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HomeMy WebLinkAboutTR-6093 Albert J.Krupski, President j } Town Hall �FFot James King,Vice-President �Q$ /�'C 53095 Route 25 Artie Foster �0 �G P.O.Box 1179 Ken Poliwoda Q ?'J� Southold,New York 11971-0959 Peggy A. Dickerson ti Z Telephone(631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1 st day of construction % constructed Project complete, compliance inspection. oS�FFo�,��, Albert J. Krupski, President ��. Q Town Hall James King,Vice-President G'y� 53095 Route 25 Artie Foster y - P.O.Box 1179 • Southold, New York 11971-0959 Ken Poliwoda Peggy A.Dickerson y�0 a0`► Telephone(631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD April 20, 2005 Mr. John Costello Costello Marine Contracting Corp. P.O. Box 2124 Greenport, NY 11944 RE: JOCKEY CREEK TRUST C/O KATHLEEN DEVORE 635 LIGHTHOUSE LANE, SOUTHOLD SCTM#70-6-30 Dear Mr. Costello: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wed., April 20, 2005: RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to Permit#6093 to remove 45 linear ft. of the west end and 18 linear ft. of the east end of the existing bulkhead and replace same in-place using "C-Loc" vinyl sheathing. Construct 112' linear ft. of new bulkhead immediately in front of the remainder of the existing bulkhead again using "C-Loc" vinyl sheathing. Project will include a 15' non-turf buffer behind the new bulkhead, and all as depicted on the plan prepared by Costello Marine Contracting Corp. last dated April 8, 2005. If you have any questions, please call our office at (631) 765-1892. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK:Ims Iffy � � \ f �' _��*.'./ " ��-R •�.+.�:.•.:� to < Board Of Southold Town Trustees v �+ SOUTHOLD, NEW YORK . March 23 2005 '• PERMIT NO. ... �a•C).q. .... DATE. ........................�....... JOCKEY CREEK TRUST C/O KATHLEEN DEVORE ISSUEDTO ................................ . r; • ` Pursuant to the provisions of Chapter b 15 of the Lews of the State of New.York, 1893; and Chapter 404 of the Laws of the 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 MATERIALSrFOM LANDS _UNDER TOWN WATERS;'•.'• and in accordance with 'the Resolution of The Board adopted at a meeting held on ..March*-23, 2005 250 00 aid b . ........., and in consideration of the sum of =................�........... P Y KathleenDevore ............._.............................................................:... ..... southola ............................................ N. Y. and. subject to: the 1 of ... . Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: Wetland Permit to remove approx. 175 linear ft. of existing , bulkhead and replace in with new bulkhead using vinyl sheathing, with the condition of a 15` non=turf buffer. landward ; of the bulkhead, and all as depicted on the plan prepared by all in accordance with the detailed specifications as presented in •the originating application. :c Costello Marine Contracting Corp. last dated March 24, 2005. J IN WITNESS WHEREOF, The said Board of Trustees hiere- i by causes its Corporate Seal to be affixed, and these presents to be subscribed by a maiority of the said Board .as of this date. a Cm s Ar oster -ABSENT Trustees � emu- _r:�_. • ..-.�., •.��•- Nor _ti ay.�•. -. �1-�•••. .3• +! ,.TTY's' 4' v �M TERMS and CONDMQNS PetCtee Jockey Creek Trust-•c/o •Kathleen DeVore :.: 635 Lighthouse Lane, Southold .. N. Y. Vatt•of the consideration fQr the issuance of the Pettait does understand and prescribe to the fol- cgs i. That the said -board of Trustees and the Town of Southold are released-from any cad all damages, or claims for dawaM of atlts arising.directly cc indirectly as a result of ay opev . sdon performed..pursttaat-�.: ..pectnie, .t+nd_.the aid Permittee..wilh_.! leis or her osu�a e�cpeasq defend any and all such suits`init ated by.third patties, and the said Vertnittee ammo s full liability with respect thereto, tur-the plete'exclusion of the.Board of Ttusteft of the T66 of Southold. 