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Home My WebLink AboutTR-5808 NNW i s Board Of Southold Town Trustees ; = SOUTHOLD, NEW YORK - Sept. 24, 2003 .. ice• .U•� y = PERMIT NO. ... .................. ........ DATE: ......... ....... , b.� ISSUED TO ..............JENNIFER.:.&....PHILI ..S.TAN.T-DN................................ «. Pursuant to the provisions of Chapter 615 of the Laws of. r; 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 =° u REMOVAL OF SAND, GRAVEL-OR OTHER MATERIALS FROM -� LANDS UNDER TOWW WATERS;'•.': and in accordance with the �:. Resolution of The Board adopted at a meeting held on ....ePt?...-Z.•-t.�' L 2003•._•:., and in consideration of the sum of $.2.0.0. H....••.... paid by En-Consult�x�ts.,...Inc.....on....behalf-•of...Jennifer••&.. Pi li-F...Stanton i _ of ..........Southalli�.tnx�,.......................................... N. Y. and. subject to the Terms and Conditions listed on the reverse side hereof, z of Southold Town Trustees authorizes and permits the following: ' ' w. _fir si Wetland Permit to remove existing asphalt driveway and replace with pervious driveway,install :, J• drywell,and remove portion of existing bituminous driveway located within 100 feet of tidal L§ ` a bound as per survey dated 3-14-02 last revised 8-7-03 and prepared by John C wetlands boundary P •� Ehlers Land Surveyor x. an in accordance with the detai{ed specifications as presented in the originating application. �! The said Board of Trustees here- t '� IN WITNESS WHEREOF, 4 • rate Seal to be affixed, and these resents to by causes its Corporate p - be subscribed by a majority of the said Board as of this date. .� s / �Ir Artie Foster Trustees AzML -ALM I- :.H.: � � '� r � ti ��• � '� � fir- ��. `> $-A t-":�Gs. TERMS and CONDITIONS JP Permittee jp_nnifer & Vailip Stalat residing at 302 Town Creek Lane Southold N. Y, as part- of the consideration for the issuance of the Permit does understand and prescribe to the fol- lowing: i. That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any opet- ation performed pursuant to this permit, and the said Permittee will, at his or her own expense, defend any and all such suits-initiated by third parties, and the said Permittee assumes full liability ld with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southo r 2. That this Permit is valid for n-period of : 24 mos. which is considered to be the' estimated time'required to complete the work involved, but'should_drahmstances warrant, request for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely, or'as long as the said Permittee wishes iproject involved, to provide evidence to anyone concerned that anti to. maintain the structure or orization was originally obtained. I 4. That the work involved will be subject to the inspection.and approval of the Board Or its agents, and non-compliance,with.the provisions of the originating application,.may.be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass don$ 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 Tnutees, the. work shall cause unreasonable obstruction to free navigation, the said Permittee will tbe required, upon due notice, to remove or alter this work or project herein stated without expenses he Town Lplemental thold. That the said Board will be notified by the Permittee of the completion,of the work anti That the Permittee will obtain all other permits and consents that may be required sap' to this permit which may be subject to revoke upon failure to obtain same. Albert J.Krupski,President suFFoc��,� CO3 Town Hall `Z G James King,Vice-President 53095 Route 25= Z1 P.O.Box 1179 Artie Foster y Ken Poliwoda 2 Southold,New York 11971-0959 Peggy A.Dickerson O,fi� �� Telephone(631) 765-1892 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#64-1-12 Jennifer&Philip Stanton 302 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 a Wetland Permit for JENNIFER&PHILIP STANTON to remove existing asphalt driveway and replace with pervious driveway, install drywell, and remove portion of existing bituminous driveway located within 100 feet of tidal wetlands boundary as per survey dated 3-14-02 last revised 8-7-03 and 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: