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Board Bo Of Southold Town Trustees
l " 'I SOUTHOLD, NEW YORK
PERMIT NO. ... .. 7. ........ DATE: ...1/U19.4........... �=
i
ISSUED TO .....E DGER...._..DONNA....MC...CART/ILL......................................
Pursuant to the provisions of Chapter 615 of the Laws of
\ .5 � 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 MATERIALS FROM jE ,
a LANDS UNDER TOWN WATERS;" and in accordance with the �y s
Resolution of The Board adopted at a meeting held on .....1.127.19.4....
1 19...9.4.., and in consideration of the sum of $...100..0.0 paid by `
.....R.OG.ER.....4.... C...CARVILL..
Southold............ ...................... the� ..... . N. Y. and subject to �
Terms and Conditions listed on the reverse side hereof, ► .f
A of Southold Town Trustees authorizes and' permits the following:
Grandfather Permit for a 20' X 45' bulkhead constructed
in 1963• All in accordance.-with.amended survey dated 4/23/86 'ty
'Oh canal off CoreV Creek F;•
�1I I�R
all in accordance with the detailed specifications as presented in F
the originating application. . «.
,? IN WITNESS WHEREOF, The said Board of Trustees here-
,�; 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 .....................> ..................
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.. ...... ... ..... ................ ...
.......� . .........�O ................
y�l Trustees
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��g�fFO�,��,
Albert J. Krupski,President �p OG Town Hall
John Holzapfel, Vice President = y�c 53095 Main Road
William G. Albertson y x P.O. Box 1179
Martin H. Gan:ell Oy �� Southold, New York 11971
Peter Wenzel 's1p1 �a0 Telephone(516) 765-1892
Fax(516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
January 19, 1993
Donna McCarvill
North Fork Water
Horton Lane
Southold, NY 11971
Dear Mrs. McCarvill:
Please note that no permits were required under Chapt. 97 of
the Southold Town Wetland Code prior to June 29, 1971. To
receive a Grandfather permit, please complete the application
and provide proof of the bulkhead being built before June 29,
1971. Without such proof a full Wetland Application mill be.
required.
We Will, for your convenience, inspect your property on our
monthly field surveys.
Sincerely,
ow
Albert'. Krupski, Jr.
President, Board of Trustees
AJK:jmd
cc.: Wickham, Wickham & Bressler
01
r} SUPERVISOR
TRUSTEES SCOTT L.HARRIS
John M. Bredemeyer, III, President
Albert J. id
Kru ski, Jr.,Vice Present j :.- '"
P .� ; ..`: ...: Town Hall
Henry P. Smith
53095 Main Road
John B. Tuthill '4 ,. `,
2 `� P.O. Box 1179
William G. Albertson ��40
Southold, New York 11971
Telephone (516) 76571892
Fax (516) 765-1823 BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
office Use only: DATE REC.
oastal Erosion Permit Application'
oastal Erosion Variance Application .� Q
Wetland Permit Application
aiver from Chapter 97 (Application'/permi
I Trustee Lands Permit Application JAN 2 ( (994
Grandfather Permit Application
ompleted Apps. Date: ilp)tv TOWN OF SOUTIgO
i�Inspection date: ,
C comments-Date. vsntw. Rec.
ariance Required: (YIN) -
eighbors notified-Date:
SEQRA Type �2"�
oord. : Date sent JM21
SEQRA Determin./date:
\ j Public Hearing/date: i
F Findings: Approved (YIN) -
Special Conditions: (YIN) --- I
I ( see file) Application Fee:
LPermit(s) issued-date:
Application Number;SCTM#1000- ��-� Date:
C L
Applicant: d
Address:
IM (Phone
Interest: (owner, consultant,lessee,etc. )
Owner of Property:
Address
Phone ( )
Subject Prop rty Location:
(Provide LILCO Pole #, Distance to cross Streets if not on
location map)
THIS IS NOT A PERMIT Page 1
Yds. to be excavated: Yds. to be filled.:
Manner in which material will be removed or deposited:
Width of canal, creek or bay fronting property:
Depth at low tide: %-3� Aver. rise in tide:
Distance to nearest channel: . Distance project
extends beyond similar projects in area:
Area zoning: Land area in acres:
Is project for private or business use:
Intended use of property: 44s;CLC4, (,IC J
Describe known prior operations conducted on premises:
�IK(acl
Has any prior license or permit been issued to erect structures,
dredge, or deposit fill on said premises: L��
Has any license or permit ever been revoked or suspended by a
Governmental Agency:
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) .