2. That this i 1$ Talid for a ptriod of - �` -- am which is cfo't>s;detbd to be the estimated time'required to complete the work involved, but should dre u utances wonar, request, for an erteasion ,may be made to the board at a .hoot da4e: 3. That 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- :odzation was originally obtained. , 4. That the wodc involved will be subject to the Inspection and approval of the Board or its agents, and non-compliance with the provisions of the od&mdng apP11catioa,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 wodc herein authorized. 6. That there shall be no interference with the right of :the public to pass cad repass along the beach between and low water marks. 7. That if future operations of the Town of Southold require the.removal and/or alterations to the location of the wotk herein-audwrized, or lf, in the opinion of--the.Board of Trustees, the. wotk..dmn cause unreasonable obstruction to free navigation, the said Peamittee will be tequkA "-due aodoe, to remove or alter this work or project herein stated without vxpewes to the Tom ` of $outhold. 8. That the said Board will be notified by the Permittee of the completion of the work a n& orized. 9. That the 'Permittee will obtain all other permits and consents that any be required sum elemental to this permit which may-be subject to revoke upon failure to obtain aame. • r � c Albert J. Krupski, President ��+ QG Town Hall James King,Vice-President ti� y� 53095 Route 25 Artie Foster y 1 P.O. Box 1179 Ken Poliwoda • Southold,New York 11971-0959 Peggy A. Dickerson Telephone (631) 765-1892 1 `1► Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD March 23, 2005 Mr. John Costello Costello Marine Contracting Corp. P.O. Box 2124 Greenport, NY 11944 RE: JOCKEY CREEK TRUST C/O KATHLEEN DEVORE 635 LIGHTHOUSE LANE, SOUTHOLD SCTM#70-6-30 Dear Mr. Costello: The Board of Town Trustees took the following action during its regular meeting held on Wed., March 23, 2005 regarding the above matter: WHEREAS, Costello Marine Contracting Corp. on behalf of JOCKEY CREEK TRUST C/O KATHLEEN DEVORE 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 February 1, 2005 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 March 23, 2005, 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 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, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approve the application of JOCKEY CREEK TRUST C/O KATHLEEN DEVORE to remove approx. 175 linear ft. of existing bulkhead and replace in-place with new bulkhead using vinyl sheathing, with the condition of a 15' non-turf buffer landward of the bulkhead, and all as depicted on the plan prepared by Costello Marine Contracting Corp. last dated March 24, 2005. 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$50.00 per inspection. (See attached schedule.) Fees: $50.00 Very truly yours, Albert J. Krup slJr., President Board of Trustees AJK/Ims SOFFO(,� Albert J. Krupski, President 0�� C� Town Hall James King,Vice-President =y` Gy� 53095 Route 25 Artie Foster p P.O.Box 1179 CA Ken Poliwoda Southold,New York 11971-0959 Peggy A. Dickerson Telephone(631) 765-1892 j Fax(631) 765 wee-(o631 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Please be advised that your application dated ` Ivy has been reviewed by this Board at the regular meeting of and the following action was taken: �)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: 1�S r TOTAL FEES DUE: 4,.4,4 SIGNED: 9 PRESIDENT, BOARD