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HomeMy WebLinkAboutTR-111-13-11 GF �'V ` y),..:� ✓l� V \�N W.:. � :iy`�y' �vT r•.yl.., r V ��. — �"°'��e,tsv_•x,�s*'�,r"�'-rr��y�..�y''.�b��:�.�n- �r s�.r__a_ IMF` r' S 1, Board Of Southold Town Trustees SOUTHOLD, NEW YORK is i;y :H PERMIT NO. ....1.1.1.-.13-11..... DATE: ..........1-..28-.93..... �t- :�� f,l . ISSUED TO .......•................Michael....&...An.Brea....C.atapano................................... ,11 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- !ha. titled "REGULATING AND THE PLACING OF OBSTRUCTIONS • !; IN AND ON TOWN WATERS AND PUBLIC LANDS and the =� REMOVAL OF SAND, GRAVEL OR, OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;" and in accordance with the Resolution1-2 C• z, of The Board adopted at a. meeting held on ...........8............... '•"� [[{;�1� 19...9.3..., and in consideration of the sum of $. 150.00 paid_ by ••y r3 ....................... .. .................................................................................................................... of .................................................................. ..................... N. Y. and subject to ,the `i Terms and Conditions listed on the reverse side hereof a of Southold Town Trustees authorizes and permits the following: Grandfather permit for bulkhead damaged by Storm 11 all in accordance with the detailed s ecifications as presented in the originating application. all said.Board of Trustees here- IN WITNESS WHEREOF, The �R. �! by causes its Corporate Seal to be affixed, and these presents to t :' be subscribed by a majority of t e. said Board as of this date. o v, ._ � y i% Trustees . Grar •, eL:..•r '1� �:.+u a.�w .[ w 1�a �r ice.. ...�8.�'��rtr.� ,a a :��.d�.`r..r.I -:,mat .�vir..�.:+..m.t. ..t,�-+tet y:.,..5•�.. �! 30 'FA l E�' A P QS•2Ue l v�T�r—'Sc %EtV YORK STATE DEPARTMENT OF E'iVIRON-MENTAL CONSLRVATIQN e�ren'�11T vUXIOfR EFFEC' VE DATE Y G FACILITY.PROCRAM N MEIER(s1 PERMIT EXPIRA7ION DATE Under the Environment ons ation Law ECL) i ly- V TYPEE OF•PERMI,Ti(Check,All Applicable EJoaeil fI (!New.,,-' ❑Renewal ❑Modification ❑Permit to Constrict OPermrt to Operate Article 15;"Title 5:`` t' Article 17, Titles 7, 8: Article 27, Title 9; 6NYCRR 373: Protection-of Water `'," '" SPOES Hazardous Waste Management Article 15. Title•15:. Article 19: . Article 34: Water Supply°.'. Air Pollution Control F7 Coastal Erosion Management Article 15;Title :15: Article 23, T)tle 27: Article 36: Water Transport Mined Land Reclamation Floodplain Management Article 15; Title 15; '° Article 24:` Articles 1, 3, 17, 19, 27. 37: Long Island!•Wells ;;.: ,, Freshwater'Wetlands; 6NYCRR 380: Radiation Control aArticle 15;.T)tle 27:,,'., Article 25: Other: Wild, Scenic and Recreational Tidal Wetlands'; �. Rivers Article 27, Title 7: 6NYCRR 360: a6NYCRR 608: Solid Waste Management Water Quality,"Certification - PERMIT ISSUED TO,i' / �J I TELEPHONE NUMBER ADDRESS O PERMITTEE•. 3301 �ou 7/ CONTACT PERSON FOR ERMITTEO'v�tp RKL TELEPHONE NUMBER ,0 t M�At�ivt ) -/77-/ICJ . NAME AND ADDRESS OF P IECTiFACILITY LOCATION OF PRO IECiiFACILITY;,;. ' CSQGUN7T� O A77 � ET � O. YTV COORDINATES N OESCRIPTION OF AUTHORIZED.A&;VITY, / . s�ewpr� By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL,all applicable regulations,the General Conditions specified(See Reverse Side)and any Special ronditionf included as part.of.this permit. e iona PERMIT ADMINISTRATOR ADDRESS Regulatory Affairs, Region One, Bldg. 40 SUNY Robert A. Greene Stony Brook, N.Y. 11790-2356 AUTHORIZED SIGNATURE. ' DATE �� Page 1 of 5 t: _ a GENERAL CONDITIONS J inspections',*x c° ,— 1. The permitted site or facility,i ncludind relevant recbrds, is subject to inspection at reasonable hours and