�'r+fi�C9-a���(�.2� �-•�dyL�-� •�y r �C.�� ���I c�. i����cefl .
Van
To ;Sc). ire
THIS IS NOT A PERMIT -Page 2
i
14.16.4(2/87)—Text 12
• ,,�� PROJECT I.D.NUMBER 617.21 SEQF
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. APPLI NT/SPONSOR F. PROJECT NAME
L
3. PROJECT LOCATION:
I Municipality Ivt,C JK=2cJ County Sc_
4. PRECISE LOCATION(Street address and road Intersections,prominent landmarks,etc.,or provide map)
5. IS PROPOSED ACTION: Non
❑New ❑Expansion odification/alteration
6. DESCRIBE PROJECT BRIEFLY: ` !�
CAD
7. AMOUNT OF LAND FFECTED:
Initially a acres Ultimately � acres
a. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
�es ❑No If No,describe briefly
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
❑industrial ❑Commercial Agriculture ElPark/ForestlOpen space ❑Other
residential
Describe: �cp
10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING,NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL,
STA E OR LOCAL)?
YYes ❑No If yes, list agency(s)and permitlapprovals
11. DOES ANY ASPECT OF THE ACTIO14 HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
❑Yes If yes,list agency name and permit/approval
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION?
❑Yes No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
- i
Applicant/sponsor name, Date:
i
i
Signature:
If the action is in the Coastal Area, and you are'a state agency, complete the
Coastal Assessment Form before proceeding with this'q.Uessment
OVER
00 Cl ;omoIuIud Oy iN(juncy)
A. DOGS ACTION EXCEED ANY TYPE I ESHOLO IN 6 NYCnR, PART 617.127 If yes,coo to the review PYOCO53 and use irra FULL Gq~—
❑Yes ❑No
S. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6T negative declaration
may be superseded by another involved agency. If No,a negati
❑Yes ❑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 patterns, solid waste production or disposal,
potential for erosion,drainage or flooding problems?Explain briefly:
Cy Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources;or community or neighborhood character?Explain briefly:
Ca. Vegetation or fauna, fish,shellfish or wildlife species,significant habitats•or threatened or endangered species? Explain brfefly:
C4. A community's existing plans or goals as officially adopted,or a change in use or intensity of use of land or other n I atural resources?Explain brlefly.1
C5. Growth, subsequent development,or?elated activities likely to be induced by the proposed action? Explain brretly.
i
C6. Long term,short term,cumulative,or other effects not identified in Cl-CS? Explain briefly.
C7. Other impacts(including changes_in.use of either quantity or type of energy)? Explain briefly.
D. 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)
Each effect should be assessed in Connection with its (a) setting (i.e. urban or rural); (b) probability Of occurring;
INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large,important or otherwise significant.
(c) duration; (d)
irreversibility; (e) geographic scope; and If) 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.
❑ 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
documantation, that the proposed action WILL NOT result in any significant adverse environmental impacts
AND provide on attachments as necessary, the reasons supporting this determination: Pacts
. Numc or Lrud nt;cncy
Prml ut 1 ype Name of Kespunstble Ur ricer to Lr.td Agency
(rile of Kesponultle Ufrtcer
]tgnutwe ur Hesponutile Urh<er on Ledd ngent:y
Stgnrlure or I'rePater tit different Irom retuunstole otrtr•er
• � Outr