OF TRUSTEES S%3FFO(,�co Telephone p Town Hall (631)765-1892 y 53095 Route.25. Q P.O.Box 1'179`r W Southold,New York 11971-0959 CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD At the meeting of the Southold Town Conservation Advisory Council held Tues., March 15, 2005, the following recommendation was made: Moved by..Don Wilder, seconded by Tom Schlichter, it was RESOLVED to recommend to the Southold Town Board of Trustees APPPROVAL WITH A CONDITION of the Wetland Permit application of JOCKEY CREEK TRUST C/O KATHLEEN DEVORE to construct 175' of bulkhead immediately in front of existing bulkhead using C-Loc vinyl sheathing. Located: 635 Lighthouse Lane; Southold. SCTM#70-6-30 The CAC recommends Approval of the Application with the Condition of a 50' non-turf buffer landward of the bulkhead. Vote of Council: Ayes: All Motion Carried W -r_' _`�=~ -'-- -~�---� �----�-'-- -_�'-� ' Kathleen and Steve DeVore Proposed: Construct of bulkhead using C-LOC 635 Lighthouse Lane, South NY 11971 vinyl sheathing immeawely in front of existing. Photos taken 10/8/04 Ap O.A. Wick f hi' t 1 it , �•' F ` r 'R r' -fir `{ �I '�N `•�}" �� �.4 f'",_ .tip•�,. `4 S ` Kathleen and Steve DeVore Proposed: Construct of bulkhead using C-LOC 635 Lighthouse Lane, Southuiu, NY 11971 vinyl sheathing immediately in front of existing. Photos taken 10/8/04 ARM vi 606 PIP . ,tea. _s�- t c . O�OSVFFD(�C� Town Hall Albert J.Krupski, President �� Gy 53095 Main Road James King,Vice-President c t P.O.Box 1179 Henry Smith COD_ = Southold,New York 11971 Artie Foster Dy • �� Telephone(616) 765-18,92 Ken Poliwoda �J�l �a0 Fax(516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use, Only Coastal Erosion Permit Application /Retland Permit Application Grandfather Permit Application Waiver/Amendment/Ch/n_gQp Deceived Application: ..-Received Fee: $ e=fEC E plication / U® �1/] iCompleted Ap Incomplete SEQRA Classification: FEB - 1 2005 ` Type I Type II Unlisted Coordination: (date sent) SAC Referral Sent: Z / Southold Town ✓Date of Inspection: 6 Board of Trustees Receipt of CAC Report: Lead Agency Determination: Technical Review: ✓Public Hearing Held: Resolution: Name of Applicant a& 0 Address Mill Phone Number: (qq8 ) g-Icl dLoa Suffolk County Tax Map Number: 1000 - 70 " a - 3d Property Location: (provide LILCO Pole #, distance to cross streets, and location) AGENT• T (If applicable) Address: Phone 41 FAX# : -QW 1 i ,Ioard of Trustees Applica' ❑ GENERAL DATA Land Area ( in square feet) : 600 Area Zoning: t5i asidtilQ. Previous use of property: 5&n6e.. Intended use of property:- kML. Prior permits/approvals for site improvements: Agency D to h47-W-Bu4/7 11.21O/oo 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: Project Description (use attachments if necessary) : �'flVl Y1,lGT �1� 1 D &Ithcad nwAl elmik c L44 an r: ,ex�_b c�f2lm -car 111n.l ,��h�� 2 BoE of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: bu 1 Lbpfid is l/ Area of wetlands on lot: �,�06 square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: I feet Closest distance between} nearest proposed structure and upland .edge of wetlands:— 14 feet Does the project involve excavation or filling? No X Yes If yes, how much material' will be excavated?