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MC DUFFEE, MARK & ELAINE
,._F- Albert J. Krupski,President o��S�FFO(�c0 Town Hall John Holzapfel, Vice President �� Gym 53095 Main Road P.O. Box 1179 -Jim King `c Martin H. Garrell O z Southold,New York 11971 y �.F Peter Wenzel �Ij�l �a0 Telephone (516) 765-1892 Fax (516)765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD April 2, 1996 James Fitzgerald, Jr. Proper-T Permit Services P.O. Box 617 Cutchogue, NY 11935 RE: Elaine McDuffee SCTM ##1000-118-5-2.2 Dear Mr. Fitzgerald: The following action was taken by Southold Town Board of Trustees. on Thursday, March 27, 1996; RESOLVED that the Southold Town Board of Trustees grant a waiver to to construct a bluestone patio on two-level elevated bed, not exceeding 18" above grade.; stones set steps to grade. Total area approx. 517 s.f. Located 175 Clearwater. Lane, Cutchogue. Enclosed please find a check in the amount of $110.00 representing a refund from a full application. If you have any further questions, please do not hesitate to. contact this office. Sincerely, Albert a. Krupski, Jr. President, Board of Trustees AJK:jmd . Cc: CAC o Town Hall, 53095 Main Road P.O. Box 1179 Telephone O 0� Southold, New York 11971 (516) 765 1801 �1 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held March 25, 1996 the following recommendation was made: 1334 Moved by Robert Keith, seconded by Kenneth Meskill, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH CONDITIONS of the Wetland Application of ELAINE McDUFFEE 118-5-2.2 to construct a bluestone patio on two-level elevated bed, not exceeding 18" above grade; stones set in sand base with mortared joints; with steps to grade. Total area approximately 517 s.f. The Council recommends approval provided the applicant directs the runoff away from the bluff. The CAC suggests grading to have runoff flow south. 175 Clearwater Lane, Cutchogue Vote of Council: Ayes: All Motion carried. r. r Albert'J. I{rupski, President q'� �G Town Hall Jchn Holzapfel, Vice President 53095 Main Road William G. Albertson y '` P.O. Box 1179 Martin H. Garrell Southold, New York 11971 Peter Wenzel Q� r'� �+a Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application Wetland Permit Application _ 8 Grandfather Permit Application l Trustee Lands Permit Application Waiver I 8TO VV'N !a� Received Applicati n: g' 6 -- - Clerical Review: - dr G Completed Applicati n J Incomplete SEQRA Classificat' on: Type I Type II A Unlisted C rdination: (date s ) CAC Referral Sent: •� Date of Inspection: 3 / G eceipt of CAC Report: ( at _ Lead Agency Determination: Technical Review: (date) Public Hearing: (date)•3 a p/. Decision: Approved (Y% ) date) WR Application Fee:$/J-0• o o Name of Applicant Elaine McDuffee Address 175 Clearwater Lane, Cutchogue NY 11935 Phone Number: 516) 734-5223 Suffolk County Tax Map Number: 1000 - 118-5-2.2 Property Location: 175 Clearwater Lane, Cutchogue (provide LILCO Pole #, distance to cross streets, and location) Agent: James E. Fitzgerald, Jr. / Proper-T Permit Services (If applicable) . Address: P.O. Box 617, Cutchogue, NY 11935 Phone: 734-5800 Board of- Trustees Appli -, :ion GENERAL DATA Land Area (in square feet) : 52,964 sq ft Area Zoning: R-40 Previous use of property: `Private residential Intended use of property: Private residential Prior permits/approvals for site improvements: Agency Date Building Dept Not known No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? X No Yes If yes, provide explanation: Project Description (use attachment$ if necessary) : Construct bluestone patio on two-level. elevated bed, not exceeding 18" above grade; - stones set in sand base with mortared joints; with steps to grade. Total area approxi- mately 517 sq. ft. 2 %: Board of Trustees Appli' :ion WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Provide area for outdoor living activities. Area of wetlands on lot: less than 500 square feet Percent coverage of lot: less than 1 % Closest distance between nearest existing structure and upland edge of wetlands: -0 feet Closest distance between nearest proposed structure and upland edge of wetlands: 50 feet Does the project involve excavation or filling? X No Yes Sand will be brought in to use as base for patio, but nothing near wetlands If yes, how much material will be excavated? -0- cubic yards How much material will be filled? -`O cubic yards Depth of which material will be removed or deposited: N/A feet Proposed slope throughout the area of operations: 0% Manner in which material will be removed or deposited: N/A Statement of the effect, if any, on-the wetlands and tidal waters of the town that may result by reason os such proposed operations (use attachments if appropriate) : The project will have no significant effect on the wetlands and tidal waters of the Town. 6 14.16.4(2/87)—Text 12 • PROJECT I.D.