.
��g�FFO(k�oG
Trustees
� }- '�'�v'. .C�'.�a.�t�..s,-d�x'�•�-�,d�,Y.�€:�.�Lrf...ir".--_-�_-�:.�-���sir�srty N .T�" ..��� ,.ta✓ L} �.
TERMS and CONDITIONS
.1'he Permittee
Holobi ian
residing at 420 Glenn Rd. , Southold N. Y., as
part- of the consideration for the issuance of the Permit does understand and prescribe to the fol-
lowing:
i. That the said Board of Trustees and the Town of Southold are released from any and
all damages, or claims for damages, of suits arising directly or indirectly as a result of any open
ation pedomxd pursuant to this permit, and the said Permittee will, at his or her own ezpease,
defend any and all such suits-initiated by third parties, and the said Permittee assumes full liability
with respect thereto, to the complete'exclusion of the Board of Trusters of the Town of Southold
2. That this Permit is valid for a period of 24 mos. which is considered to be the'
estimated time'required to complete the work involved, but should.circ u istances warrant, request
for an extension 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 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-oompliance with.the provisions of the originating application,-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 rqxm a1009
the beach between high and low water marks.
7. That if future operations of the Town of Southold require the removal and/or alftradons .
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 required,
upon due notice, to remove or alter this work or project herein stated without expenses to the Town
of Southold
8. That the said.Board will be notified by the Permittee of the oompledon.of the work auth-
orized.
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 tame.
Albert J. Krupski,President ��� C'� Town Hall
James King,Vice-President �� G'y� 53095 Route 25
Artie Foster H - P.O.Box 1179
Ken Poliwoda Southold,New York 11971-0959
Peggy A.Dickerson y ��� Telephone(631)765-1892
Fax(631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
August 20, 2003
Mrs. Rita Holobigian
420 Glenn Road
Southold,NY 11971
RE: 420 GLENN ROAD, SOUTHOLD
SCTM#78-2-22
Dear Mrs. Holobigian:
The Board of Town Trustees took the following action during its regular meeting held on
Wednesday, August 20, 2003 regarding the above matter:
WHEREAS, RITA HOLOBIGIAN applied to the Southold Town Trustees for a permit under
the provisions of Chapter 97 of the Southold Town Code, the Wetland Ordinance of the Town of
Southold, application dated July 21,2003, and,
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
August 20, 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 standards set forth in Chapter 97 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 approve the application of RITA HOLOBIGIAN to fill
in low spots in back garden with 40 cy. of clean fill and 20 cy. of screened top fill, to seed for
lawn, with the condition of a 50' non-disturbance buffer and a hay bale line placed down at 50'
before the project begins.
Permit to construct and complete project will expire two years from the date the permit is signed.
Fees must be paid, if applicable, and permit issued within six months of the date of this
notification.
Inspections are required at a fee of$5.00 per inspection. (See attached schedule.)
Fees: None
Very truly yours, ,//7
Albert J. Krupski, Jr.
President,Board of Trustees
AJK/lms
Town Hall, 53095 Main Road
P.O. Box 1179
Telephone O Southold, New York 11971
(631) 765-1892
SOUTHOLD TOWN
CONSERVATION ADVISORY COUNCIL
At the meeting of the Southold Town Conservation Advisory Council held Tuesday,
August 12, 2003, the following recommendation was made:
Moved by Bob Ghosio, seconded by William Cook, it was
RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH
A CONDITION of the Wetland Permit application of RITA HOLOBIGIAN to fill in low
spots in back garden with 40 cy. of clean fill and 20 cy. of screened top fill, to seed for
lawn.