_cubic yards How much material will be filled?,3ut tlu 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: CAJAP 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�11 —140 -(u ytirsQ ekL 10 4AX enVJ dMi e.v 1 d asp AQ YAP eC461►c ► t 101&wt 69 -!5en SM 3 Board of Trustees Applicr Dn County of Suffolk State of New York AlAfi r"k &Cj� BEING DULY SWORN DEPOS S AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS) AND THAT ALL STATEMENT'S 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 So=OLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY. AND ALL DAMAGES AND CLAIMS I ARISING UNDER OR BY VIRTUE OF SAID PERMIT( S) , IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPR.ESENTATIVES( S) , TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. i Signature SWORN TO BEFORE ME THIS DAY OF Notary ublic C;YNTHIA M. MANWARING :�T,4RY.PUBLIC, STATE OF NEW YORK NO:01 MA6100507 QUALIFIED IN SUFFOLK COUNTY OMMISSION EXPIRES OCT. 20 7 COSTELLO MARINE CONTRACTING CORPORATION DOCK BUILDING•JETTIES•BULKHEADING•STEEL&WOOD PILING • FLOATS 423 FIFTH STREET • P.O.BOX 2124 • GREENPORT,NEW YORK 11944 • (631)477-1199/477-1393/477-0682 FAX(631)477-000E ' r AUTHORIZATION FORM owner of Business roperty Name. located at 5ji6o Lc, A) Y do hereby give Costello Marine Contracting Corp. the authority to act as agent in my behalf in applying for all of the necessary permits for work to be completed at my above referenced property. Datd Signature Albert J. Krupski, President �OSufF0j/( Town Hall James King,Vice-President =`Z`� G.f, 53095 Route 25 Artie Foster p P.O. Box 1179 Ken Poliwoda C00 Southold,New York 11971-0959 Peggy A. Dickerson y 0� 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, �2�lr4 J_ Z&14 7� , residing at being duly sworn, depose and say: That on the day of , 200 , I personally posted the property known as (','357 L1ti y a E A.., ti. f. //Q 7/ by placing the Board of Trustees official poster where if/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 Ujad,. '7'1 44eh a3,&100 S 'on (0 46 ui wo emn Dated:, a�{ � QsiatuWre) Sworn to before me t�s %'ay off r00S Veronica F. Cidone Notary Public, State of New York No: 52-4661406 Qualified in Suffolk County of Public Commission Expires ©ec.31, 1' PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: P' ��scr STATE OF NEW YORK ' COUNTY OF SUFFOLK .1�•�" LJ. ����=r��' , residing at 1',o1,:.ire %;.��� being duly sworn, deposes and says that od the f5 day of GIf ,; _, deponent mailed a true copy of the Notice set ort 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 we a mailed at the United States Post Office at I /'o , that said Notices were mailed to each of said persons b (certified) (registered) frail. 4q./ me this /6�t Veronica�.'�OM y Public Notary Public,state of Now York No: 52-4661406 oualified in Suffolk Coun� z� Commission Expires Dec.31, 6 NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: Kathleen DeVore S.C.T.M.# 1000-70-6-30 YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: 2 . ❖ Construct approximately 175 linear feet of bulkhead immediately in front of existing bulkhead using C-LOC vinyl sheathingl. 2 . That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows : 635 Lighthouse Lane, Southold, NY 11944 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 Wednesday, March 23, 2005 on or about 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: Kathleen DeVore MAILING ADDRESS: 61C Old Mill Road Chester, NJ 07930 Enc. : Copy of sketch or plan showing proposal for your convenience. 617.20 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART 1-PROJECT INFORMATION To be completed b licant or Proj act S onsor 1. APPLICANT/SPONSOR 2. PROJECT NAME COSTELLO MARINE CONTRACTING CORP.(CMCC) KATHLEEN&STEVE DEVORE 3. PROJECT LOCATION: Municipality SOUTHOLD County SUFFOLK 4. PRECISE LOCATION(Street address and road intersections,prominent landmarks,etc.,or provide map) 635 LIGHTHOUSE LANE,SOUTHOLD,NY 11971 SCTM# 1000-70-6-30 5. PROPOSED ACTION IS: Q✓ New Expansion 1:1Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: CONSTRUCT 175'OF BULKHEAD USING C-LOC VINYL SHEATHING IMMEDIATELY IN FRONT OF THE EXISTING BULKHEAD. 7. AMOUNT OF LAND AFFECTED: Initially ----- acres Ultimately ---- acres 8. 