tntervals,-by.an authorized represdntative of-the Department of Environmental Conservation(the Departme 11 nt)ao.determine whether the permittee is complying with this permit and the ECL. Such representative,may order the work suspended pursuant to ECL 71-0301 and SAPA 401(3). A copy of this permit;'Including all referenced maps, drawings and special.conditions, must be available for inspection by the Department at all,times at the project site. Failure to produce a copy of the permit upon.;cequest by a;Department representative is a violation of this permit. Permit.Changes:.and Renewals 2The'bepartment reserves'the'right to modify, suspend or, revoke this permit when: a) the scope`'of the permitted activity is„exceeded or a violation of any condition of the permit orprovisions of the ECL'and pertinent regulations is found;' b) :the permittwas obtained.by misrepresentation`or failure to disclose relevant facts; material in is discovered; or . d environmental conditions, relevant'technology, or applicable.law or regulation have materially f)f changed since the,permit wasissued.; 3 The Permittee must submit a separate application to the Department for renewal, modifica- _tion,6rt�ansfer of this permit. Such application must include any forms, fees or supplemental infor- 'nation the;Department requires. Any,renewal, modification or transfer granted by the Department "must`beAn.`-writing. 4 .The permittee must submit a renewal application at least: a) 180,days before expiration of permits for State Pollutant Discharge Elimination System (SPDES), Hazardous,-Waste Management Facilities(HWMF), major Air Pollution Control (APC) and Solid Waste'Management Facilities (SWMF) and b)"3d days before expiration of all other permit types. 5.,- Unless.'expressly,provided for by the Department, issuance of this permit does not modify,supersede 'or rescind.any_order or determination previously issued by the Department or any of the ter+i;,, con ditions-or requirements contained;in such order. or determination. Other LegaC Obligations of Permittee the full legal responsibili 6 The Permittee has accepted expressly, by the execution of the application, :ty for,all,ddamages,',.direct.or indirect, of,whatever; nature and'by whomever suffered,`arising out of the protect described'in this permit and has agreed to indemnify and save harmless the State from ry., g.,, auits, actions, damages•:and.costs of eve name and,description resultin from this project. 7 'This permit does not convey to the permittee any right to'trespass upon the lands or interfere with r,the ripanan_nghts'ofothers in order o,perform the permitted work nor does it`authorize the impair - meot of any`rights,title,'or interest in real:or personal property held or vested in a person not a party to the.permit 8 �;The'.permittee Is responsible forobtaining any other permits, approvals, lands,easements and rights- 'of way that may be required for this proiect Page 2 of �_ � i' �\ ,uE'NERAL CONDITIONS-FOR ICLES 15 (Title 5),.24 25,,34 36 and 6 rYCRR R cure operations by the State _- rw York require an al-, other emironmen deleterious materials associated with the ,.. on in the position of the structure or work herein authorized or project. bra the opinion of the Department of Environmental Conservation-':('-I3 ;Inv material dredged,in the prosecution of the work herein permitted ;£'shall cause unreasonable obstruction to the free navigation of said shall be removed evenly,without leaving large refuse piles,ridges across i'waters or flood flows or endanger the health, safety or welfare of the bed of a waterway or floodplain or deep holes that may have a the people of the State.'