Located: 420 Glenn Rd., Southold. SCTM#78-2-22
The CAC recommends Approval of the application with the condition of a 25' non-turf
buffer. --
Vote of Council: Ayes: All
Motion Carried
ti
Albert J.Krupski, President �oSVFFO��CO Town Hall
James King,Vice-President Sao G,y 53095 Route 25
Henry Smith o= P.O.Box 1179 4-
y Southold,New York 11971-0959
Artie Foster A
Ken Poliwoda Telephone(631) 765-1892 <3LLYV&A
1Jf�JfQ1 �a�� Fax(631) 765-1366 A-
n�
VN1&ItA
BOARD OF TOWN TRUSTEES ' S -
TOWN OF SOUTHOLD (c� Lji-Y coo
Office Use Onlyg0�"
(3 �
\ Coastal Erosion Permit Application
Wetland Permit Application Major .Minor 's d
_Waiver/Amendment/Changes
-Received Application: 7 dl 43
deceived Fee:$
,Oampleted Application 7
_Incomplete E C E 0 V E
_SEQRA Classification: D
Type I Type II Unlisted
Coordination:(date sent) JUL JJ 2003
SAC Referral Sent:
—.,Date of Inspection: Southold Town
_Receipt of CAC Report: Board of Trustees
_Lead Agency Determination:
_Technical Review:
_✓P"ublic Hearing Held: a0Jo 3
Resolution:
Name of Applicant ITS H OLO f 6 Ia N
Address [9ZEAf' iv pd iq-t� j Soo 1 11C�L 1� - J
coo
Phone Number:(63i) 2
Suffolk County Tax Map Number: 1000-
Property Location: 4,10 &LEW N R 0 fI
(provide LILCO Pole#, distance to cross streets, and location)
AGENT:
(If applicable)
Address:
Phone:
Board of Trustees Application
GENERAL DATA
Land Area(in square feet): `a (� 0 O S c TV
Area Zoning:
Previous use of property: �O
Intended use of property: 11-e 12�
Prior permits/approvals for site improvements:
Agency Date
P 2 0 0 �v arl 1q , �w l� fo,-e meek
No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspended by a governmental agency?
No Yes
If yes, provide explanation—
n
Project Description(use attachments if necessary): fay ►� 'C)vJ
Board of Trustees Application
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: �� ye I ok y P Syj
Area of wetlands on lot: Z p 0 square feet
Percent coverage of lot: %
Closest distance between nearest existing structure and upland
edge of wetlands: 1 '� 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? t� cubic yards
• n
Depth of which material will be removed deposited: • fek
Proposed slope throughout the area of operations: 5LVU
ti
Manner in which material will be removed or deposited: �o L'G
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):
1•4-16-d(2/87)—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. APPLICANT!SPONSOR i 2. PROJECT NAME
6Q I TV; 1-I�L c�2l � f►�4N
3. PROJECT LOCATION:
Municipality 1 90ce- t 1 County U I✓ — L(1
4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map)
Izo &I-eMV �a
• SOLR
5. IS PROPOSED ACTION:
❑New ❑Expansion Modification/alteration
6. DESCRIBE PROJECT BRIEFLY:
i o vet A-rt c t-o v✓
F-OQ See
7. AMOUNT OF LAND AFFECTTtEA,,,.-.s �'/ y �� ft i 0.W
Initially n acres Ultimately acres
d. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING t-:ND USE RESTRICTIONS?
1
es ❑No if No,describe briefly
I _
9. WHR IS PRESENT LAND USE IN VICINITY OF PROJECT?
t_, esidential ❑.!ndustrial r Commercial ❑Agriculture L!Park/Forest/Qgen space Other
Desc:ibe:
W. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL,
STATE OR LOCAL)? /
❑Yes LLn No If yes,list agency(s)and permit/approvals
11. DOES ANY AS PT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
❑Yes' No if yes, list agency name and permit/approval
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE :MODIFICATION?
❑Yes ❑Nb
I CERTIFY THAT THE INFORMATION P90VIDED ABOVE IS TRUE TO THE BEST OF MY KNCWLEDGE
Applicant/sponsor name: 1+0t:0 a Date: L
Signature:
_ d(k 6 k 0 A—
If the action is in the Coastal Area, and you are a state agency, complete the
iCoastal Assessmen`•. Form before proceeding With this assessment
0VER
PART I1—=VVInC lh1EN T c SMEN I o be comcletea by :Age.n.c-
GCES ACTICN EXCEED ANY - :THFE_HOL7!N 5 NYCRR. ?.A::T 51T.'Z? If yes. cocrdinate :he review ,rocess ana use the FOIL_ _xiF.
1 '!2s Va
a. WILL.ACTICM REC=.VE .Crt-.CINATED RE`/IEIN AS PRCVI0ED =JR UPI L:STED ACT.iCNS iN 5 NYCRR. ?ART 5t7.7- if No. a negatwe ..ec:ara
may be sucersedec oy anotner;nvolvea agency.