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? RiResidential ❑Industrial Commercial Agriculture Park/Forest/Open Space Other Describe: PRIVATE RESIDENTIAL WATERFRONT 10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING,NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL,STATE OR LOCAL)? ❑✓ Yes No If Yes,list agenoy(s),name and permittapprovals: ACOE,NYSDOS,NYSDEC,SOUTHOLD TOWN TRUSTEES 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Yes R]No If Yes,list agency(s)name and pem,it/approvals: . 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 Applicant/sponsor name. J STELLO PERMIT MANAGER ,CMCC Date: lb / Signature: e action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this asgessment OVER 1 , PART II- IMPACT ASSESSMENT `ry be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR,PART1617.4? If yes,coordinate the review process and use the FULL EAF. Yes 11 No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative declaration may be superseded by another involved agency, Yes 11 No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten,If legible) C1. Existing air quality,surface or groundwater quality or quantity,noise'levels,existing traffic pattern,solid waste production or disposal, potential for erosion,drainage or flooding problems? Explain briefly: C2. Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources;or community or neighborhood character?Explain briefly: C3. Vegetation or fauna,fish,shellfish or wildlife species,significant habitats,or threatened or endangered species?Explain briefly: C4. A community's existing plans or goals as officially adopted,or a change In use or intensity of use of land or other natural resources?Explain briefly: C5. Growth,subsequent development,or related activities likely to be induced by the proposed action?Explain briefly: C6. Long term,short term,cumulative,or other effects not Identified In C1-05? Explain briefly: C7. Other impacts(including changes in use of either quantity or type of energy)? Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA(CEA)? Yes No If Yes,explain briefly: E. IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? Yes No If Yes,explain briefly: PART III-DETERMINATION OF SIGNIFICANCE(To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large,Important or otherwise significant. Each effect should be assessed in connection with Its(a)setting(i.e. urban or rural); (b)probability of occurring;(c)duration;(d)irreversibility;(a) geographic scope;and (f)magnitude. If necessary,add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been identified and adequately addressed. If question D of Part II was checked yes,the determination of significance must evaluate the potential Impact of the proposed action on the environmental characteristics of the CEA. Check this box if you have Identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. Check this box if you have determined,based on the Information and analysis above and any supporting documentation,that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide,on attachments as necessary,the reasons supporting this determination Name of Lead Agency Date Print or Type Name of Responsible icer in Lead Agency 71tiaof Responsible-Offl—cer Signature or Responsible Officer in Lead gency Signature of Preparer(if dulerent Trom responsible officer ,i f ' e " ,y Gay sn,.Foc� JoG�� �.J ro e 7zP AbAVP P� VIC iiv/T r �c�fQ1� Lac ctT/o�r♦v1A1� or �t�J.t�r T�1�ao�y+�aTY OIy�/�?S• © _..11�c+f`S E.G/B�+�S © .JoNNtl.✓t.t l�iRa/N�a O f{oor�3o+'�, ;Zosv4 7y 1ri'37'.aB6T I�aR�S 4a4S �i AVA W0. 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"WADI iOAlD Of PU51'f[S DI ~ i • i rY`J 401fil.Yffl,t i ; w �, •; ',YJC�! ��ttK TN14 � a�r1 OVIERIS)OF RECORD. y SUBJECT OF PUBHC EAll 11+j(afti tvu�►butUnd In long � TIME&DATE OF PUBLIC HEARING w OWh; ;01'000rabW ISM. `��,• !.