`or'i ause loss or destruction of the natural tendency to cause damage to navigable channels or to the banks of resources of the State.the owner may be ordered by the Department to a waterway. - remove or alter the,structural work, obstructions, or hazards caused 14 There shall be no unreasonable interference with navigation by the work thereby without expense to the State, and if. upon the expiration or herein revocation of this permit, the structure, fill, excavation, or other 15 If upon the expiration or revocation of this permit,the project hereby modification of the watercourse hereby authorized shall not be com- authorized has not been completed,the applicant shall,without expense pleted. the owners, shall, without expense to the State, and to such to the State, and to such extent and in such time and manner as the extent and in such time and manner as the Department of Environmental Department of Environmental Conservation may require,remove all or Conservation may require`,remove all or any portion of the uncompleted any portion of the uncompleted structure or fill and restore the site structure or'fill'an&'restore to its former condition the navigable to its former condition.No claim shall be made against the State of and flood capacity of the watercourse.No claim shall be made against New York on account of any such removal or alteration. the State of New York on account of any such removal-or alteration. ..:;16. If granted under Article 36, this permit does not signify in any way 10. That the State,of New York shall in no case be liable for any damage that the project will be free from flooding. or injury to the structure or work herein authorized which may be caused 17 If granted under 6 NYCRR Part 608. the NY5 Department of Environ- by or result from'future operations undertaken by the State for the mental.Conservation hereby certifies that the subject project will not conservation or improvement of navigation,or for other purposes,and contravene effluent limitations or other limitations or standards under no claim or right to compensation shall accrue from any such damage. Sections 301, 302. 303, 306 and 307 of the Clean Water Act of 1977 11. Granting of this permit does not relieve the applicant of the responsi- (Pl.95-217) provided that all of the conditions listed herein are met. bility of obtaining any'other.permission, consent or approval from 18. All activities authorized by this permit must be in strict conformance the U.S.Army Corps of Engineers, U.S. Coast Guard, New York State with the approved plans submitted by the applicant or his agent as part Office of General Services.or local government which may be required. of the permit application. (� 12. All necessary precautions shall be taken to preclude contamination C������, l \�lC\-t of any wetland'or waterway by suspended solids, sediments, fuels, Such approved plans were prepared by ii solvents,lubricants,epoxy coatings,paints,concrete,leachate or any Z on SPECIAL CONDITIONS 1. 'A copy `of this permit 'With 'Supplementary conditions and `approved plans must be available at the project site whenever authorized work is in progress. 2. The, permit sign enclosed with the, permit or a copy of ,'letter of approval must be protected from the weather and posted in� a conspicuous location at the work site Until.., completion. of authorized.t"work. 3. '. At .least 48 hours prior to commencement of .the project, the` permittee' must, complete' and _return the top portion of"the `enclosed ' receipt form certifying that :he is fully`-;aware 'of Wand understands `all, provisions and 'conditons `of' this permit. Within one week of -completion of the permitted .work, the bottom portion of that; `form must also be completed and returned. 