L!Yes No
C. C:ULO ACTION FIESULT iN ANY AGVE=SE_==E..TS ASSCC:ATcD WIT':! 7"E TOLL IOJING.tAnswers may :e nanowritten. if ;egible)
I C1. Existing air quality, surface or'grounawater quality or quantity, noise :evels, existing :,afffc --atterns, solid waste prccuc:ion or glscC
potential for erosion, crinage or;loading problems?=colain briefly:
C2. Aesthetic,agricultural, archaeological,historic, or other natural or cultural resources:or community or neignberneod cnaracter? Exalain C,
C3. Vegetation or fauna. :Isn. srellfisn or wildlife species, slgniiicant habitats,or threatened or endangered soec:es? =:clam orlady:
C-1. A community's existing plans or goals as offlemily adopted,or a change in use or intensity of use of land or other natural resources?Explain cr
CS. Growth, subsequent ,.evelooment.or related ac:!vities likely to be induced by the orobosea action? Explain onefly.
CS. Long term, snort ;erm. c rmulative,or other etfec;s not identified in C.-CS? =xolain briefly.
other imoac:s iinctucing c-anges in use of either quantity or :ype of energy)? Exptain nr;efly.
t
I
�. :S THEFE. :R lS TH=_F!E ;_!KELY 70 aE.C:CNTROVEFSY RELATE-0 TO POTENTIAL ACVERSE _NVIRCNIAENTAL:,;PACTS?
_ Yes !Na :f Yes. exclain briefly
?ART III—D1=r ERMINATICN OI:-_SIGNIFICANCE (To be completed by Agency)
INSTRUCTIONS. For eac:'I adverse effect identified Stove.determine whether it is substantial,large, important or otherwise signific.
Each affect should be assessed in connection with its (a) Setting (i.e. urban or rural); (b).probability of occa=ng; (c) duration:
irreversibility:(e) geograenic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure
explanations ca-main sufficient deiaii to snow that all re!evant adverse impacts have been identified and adequately addresser.
r Check this box if you have identified one Or more potentially large or significant adverse impacts which MA''
occur. Then proceed directly to the FULL E.�E andlor prepare a positive-declaration.
i C~ec.< this box if you have determined, based on the information and analysis above and any su000rtinc
i documentation, :hat the pr000sed action ;PILL NOT result inertly significant adverse environmental imcactS
AND provide on attachments as necessary, the reasons Supporting this determination:
I
i
i
-- - N„Ile of .caU Agency
i
lnnt or :vpc N.une Ji '(esccn%;oie t.:incer:n Leao.1�genCV :file or >Le:oonsrore Officer
I
�IgnatL'fC 9r se.•ent :fnT rC5oOn5101,!offiC2r1
lesconslote'.rtiCer in Leto Agency )ignature or lreoarer tit toi
' Jttc
Albert J. Krupski,President O��SVfFO(�CO
Town Hall
James King,Vice-President �`Z` G�f.� 53095 Route 25
Artie Foster O ' P.O.Box 1179
Ken Poliwoda W Z Southold,New York 11971-0959
Peggy A. Dickerson �,ti �� 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)
AFFIDAVIT OF POSTING
I, residing at (42.0 � ���� Qc0A
AJ� « �
being duly sworn, depose and say:
That on the ' day of 4yelrf",200 , I personally posted the property known as
j C� 12 �ZcD'_ S C)
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 of the public
hearing. Date of hearing noted thereon to be held oX3
�rl Of, 9W ft.
Dated: _
(signature)
Sworn to before me this
M day o f4f,/-2004
Notary Public Notary -
PETER J, GPAIG
p�qc,Sta!e of New York
Oual'ified i n30 972102
Commission Ex Nassau County
fires Sept, 17 `��
PROOF OF MAILING OF NOTICE
ATTACH-CERTIFIED MAIL RECEIPTS
Name: Address:
Mrs. Ann Kosel 320 Glenn Road, Southold, NY 11971
Mr. Tack Kavanagh 500 Glenn Road,- Southold, NY 11971
Mr. V. Ricciardi 60 Shepard Drive, Southold, NY 11971
•
STATE OF NEW YORK
COUNTY OF SUFFOLK
.RTTA.HOLOBTGTAN ,residing at 420 Glenn Road Southold, NY > > A71
being duly sworn, deposes and says that on the
day of ,20_, 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 df Southold; that said Notices were mailed at the United States Post
Office at ,that said Notices were mailed to each of said persons by
(certified) (registered)mail.