� �� �,� . i 4 f �k" ti f" G►e Min �Ytt's� t ►M � b 16 tly *iA are . {{{ Apm WARD Of 1PlJ`ai tk 'turn l �,DJRQD♦1631110 I8`+' r` M ♦ r.t . 4e,'�!i'.� IL " ;lilt • �'�1 \ 1 1i y y i+ �: 1 � � ',;;" �� 1��' ;.� ' ►�`:j. � '� +'ifr7' It tK e 1 , f„ 1 / 1 ' � .3 COSTELLO MARINECONTRACTING `LION DOCK BUILDING JETTIES ® BULKHEADING STEEL& WOOD PILING a FLOATS 423 FIFTH STREET P.O. BOX 2124 a GREENPORT,NEW YORK 11944 (631)477-1199/477-1393/477-0682 o FAX(631)477-0005 ® I _C 8.cos APR - 8 2005 Soutdoid Town /�.O• 7-24� 1/79 Board of Trustees S.C. 7-A4. /O•M 70—Co-So. /76 4 141- 0( Town Hall staff COG 53095 Main Road Albert J.Krupski,President =`Z' 'y� P.O.Box 1179 James King,Vice-President y Southold,New York 11971 Henry Smith Artie Foster Telephone(516)765-18,92 y�jpl � Fax(516)765-1823 Ken Poliwoda BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Off ice Use Only Coastal Erosion Permit Application Wetland Permit Application Grandfather Permit Application Waiver/Amendment/Changes Received Application: Received Fee:$ Completed Application FILE COPY Incomplete SEQRA Classification: •Type I Type II Unlisted Coordination: (date sent) CAC Referral Sent: Date of Inspection: Receipt of CAC Report: Lead Agency Determination: Technical Review: Public Hearing Held: Resolution: Name of Applicant J 0�Q3C� Address k1_aaN&_&L I - Phone Number: Tax Map Number: 1000 - Suf f o lk County � 0 Property Location: (provide LILCO Pole Mume Lm4fi&mn distance to cross streets, and location) AGENT: _12A (If applicable) Address• 41 _ l Phone FAX#: 1 Board of Trustees Application GENERAL DATA Land Area (in square feet) : aQ SOD b� Areai Zoning: „/�� �en�le 11�r rPSIChQ,� Previous use of property: ��j �I/�P61e�. - Intended use of property: MC_. Prior permits/approvals for- site improvements: Agency SD to A f&�G '� d.210/oa 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: Project Description (use attachments if necessary) : �ovrAe-� 11� ' of ua�� Board of Trustees Application W LAND/TRUSTEE LANDS APPLICATION DATA Purpose of the propos ed operations:D YPwfyc �� D Area of wetlands on lot: �a. db� square feet Percent coverage of lot: �3(1 closest distance between nearest existing structure and upland edge of wetlands: 1 fee closest distance betwee nearest proposed structure and upland edge of wetlands: R feet Does the project involve excavation or filling? • No �� Yes cubic yards if yes, how much material will be excavated? _ How much material will be filled?3& + 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) : M%le `IA1%1AA YAP Q � l'C`7�� 9AI l'�/llA/l IVUt��2�n crn/1 3 Board of Trustees Application County of Suffolk- State of New York [J BEING DULY SWORN DEPOS 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 AND FREE HARMLESS E FROM ANY. AND ALL DAMAGES AND CLAIMS TRUSTEES ARISING UNDER BY VIRTUE OF SAID PERMIT(S) , IF GRANTED- IN COMPLETING THIS APPLICATION, I. HEREBY AUTHORIZE THE TRUSTEES, THEIR pE� OR M S�S�r TO ENTER ONTO FYP�� TO INSPECT PRE CONJUNCTION WITH REVIEW OF APPLICATION. Signature SW ORN TO BEFORE ME THIS DAY OF � .Vn i ' Notary ublic GIPNTHIA M. MANWARING l ARY.PUBLIC,STATE OF NEW YORK NO:01 MA6100507 QUALIFIED IN SUFFOLK COON -COMMISSION EXPIRES OCT.20 7 SoysFocr.� G'G�d -p��7 J c.. AbAle OR � L � A VIC /N/T?' /tif61P L OCAT/OwMAP o S 4oao�: o :4�000r. ,ea�.tcEwr T�1aop�EQT�►Ow.�e�as: © ✓�ME$ E.G/8 Do�IS O �ION�.d•Jt.f•(!/ROPI v S O f{o ison/� f2oSA /45 ru/Z as$ *6 45 Lr•,/. ��aT/� ,/y.y. 11771 /i5'v 40, rJ J! //97/ H�LIGWEA���/C-7 _P3Y �_4Er.9ovip✓C-' ¢�'z�,v. F�'ET ®� ! / a"S? �sw� A�rrJ/BCiAv. /tiI-Lr/G�, tv-/?l,.dC� G!�/i.��`*l.•�•,c,vG'✓tivya. 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