4. If. the permittee intends to undertake any project design modifications .after"permit issuance, the ' permittee must submit the appropriate plan changes for approval ' by :the Regional Permit':Administrator prior to undertaking any such modifications. The permittee is advised 'that substantial modification may require submission of a new application for permit. DEC PERMIT NUMBER PROGRAM1A.CILITY NUMBER. ; . Page 3 or 5 AM{ $c NEV ` i" K STATE DEPARTMENT OF ENVIRONMENTAL CONSE-`'-TION oboe el SPECIAL CONDITIONS For Article 25 Tidal ,Wetlands M1 / '. • 6. r` e 'al 7 Use` of a timbers . (wood)- treated...,-with ,pentachlorophenol,•is strict ly. prohibited• 8. All ;-f ll,must :be'from an approved source and consist' of clean gravel•`and soil. Use -of`?asphalt-, slag, flyash, r '!broken, concrete .or other: demolition. debris is' ; prohibited. 9. ;All fill must, be: graded "to match:;the elevation of the 'land immediately adjacent to the bulkhead. 10. Contamination of tidal' wetlands ;.and'.;the waters of New :_York ''State; by suspended `solids, - sediments, fuels, lubricants,` epoxy coatings, `�paints, concrete, leachate or�any�"other,'environmentally ideleterious materials 'associated with'..the, conduct ,of the;-permitted, activity.' i `;prohibited. s s 11 Any 'debris or 'excess :material ''from`construction of this project'_'amu'st' be' immedately and completely removed from ;the_-adjaacent`<area- and disposed of rat, an:; approved ,upland ;,'�Disposal�'.of debri"s,= inttida.l:,.wetlands is r r f 12. Supplementary Special ,Conditions :(A) ,'•thru (J) attached. Regional Pe rmit '.Administrator z " xt NYS`,Dept £of 'Environmental Conservation Buildin 40;. `SUNY• ;'— Room 219 g " , Stony', Brook,, :'.NY 11790-2356 (516)' 151 ,1389' 13 /1/m t /le i�% so2 GXfAvx� .a.✓ fa�z� , DEC PERMIT NUMBER.`rx PROGRAWFACIUTY NUMBE ',_ ` r _ Page 4 of 5 - t 3 N s" fiy 3 :SUPPLEMENTARY SPECIAL CONDITIONS : The following ,conditions apply to all permits: A. If any ..Of the p ermit conditions .are 'unclear, the permittee shall con- , tact 'theDfVIs ort of Regulatory ,Affairs at the address and telephone noted be100. 4 { con roved B. A copy;' o•f :this ;'permi.t with supplementa�Ysiteawhenevernauthorized plans, be :available at the projec work is inprogress: , h s of letter` of d C. The, peYmit'Msign enclosed with the permit., or a copy t _approval shallrbe 'protected `,from the`, weather and posted in a con spicuous location a,t the work site until ;completion of. authorized work. D. ;At least '46 hours prior`- to `commenceo�tionf ofhtherenclosed'�receipt Jorm ,_shall, �complet.e and ,,return .the top p provisions and certifying that hejs .fully: aware of and understands all conditions of Aathis•�pe.rmit. : Within one week ormCshall.talso betcom ' .,permitted wtork;, ;,the bottom, portion of that fo plet,ed and; returned. 'ects .involving 'activiti.es to be :accomplished 'lover ional..Permit aof E. For prod ermit,tee :: hall` notify.-' the Reg more •than done ;year, ,the p rior _to the commencement Admin st:rator .in writing -.at least 48 hours p of resumption of work . each ;year y .;after permit issuance, the F. If project design modi'Eications,' take--placelan; chap es F;for approval by :.permttee shall :;submit'.the.'appr.opr•;iate p. 9 ;the Regional Permit Administrator,•'%prior;;;to::rundertaking any such .modi y .f ications: .The<`permittee is ,`adv.ised 'that .substantial modification may require submission of a new app lication `for permit. C. All necessary,Lprec;autions shall: be " taken o p reclude 'contamination . of an +wetlands ;;or .waterwa by'suspended solids, ,sediment , fuels, Y aints, concrete, leachate or solvents,'": lub,r"icants, ".;epoxy coatings, p ' 'an other,,environmentally deleterious materials associated with the Y project Work.' r wi 'h, al;l o,f ^the terms and conditions H. °Any failure 