>�
Sworn Woofe this v`-3
Day of20
Notary Public
LYNDA M.BOHN
NOTARY No.01i606020932State of New York
fie March 8: 20d7
Termerrn Expires Mar
i'
NOTICE TO ADJACENT PROPERTY- OWNER
BOARD OF TRUSTEES, TOWN OF SOUTHOL.D
In the matter of applicant:
AOLOgiG' 1ifIJ SCTM#1000- �� � �' 2�
YOU ARE HEREBY GIVEN NOTICE:
1 . That it is the intention of the undersigned to request a
Permit from the Board of Trustees to:
04
2 . That the property which is the subject of Environmental
Review--is located adjacent to your property and is described as
follows :
6-DOS�
3 . That the project which is subject to Environmental Review
under Chapters- 3-2 ° 37 , or 97 of the Town Code is open to public
comment on: You may contact the Trustees Office at
765-1892 or in writing.
The above referenced proposal
under
doesreview
not referenBeard any f
Trustees of the Town of Southold and
other agency that might have to review same proposal .
OWNERS NAME : J°C 14 01-0("S ( 6 6-al IV
MAILING ADDRESS : °-='2_ i C±j='--3V
PHONE - 5'-Zz-
P 5au i/toc-��
Enc. : .Copy of sketch or plan showing proposal for your
convenience.
Board of Trustees Application
County of Suffolk
State of New York
IT P� 140 L C7 R(C-) AW 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 HISIBER 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.
C.
Signature
SWORN TO BEFORE ME THIS ( DAY OF ,2CV-
64No ' Public
LYNDA M.BONN
{NOTARY PUBLIC,State of NeW`fo'tk
140.01 B06020932
Qualified
in SuttojW Ma ch QmAIS 2QA :
.Term Ey
APPLICANT
TRANSACTIONAL DISCLOSURE PORH
The Town of Southold's code of Ebhies ' rohibits conflicta of
nterest on the part of town off cere 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 L-o avoid same.
YOUR NAHE: • r. .
TLast name, first name, m dd•le inibial, unless
you are applying in the name of someone else or
other entity, such as a company. If no, indicate
the other person's or company's name. )
, t'• _. . . •'";��t:„+mot::::i'Gp.;.,y. -
MATURE Olt APPLICATIONS (Check all that apply. ) t
Tax grievance
Variance
Change of zone
App�pval of plat ;h
Exemption from plat or official map
Other ✓
(If "Othen" name the activity. ) Ap•;�) F LL
Do you personally (or through your ebinpany► npeuse, 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. "Buniness
interest" means a business, including a partnership► in
which Ehe 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
VZ-
if you answered OYES,". complete the balance of Chid korm and
date and sign nhere indicated.
Name of person employed by the Town of Southold
Title or position of that person
Describe the relationship between yourself (bba 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) s
A) the owner of greater than 59G of the shares of the
corporate stock of the applicant (when the applicant
is a corporation))
t) the legal or beneficial owner of any interest in a
noncorporate'entity (when the applicant is not a
corporation))
C) an officer► director, parbner, or empibyee. of the
applicant► or
D) the actual-applicant.
DESCRIPTION OF RELATIONSHIP
submitted
Sig•naLura.....
;G,:
print name � ;,� x ,
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MQORNG.S .AND STAKES MUST DISPLAY UTSIBLZ:'MOORING.NUMBERS.
ALh DOCKS` AND BULKHEADS MUST.DISPLAY:`.V�SIBLE; PERMIT- NUMBERS
4 cap,-
4'?...A �.�3++a�S -i_�yrr�1-~i��s4:�rr..h.=r�d.�.••i��v..+e+� Pans 1=i��.+^;�- :�al� •� � .
Board +af Sat�tho1-d Town. Trustees, ,..�.