None Very truly yours, Albert J. Krupski,Jr. President,Board of Trustees AJK/cjc cc: DEC JENNIFER AND PHILLIP STANTON,302 TOWN CREEK LANE, SOUTHOLD Figure /. Looking north toward existing dwelling and over hituminous driveway to he removed %F Ok �! .. �, V � •r' '.... ,1 .. ..ate � _ ,. ,..' -,.,, ` Figure 2. Looking west over existing asphalt drivewgj,to he removed and r laced with • oS�F��oG o = Town Hall, 53095 Main Road 'T P.O. Box 1179 •Telephone Southold:New.York .11971 ,jy�ol � �-• (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 asphalt driveway and replace with pervious driveway; install drywell; and remove portion of existing bituminous driveway located within 100' of tidal wetlands boundary. All proposed work (including new porch) located more than 100'. from tidal wetlands boundary is beyond Trustees jurisdiction. Located: 302 Town Creek Lane, Southold. SCTM#64-1-1.2 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 5URVEY OF PROPERTY 51TUATE: 5OUTHOLD N TOM 5OUT14OLD SUFFOLK COUNTY, NY W e � E SURVEYED 03-14-02 FEMA ZONE ADDED 12-05-02 WETLAND FLAC25 LOCATED 0I-15-03 TOPO 8 PROPOSED PORCH 03-Iq-03 AMENDED 05-0q-03, PROPOSED ACTIONS 08-01-03 SUFFOLK GOUNT( TAX # 1000 - 64 - I - 12 CIERT=TO: P=B.STANTON LAND NOW OR FORMERLY OF JBNNIM LAMBERTS STANTON PHILIP B. STANTON d JENNIFER LAMBERTS STANTON IPWONI[C AIESTRACT,IINC. CYMANIK, N.A. o�� WOOD FENCE I 1`' VO o`er O proposed ;ry u3 driveway IS �t�Iltiee-___-----_ 0 O� unde�q�o��d 5Q Q i r \�i HEWN rr1 13 ul- 18='ter I I / \ •ZZ Oa1 k Y ( IAs ONLINE E-W \ --I,d q1rlvewoy to \ I —� Z 0 be ycemo?ec) _ / 1�186051�OOn ' ON LINE E-W z' 91.70 LD �� "(�0 0 \ 16\ ITT VO*- rrrr11 � t�— rn� \ \ 4' No W EL no' O Z � Q` u ' T �O cd• f TrusteeITS � \ I �. �m drlvewcay to — \ -I t2e removed — — - - W/D —ems FCOpv RFF 6S qOP Y F�OD�iPNe Ae 2p8 \ I � osIhq/t dr DR WELD \ \ '�e "e Q O.2 E u% Irv/o shqlE Stone r�P/qGe \ gterlq/ lr _ QQ Iqq N �♦tlq romlEn Y Rob Hera`fy�nn ♦ sultonts N 0Eyl 4% `\ Ski �Loq r S� 25•��! OV- NEW NOTES: `/�.� Yhau[horized plLeratlon or oddltlon toe survey V map beariry Itcansetl loritl wrveyor�zeal Iz o violation off 5ecto.Yo0 subdivlslon i of h- Now York State EWcotlOn Lan' 0 CONCRETE MONUMENT FOUND j •Only coo—From the orlg'wl of W survey markotlsth an ar`gnnel of the lone zurveyor4 en p PIPE FOUNDstamped. hell- nsldered to vend true f copies• STAKE FOUND tg s rNf eNoS di eted arem akylfy rot NIs ey nos f 1—tatl N accordant ,, the ex- ® SLFg fgtle of fret o for Land r I adoptetl fny Ne Nan York State -rtlrlo ,Professly q '�•w /t lo— 50•-6,(N�� Lond Surveyors. Said cnrtlFlcatlons shall rvn only (� to the person For nhom I. survey Is prepped, FLOOD ZONE AND TOPO LINES �� ` his be elf to the title compony,govemmen- ^v tal ogancy antl IendNg inztltutbn listed hereon,mtl �AI�D J to the assignees of the leaning NSNtutbn.GerNNco— REFERENCE U5GG NGVD '2q DATUM �f v I—are-``r°M`��le to°dd""�I"s`I`"`Ions AREA = 24,160 SF OR 0.55 ACRES J®HN ICCa EHLERS' LAND SURVEYOR 6 EAST MAIN STREET N.Y.S.LIC.NO.50202 GRAPHIG SCALE I"=30' RIVERHEAD,N.Y. 11901 369-8288 Fax 369-8287 REF.\\Hp server\d\PROS\02-129.pro ene ooj a�zerF•I a-laa Albert J.Krupski,Presidenl i ' Town Hall James King,Vice-President �gUFFO(,�-c 53095 Route 25 Smith � P.O. Box 1179 Henry �Z' Gy Southold,New York 11971-0959 Artie Foster C Ken Poliwoda C4 = Telephone(631)765-1892 py� • !� Fex(631)765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Applicati n Wetland Permit Application Major Minor Waiver/Amendment/ h nges Received Application: d Received Fee:$ D�`� Completed Application Incomplete SEQRA Classification: Type I Type H Unlisted Coordination:(date sent CAC Referral Sent: Date of Inspection: p Receipt of CAC Report: Elopardof E Lead Agency Determination: Technical Review: Public Hearing Held: D� Resolution: IdOrda stees Name of Applicant JENNIFER&PHILIP STANTON Address 18 ORCHARD STREET,NO.5,NEW YORK,NY 10002 Phone Number:212-941-6101 Suffolk County Tax Map Number: 1000 - 64-1-12 Property Location:302 TOWN CREEK LANE,SOUTHOLD (provide LILCO Pole#, distance to cross streets,and location) AGENT:EN-CONSULTANTS,INC. 1 I (If applicable) it Address: 1329 NORTH SEA