'tb comply._precisely, of .phis permit', lunless,-.authorized in ;writing, shall be treated as a violation of the Environmental` Cons.ervation Law 3 fi rovals that. may. , . y . ermits- or :app I . The :permYittee is 'advised to obtain :an pNY Ibe'`retiu3red `krom~the ,U.S. Department ,of' Army Corps.:of Engineers': District', Z6 `Federal Plaza, New ,Yor.kr NY 10278r -(Attention: n r'ior" to commencement oC .work. authorized herein. Functions Branch) ► P ,s The ran;ting `of this permit does not ,relieve the permittee of the e. en J 9 rant, ° easement, ' or ` other necessary responsibil ty .of :.obtaini"ng a •g a r`ovalfrom the `Division of .Land `Utiliza.tionAlbanicNY12242rawhich PP., Y Services`, dower euilding,.:Empire ;S�ate Plaza, may besx;equi:red. for .any encroachment upon State-owned lands `underwater . t { f Regional`.Permit Ad tion ministrator NYS Dept.' of Environmental Conserva Bldg 40, SUNY Room 2 2356 lly7 7 V•. s � fi �y Si S Stony Brook r :.NYC ids J o t s of k4 � t Wa 4 - -- a t-:' 'k`' 3° `9^. Y s ✓c fi + fx a ✓ zt mot`4t A x 5l rt89 A h�! Zr t i r''a"sgyffi„➢nx.>f -.� .'#:•' s,.. .��g1.}y� _y�'`'^ty ,. i.sRc.�.d.,s..y. .. ,,Fu. ..�n+.y*?.s,�.:r:�dy.:2f,�W, 2`� ;; .yx,:.}.2>•, c,aksrMr�i( y"E`.'2 f',•t .�,, .ttlr}�.;�iy;i. �+ia�'a ..... .. ... 5S - 3 2 3r�Ry P PATIO yaynt; 1 It,, r TaP _.., S.S'� �?� KkK �k x R'EPLAcE So �I DS. >rOST r Ll. F Rc►t-% u PR A►J D w; APP'Ait wATE9� MARK - :;I..ITTLE :PrCDWIC k3A. =Nsr>1t..l,. ,� ► �3itisT I+; PIKES -i'o :auPPtR7i" 73ULIKHFAb EARED FOR . _PR�PfiQE.Tj $y; MICHIIEL. �t- .J4NbREfi ' CA� �PAN� COSTELLO . MARiuC ,caN?f. loy$5 : NhSSAU AIN'T: RDAb, LAaX al:�Lq Cv�c�t.o6�E1 N �� Ily3�' G��. n! postT ►eS� mqq �67PLAte 4osT DILL (s� Yd�� r /tL./�� !. y TiF riav �aR• PCADIVAN I3AtTCR Vr-aF PEA ORAAJ . .•;C, y�rl � r M1 t. PPIOpERTI ' -bCATIDM e.1�1G1AIhS5&U. WI WT.EVID NM�CILA� C UTC►to Costello Marine MUM l__. ,A.imm* CNTI Fm)D Contracting Corp, .3rld L GQUT N :4AN -. y : y P.O.Box 2124 �. Q NY 11944 t n4npo o97a BE,TRf14(mE. -SA NUA P•� .94 I 110,3 9r 20.1(8/87) -9d . -New York t at.e Department of EnvII ironmental Conservation Y. .. Adh low- , The Department of Environmental. Conservation (DEC) has' issued ;_permit(s) pursuant to the Environmental --Conservation .•Law .r ,tv , .for work being conducted .at this site. For further conformation regarding -the nature and :extent of work approved and any Departmental conditions - on it, contact the Regional Permit Administrator listed below. Please refer to the permit number . shown.. when contacting the DEC. Regional Permit Administrator Permit Number 1-u , � / ��-� z_; ,� s;_ NOTICE ozx 117,0-2356 NY ;31100' Expiration Date Gy NOTE: This notice is NOT a permit .. 1Wj� Suf FiJ� r _ TRUSTEES : COGS John M.Bredemeyer,III,President SUPERVISOR Henry P. Smith,Vice President co a SCOTT L. HARRIS Albert J.Krupski,Jr. 0 John L.Bednoski,Jr. �© ��� Town Hall John B.Tuthill l ��r 53095 Main Road P.O.Box 1179 Telephone(516)765-1892 BOARD OF TOWN TRUSTEES Southold,New York 11971 Fax(516)765-1823 TOWN OF SOUTHOLD COASTAL EROSION• MANAGEMENT PERMIT APPLICATION TOWN WETLANDS PERMIT APPLICATION TRUSTEE LANDS PERMIT APPLICATION Office Use Only: Coastal Erosion Permit Application Wetland Permit Application D Trustee Lands Permit Application Grandfather Completed Apps. Date: [ JA�Q 1993 Variance Required, Neighbors notified Date: TOWN OF SOUTHO�.9� SEQRA Type ___--- Coord. Review-opt. ,mand. Date Rec. by Office Insp. comp. /date: SEQRA Determin./date: Public Hearing/date: Findings: Permit Vote: (YIN) : Special Conditions: ( also see file) Application Fee: Application Number; SCT14 #1000- (11 - 1 3- l 1 Project Name (If any) (�,� -4- DAAAQM C� iyt,a Date Prepared: Applicant: Address: Phone (51 ) - Interest: (owner, co