SO.UTHOLD, NEW YORKMoorihg
f��l
-xs pF 6r.NO, :i 9�9 9 DATE=AID. ?:s
.ED�5T0
t r. -
•-x
•�'k: •tom'-`.:.t; �.. u�aar;tQ 9 ro'visio I .
P_.. ns:of; Cha fei.'6 t5'of the taws. of.
;the: - f of Aew Yo�7c t.8'43= and.Chu t P .
to :< p. er�t04:of fhe.Laws of the:: .�.�
Slated :£Ne ,
y# YorjC,:a952;':and the.5outhoid Town Ordinance`en= -'
,r ,
tifled: .REG (:A�11kfG'AND:THE PLACING bF OBSTRUCTIONS: ,, ,
w,
IN AND ON;10W. WATERS: AND PUBLtC L1A'NQS 'arid fhe
R1=t�iOYAL S ND GRA. '
: Q. ,_.. YEL OR OTHER MATERlAtS FROM %J
h' t LtANDS'D D. TOWN.:)IVRTER and in,.� N ER' S� ;accordance':wifh :t(ie
,Y. _ �o.n of fhe Board adopted. at a meeting heid.on 4ugust._.1.
•
Y
fhe;.sum.of $ id'by :' _
peQ .g.
SouthH
..Term a a•017 i' __.4 ........ N.. Y. and..:subject.to: the
K .s n M',Cond�tions:µ(irked t,on the reverse .side: hereof,:. : y
A:S1 thold Town Tiusfeallthorizes and perrrrits tjie. foliawing: . ,� '
pp scation :approved under the -Gr4#df; pier Clause
3 ix p-
4k ::to secure a, permit .for a. foot .
- ;} �« utho'Id a1T in accordance t
application submitted. with the
4
a1I'.in:accorda.�ce.wi}h fihe`:defiai(ed:s ecifications as. : resented in�� i• P , I
�r the originating.appiicafiion
y
IN WITNESS:WHEREOF, .The'-said Board. of.Trustees here-
by causes ifis Corporafe•Se.. to.be mixed and fhese:'prese'nts. to .,
{ be subscribed;.by a. ma.jdrity of the '.d :_ oard�as of his d -
. . 3:
rY i C=.
c y�;• '!� Trust.es _ I
W,,,,[[ r :b�...+`.jGr.:`�r` f�,'!` ::1.�.� 'iv
. ���_.�•'-.MV���F .� • a t jet
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Al
TERMS and :CONDITIONS
The Perrnittee Louis .R. . De Ronde
residing at.. 6 G.lenn. Road. Qo-u;Lho I cl_ "�• `r.;.as f
part of the .'consideration for the issuance of the Permit does understand..and presaYbe.to the fol- ^'
lowing: :. 1 : That. the. Southold Trustees Permit..must be prominently
displayed.1 on the premises effected -thereby .during the period. of
''• • That the said Board of Trusiees and the 'xowa of Southold :are released from.as arid work
y
1'.all'damages, or claims for damages,.of.suits arising.directly or indirectly as a'iesult of nay ogcr- unde
-6ti0a pu.fotrped'.purs=t to tliis petudt, and the said.Petmittee will, at his or her own eapease,.the
defend.any and all such snits.initiated by:third.parties;and the said Permittee assumes full liability PerMi.
atit4.respect thereto, to tlzc complete exclusion.of-the'Board of Trustees of-the Town of Southold
3:.:::Mc this Permit is..valid fot`a period of: Z 9 : mos. which is:considered to be the `
sillfiCie t time required-,to work involved,.but should circumstances-warrant,.regtiest'
for an extension may be made to the'Board ai a later date.
'4• That this Permit should be:retained indefinitely, or as Iong-as the said Permittee wishes
to maintain.the-structure of project .involved; to provide.evidence to anyone concerned that aath .°`':.:;
{. or=tion was originally obtained.
S That the: work involved will be subject to the inspection and. approval of the Board or
its agents, =4-non-compliaace with the provisions-of,the originating application;may be cause for
revocation of.this' Petmirby resolution of the said Board. '
6: That.there will be no*unreasonable.interference with navigation as 'a result of the work
I
erein audio
. --:-
7. Mat there-shall be no-interference with:the right of the public to pass and repass,along
��. the beach between high'and low water mat?cs,
&.-That if futute operations.'of the:Town of'Southold require the removal and/or alterations. '
# � In •the.location of the, herein anthoiized; or if, in die opinion•.of'the`Board of Tnutees, the'
work shall:cause unreasonable obstntctsori 'to'free'navigation, the said Pertnitiee will.be required,
upon due notice,to remove or alter this work or.project herein stated-without expenses to the Town
.. } of Southold.