ROAD,SOUTHAMPTON,NY 11968 Phone:631-283-6360 Board of Trustees Applic, ' ion GENERAL DATA Land Area (in square feet):24,160 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 a enc X N " � U If yes, provide explanation: 2CJIU Ul Southold Town Board o rus ees Project Description(use attachments if necessary): REMOVE EXISTING ASPHALT DRIVEWAY AND REPLACE WITH PERVIOUS DRIVEWAY;INSTALL DRYWELL;AND REMOVE PORTION OF EXISTING BITUMINOUS DRIVEWAY LOCATED WITHIN 100 FEET OF TIDAL WETLANDS BOUNDARY,ALL AS DEPICTED ON THE SITE PLAN PREPARED BY JOHN C.EHLERS LAND SURVEYOR,LAST DATED 8-7-03. ALL PROPOSED WORK(INCLUDING NEW PORCH) LOCATED MORE THAN 100 FEET FROM TIDAL WETLANDS BOUNDARY IS BEYOND TRUSTEES I JURISDICTION PURSUANT TO SOUTHOLD TOWN CODE CHAPTER 97. i I I Board of Trustees Applica :)n ' WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: IMPROVE CONDITION,CONFIGURATION,AND MAKE UP OF EXISTING DRIVEWAYS. Area of wetlands on lot: +/-1150 square feet Percent coverage of lot:+/-5 0/6 Closest distance between nearest existing structure and upland edge of wetlands:+/-102 feet (STOOP) Closest distance between nearest proposed structure and upland edge of wetlands:+/-104 feet (PORCH) 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: NIA feet Proposed slope throughout the area of operations: N/A Manner in which material will be removed or deposited: N/A Fr' r 1 1 L Zuujl 0,uulnold own Board of Trust es 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 ENTAILS THE COMPLETE REMOVAL OF AN ASPHALT DRIVEWAY,AND THE REPLACEMENT OF ANOTHER WITH PERVIOUS STONE. THE PROJECT WILL HAVE A POSITIVE IMPACT ON THE ADJACENT TIDAL WETLANDS AND WATERS OF THE TOWN,AS IT WILL REDUCE COVERAGE BY IMPERVIOUS SURFACES AND REDUCE POTENTIAL RUNOFF. j 14-16-4(21B7)—Text 1:2 PROJECTI.D. NUMBER - 617.21 SEQR 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: 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) 302 TOWN CREEK LANE,SOUTHOLD,SCTM#1000-64-1-12;MAP PROVIDED 5.IS PROPOSED ACTION ® New ❑ Expansion ❑ Modification/alteration 6 DESCRIBE PROJECT BRIEFLY: REMOVE EXISTING ASPHALT DRIVEWAY AND REPLACE WITH PERVIOUS DRIVEWAY;INSTALL DRYWELL;AND REMOVE PORTION OF EXISTING BITUMINOUS DRIVEWAY LOCATED WITHIN 100 FEET OF TIDAL WETLANDS BOUNDARY,ALL AS DEPICTED ON THE SITE PLAN PREPARED BY JOHN C.EHLERS,LAND SURVEYOR,LAST DATED 8-7-03. ALL PROPOSED WORK(INCLUDING NEW PORCH)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 0.55 acres Ultimately 0.55 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? ®Residential ❑Industrial ❑Commercial ❑Agriculture ❑Park Forest/Open space ❑Other Describe: ta_ DOES ACTION INVOLVE PERMIT APPROVAL,OR FUNDING,NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL, STATE OR LOCAL)? ®Yes ❑No If yes,list agency(s)and permittapprovals DEC rnp I 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? S E P 2 2003 ❑Yes ®No If yes, list agency name and permittapproval Southold Town 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MO IFICATI ❑Yes ®No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicantfsponsor name O ERT E.HERRMANN,COASTAL MANAGEMENT SPECIALIST DATE 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 f� NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant:JENNIFER&PHILIP STANTON SCTM#1000- 64-1-12 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 ASPHALT DRIVEWAY AND REPLACE WITH PERVIOUS DRIVEWAY;INSTALL DRYWELL;AND REMOVE PORTION OF EXISTING BITUNIINOUS DRIVEWAY LOCATED WITHIN 100 FEET OF TIDAL WETLANDS BOUNDARY,ALL AS DEPICTED ON THE SITE PLAN PREPARED BY JOHN C.EHLERS LAND SURVEYOR,LAST DATED 8-7-03. ALL PROPOSED WORK(INCLUDING NEW PORCH)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: 302 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.2492003@7:00pm 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 gAFF01/r Town Hall Albert J.Krupski, President 0�� CD James King,Vice-President �`Z` Gy 53095 Route 25 o P.O.Box 1179 Artie Foster Ken Poliwoda ti = Southold,New York 11971-0959 Peggy A.Dickerson �,j, �� 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 F SUFF LK) STATE OF NEW YORK) AFFIDAVIT19UOR IRTS INC. d6a 1329 NORTH SEA RD. I, �o�,r-f' �1-Qiyr�Manh , residing - c��.