ultant,lessee,etc. ) �Jp,OM Owner of Property: Address 3 b Phone ( ) Subject Property L cation: S (Provide LILCO Pole #, Distance to cross Streets if not on location map) THIS IS NOT A PERMIT _ Y Yds. to be excavated: Yds. to be filled: 5 a Manner 'n whi (h material will be removed or deposited: Width of canal, creek or bay fronting property: ,U( Depth at low tide: N JA Aver. rise in tide: & (-4 Distance to nearest channel: '4- Di.stande project extends beyond similar projects in area: Area zoning: .'1�� ti Land area in acres: �- - Is project for private or business use: Intended use of property: Describe known prior operations conducted on premises: ��1/L�Q �Q�►,Q Has any prior license or permit been issued to erect structures, dredge, or deposit fill on said premises: Has any license . or permit ever been revoked or suspended by a Governmental Agency: __'Y\,p M1S Project Description The project description must also include plans for reclamation of land disturbed during construction of the principle and accessory structures and underground structures. (i.e. , 'pipeline and septic system; make additional attachments if necessary) . QAA_QT1 A, D Authorization (Where the applicant is not the owner) I residing at (Print-owner of subject property) (Mailing address-phone) To hereby authorize to apply for Coastal Erosion permit( s) from the Southold Town Trustees Signature THIS IS NOT A PERMIT t f County of Suffolk ) State of New York ) O Co D. 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 WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION- AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD Or 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 REPRESENTATIVE(s) o TO ENTER ONTO MY PROPERTY TO- INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. c S GNA`i'URE SWORN TO BEFORE ME THIS DAY OF M V , 19 Notary►ublir,S�of New York Clue il�ied nSuSuffolk Co n NOTARY PUB I C Commission Expires November Suggested space for location Map THIS IS NOT A PERMIT po� N�SS�U r'�11�T � . m _C_! i c z-3raR� S G FR. N6VSE el e F Tafl__ of PLANK_ m EXISTING � � REPLACE SO `f Da. LOST 'F1LL. FRoT-� UPkAA1b SoQpGE APPAIM"'i H�6H WA7�R MAC►( -- __.. LITTLE PFCnf. lC. t3A�� MN_STm-L Qb bATTF1 PILFS To SuPPCR-r T'REP�E� FOP, PKEPAPE.Tj $y; MICHAFI: -+- AN DREA CNTpopfA b COSTELLO MAP-WE corvYe. 6gts NA55AV -POINT a DA6b Qb)L aP`kt4 CvTc#to6U E� N LI IIg3S GP.F EN POR Ta VJ j 119qq �' N UA kj aID t • t •t t -pEPLAtL' koST DILL. (-SO YD5) PILIAIG t T/F- /30 U a� PE,40M,4N .I3ATT E R._P_1_Lr:; yr-�e PFAOMAO �lf fAD. t PFcPF-QT3 I-bCATIDN *J i&A(n�nf�..=fr+�Qf� CUTCWDGUE I 1,31 11114 Costello Marine MLUAEJ--tA-kbkF*- CATAPAM Contracting Corp. 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Il w. •�.. i /•AW // .,O +• i IN 11 C 9 ,///���■o(1/�e�1/�1/ �. � ,I I.iM�I i�/ '� a ��.f ,pl• .. `�i 11'S `(� .I u�o�'C I • • •�� V A.. ♦, • t•" �, d f j•f LIAR) ,.•'' •.�` r" lat. so Y.14 WILMA411 it Of 0 ' rA PRO /••1 � /.•Aal I�iW� 1 ��., t �pr Poll N1,o[i N,. _r` f.fdd ,.• 15 \f 1 •a t• .•+• + ,t/etc.1113.11/ 0.6 •01.011 /err — - ■.n tM t t \f LIM[ l is 1.6 ` r ,a it)C>0 f � c � 13 + 15 371 k/tlur © COUNTY OF SUFFOLK WWWSOUTHOLD ' i« D__ Properly Tax__ Agency M �2, Icu[•1r[tl _ Co•nly c•nI.. ptT•I:TIA 1000 „• Riv•r6•od,i.1.,Nti v Yolk �� � ►10rERLY MAP AUTHOR 1 7J1TION FORM Date: I► ��'� �o �`r� �Y owner of .C .�S__ f . v_p_1_._ _ Business/property name located at- C U` CA-O Co- -FI_ ki q do herby give ,Costello Marine Contracting Corp. the authority to act as agent in my behalf in applying for all of the necessary permits in order for work to be done on my property described above. Signature r , CoSTttto MA18NE CONTRACTING CORPOIZ.A►TION DUCK gUILIJINd • JtTflF5 • 911I_104FADING + STFFL 'NOOD PILING • FOUNDATIONS . Y s