{� 9:"That'the said.Board will be'notified.by the Peimictee or the eompletioa:of the work.auih-'. :` . .. ..
adzecL '(See tear off sheet.j' `
That the:.Pecmittee will obtain all other.Permits:and consents that ma be ed
h0'. ' P, , y requir suP'`..
�' .'. elemental co this peimit which'may be'subjecE to revoke.upon;failure to obtain same.
J.
ALL DOCKS AND .BULK-..
NEADS MUST. DISPLAY
VLS1B•LE'PERh1IT NUMBERS. BOARD OF' TOIVN TRUSTEES
TOYIN>.OF-.SOUTHO LD
ALL MOORINGS. AND. ' Telephone
141ain Road
STAKES MUST DISPLAY. (51'6-765�18'92)
VISiBLE'.Niob'RlNG.-.N;IjMBERS. .. 'Southold,: New York 1..1971
NOTICE OF ACTION NOT A PER&UT,
Louis R: ;De Ronde
To. ..................'..... .... ........ ..
I.; Your application-, dated: Z719/.85. .......... ,has beer'. reviewed by
this Board; at'a* `meeting of the Trustees .held an.:A��s�.�a..'79.$�:......:....
: .
and-restiltih' in the action,. as: indicated ,below:
(..XM) Application approved.
(:.:..j Application denied. .
Application tabled.
2. Comments.and remarks:
APP,li.cation 'aPP roved .as Per resolution adopted
on :August .1, -1985.
,
3. . If your application is approved-.above, a Permit Fee is now due' and
should.be made payable. to the order- of,the Board.of Southold Town' .
Trustees.. This fee is computed 'beiotiv according to the Schedule.'of
. Rates as set forth in the Instruction Sheet (Farm 111). . This fee. must
be paid within';•90 days or reapplication and additional fee will. be
necessary.
If-the Permit. Fee is .paid in'person to 'the Clerk o.f the Board, the' Permit .
will be- obtainable at, the same time, if the fee is paid by mail, the Permit
will' be.-mailed in reply..
Computation of Permit Fee.:
Total Fee for• this applicafion.......................
President, Board- of Town. TrL
Fsolow
o.
Issued .-TofA ,
i Zda Datomw
Address .-
-AIV
THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION
TOWN TRUSTEES OFFICE TOWN'OF SOUTHOLD
:. SOUTHOLI) N.Y. 11.97i
TEL.: 765-1892 '
Name of Creek:
TELEPHONE
(516)765-1892
'BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road.
P.O. Box'728
Southold,New:York 11971
GRANDFATHER- APPLICATION-
Name of App13.cant: LQUIS R. DE RONpE
2. Address of Applicant: 6 GLENN. ROAD
SOUTHOLD
3. Telephone Number: 516-921-3059
4. ' Year of Construction` UNKNOWN
5. Sketch of the work including. sizes:
r 74
*. MAILING ADDRESS: 279 SWAN CT. , MANHASSET, NY ' 11030
6. Mark off on the map attached, where your property 'is located
using an X.
S Hato e: Azle
Please note that there is a $5.00 filing fee, which is a one -time
-- fee, for this aFPlicatioa
Mooring Applications-' $5.00 Application Fee and a $5,00 annual renewal
fee each year.
0
a. TELEPHONE
(516).*-1892•
BOARD 'OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 728
i Southold, New York.11971
CREEK STRUCTURES INVENTORY
Current Owner's Name: �' ' `. Index No.
Address:'. L4 (0.J
Creek:. l�V�
Purchase. Date:
Telephone No. e Date' of Field Work: -
Wt
Previous Owners: .0 C��.t S
Permit Applicant:
Permit No. :
Permit Specifications:
g
Specifications Found: /2d� P�( OY_\ k.('o1'1
Condition:
�r
i Comments:
1 '
i
y
1 M,
IT
fir-
WATER
y� :f
-
r ;: AM
Gods 2 Cr e e