�T�,oAApTnI�N Y 11968 631-283-6360 being duly sworn, depose and say: ti That on the 17 day of , 2003 I personally posted the property known as by placing the Board of Trustees officiaTposter where it can easily be seen, and that I have checked to be sure the poster has remained in place or eight days prior to the date of the public hearing. Date of hearing noted thereon to be held ov— try Dated: (signature) Sworn to before me this day of�� 2003 9 No ary ublic I�IN.STFPIEI� NdaryP�fic S�te�N�'�k Ca¢�o�Na�1�l Qa�db591atC�q PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: PHILIP STANTON 18 ORCHARD STREET,NO.5 NEW YOM NY 10002 JENNIFER&PHILIP STANTON 18 ORCHARD STREET,NO.5 NEW YORK,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 that said Notices were mailed to each of said persons by (certified) ,__q_______) mail. Sworn to efore me this day of ,20 03 "J Notary Pub&i J , ., .- K71llS1EPlEN3 RhyFa-mal xyd wbm -d of Trustees Application AUTHORIZATION (where the applicant is not the owner) � c residing .at G � . (print owner of property) Imailing address) do hereby authorize5�� l�C (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. Owner' s signature U D � CEP _ 2 7003 gouthold Town Board of lrpstees 8 -ard of Trustees Applicati�- County of Suffolk State of New York ?U 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. Y Signature SWORN TO BEFORE ME THIS DAY OF ,20 " LYDIA CHEUK Notary Public,State of New York No. 02CH6063678 Qualified in New York Cour.`y Commission Fires Septeml>-- 4,2005 Nlyary Public • I APPLICANT ` TRANSACTIONAL DISCLOSURE PURR The Town of Southold's Code of Ethic•a prohibits conflicts of interest on the parU of town officers and employees. The purpose of this form is to provide information wh cli can alert the town of possible conflicts of nterest and allow it to take whatever action is necessary to avoid same. YOUR NAME: �1''z EP R. r (Last name, first name, m ddle 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. ) NATURE OP APPLICATION: (Check all that apply. ) Tax grievance Variance Change of zone App�4ova'1 of plat Exemption from pla or official map other (If "Other," name the activity. ) (A>,Yaj S Do you personally (br through your company, spouse, sibling, parent, or child) have a relationship witli 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 titan 5% of bite 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 apace 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 5% of the shares of the corporate stock or the applicant (when the applicant Is a corporation) r B) the legal or beneficial owner of any interest in a noncorporate entity (when the. applicant is not a corporation) ) C) an officer, director, partner, or employee of the applicantl or b) the actual applicant. DESCRIPTION OF RELATIONSHIP Sub �� f L93 Submitted thi d y �^ signature Print name . 1 AP PLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The pMose 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. I YOUR NAME: e.n 1�bVe c+ kAe. Gt�� - �� 16..� ,L4,C . (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:eA DVS 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. YES NO X, If you answered"Yi ',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 day of 200 3 Signature Print Name o r'- 1� +r►c-wh 1320 North Sea Road Southampton, New York 11968 631-283-6360 M Fax: 631-283-6136 ncon EN-CONSULTANTS, INC. E-m ww.encconnssuultants.com ENVIRONMENTAL SERVICES August 28, 2003 Town of Southold n (� Board of Trustees ® U E Post Office Box 1179 Southold,New York 11971 2003 Attn.: Charlotte Cunningham SEP ^ 2 Re: Jennifer&Philip Stanton Southold Town 302 Town Creek Lane, Southold Board of Trustees SCTM#1000-64-1-12 Dear Ms.Cunningham: In regard to the above referenced property, enclosed are the following for the Board of Trustees review: 1. Three(3)Wetland Permit Applications, (including Notice and Proof of Mailing to adjacent owners). 2. Three(3) Short Environmental Assessment Forms. 3. Three(3)copies of authorization&disclosure forms. 4. Three(3)work plans. 5. Three(3)copies of survey. 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. ASinc, L Robernn Coastal Management Specialist 1 f /khs Enc.