•NUMBER 617.21 SEAR Appendix C Stater 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 James E. Fitzgerald, 'Jr. McDuffee patio 3. PROJECT LOCATIOCitchogue Suffolk Municipality County 4. PRECISE LOCATION(Street address and road Intersections,prominent landmarks,etc.,or provide map) 175 Clearwater Lane . See attached maps. 5. IS PROPOSED ACTION: ®New ❑Expansion ❑Modificationlalteration 8. DESCRIBE PROJECT BRIEFLY: Construct bluestone patio on two-level elevated bed, not exceeding 1811 above grade; stones set in sand with mortared joints.; with steps to grade. Total area approximately 517 sq. ft. 7. AMOUNT OF LAND AFFECTED: Approx 517 sq. f t. 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? ®Residential ❑Industrial ❑Commercial ❑Agriculture ❑Park/Forest/open apace ❑Other Describe: Medium- to large-size private residences 10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING,NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL, STATE OR LOCAL)? X]Yes ❑No If yes, list agency(s)and permitlapprovals Southold Building Dept 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes ®No If yes,list agency name and permitlapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? ❑Yes ®No I CERTJFaY�TeAyT Tgl( INF.pIFi�1�Tg10�PagVlp;D&BO E IS TRUE TO THE BEST OF MY KNOWLEDGE JJProperl-';T 1P''1 L ffitSe4rviJr. ces Applicant/sponsor name '% Date: Mar 6. 1996 Signature: I! the action is In the Coastal Area, and yod are a state agency, complete the • Coastal Assessment Form before proceeding with this assessment OVER 1 PART il-ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD-IN 6 NYCRR, PART 617.12? If yes,coordinate the review process and use the FULL EAF. ❑Yes ❑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 ❑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, nolse levels, existing traffic patterns, 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. IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑Yea ❑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;(e)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. ❑ 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 Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer 9,different from responsi e o icer) Date_ 2 6tRAG.Eco n irr � it L`. Ta "lore' t�M� �NDUsE. Ill z 0 u1 0[ 1 . -8LuF—sTON7 TAT(0 5Tp FIXAT S'AkE; 10 ��FiTZ�EP,�11J 3I6 f of 6 se[ Sec III a wf }\ MATCH � lIN[ 4 • l ,.• , •iMdoo. 1•• t 1• TOWN 01 `d IAw' 9 t, •tu• ' $j ' al. lOUTNOlO •�_ 'a i l Ni• y �.� MaAeA word 10 lu•otw•nt .ua j '•ra 47) 1 _ — , ..�• d 12.3 1.?A161 I_ t I D 1r. ..... It• p 10 '�• 1 4 .•r•4. `• t i y �Q r 43a�1a1 ...• .,l' d• , ••• J •i CA THE SITE OF THE PROPOSED `J ".1Aw Lap•, �" "' t ''`oaf•r 1\• y� a *,50 1 [ ilt '•r J ` PROJECT IS CROSS-HATCHED - \\ IN J14 • 9 . w �b 9 •J r f TAX MAP Application re pdu�ng�the roe of Elaine McDuffee, SCTIVI#1000-118-5-2.2 MAR 8 � Represented by PROPER-T PERMIT SERVICES P.O.Box 617 Cutchogue,NY 11935 James E. Fitzgerald, Jr. 516-734-5800 .%�°{;I�'•IJ .JAL March 5, 1996 DUE TO RECENT BAD WEATHER, IT HAS NOT BEEN POSSIBLE TO STAKE THE PRO- JECT AND TAKE PHOTOS. THIS WILL BE DONE BEFORE THE NEXT SCHEDULED IN- SPECTION AND THE PHOTOS WILL BE SUBMITTED. PROJECT SITE PHOTOS a Application regard iun�gg�t�he pprroperty of Elaine McDuffee, SCTIVI#1000-11$-5-2.2 Represented by MAR .- 8 M% PROPER-T PERMIT SERVICES P.O. Box 617, Cutchogue,NY 11935 James E.Fitzgerald, Jr. 5167734-5800 March 5, 1996 8 N6 Proper-T Permit Services MAR POST OFFICE BOX 617, CUTCHOGUE, NEW YORK 11935-0617 ,� U ( 16)734-5800 March 8, 1996 President Board of Town Trustees Town of Southold Town Hall, 53095 Main Road Southold, New York 11971 Re: Ap plication for Permit on Behalf of Elaine McDuffee Dear Sir: Attached are documents which have been prepared in support of the application for a permit to construct a patio on the property of Elaine McDuffee in the Town of Southold. Proper-T Permit Services represents Mrs. McDuffee in this matter, and a letter of authoriza- tion is part of this submission.. It seems that this project might be accomplished under a waiver from the Board, instead of a full Wetlands Permit. If that is the case, please process the applica tion accor&&. If there are any questions, or if additional information is needed, please call me. Yours truly, s E. Fitzgerald Enclosures: Application Fee ($150) Letter of Authorization Notarized Statement of Applicant Notice to Adjacent Property Owner Proof of Mailing Notice Application Form(3 copies) Short EAF (3 copies) Vicinity Map (3 copies) Tax Map (3 copies) Survey of Property(3 copies) Project Plan(3 copies) Project Site Photos (3 copies) a subsidiary of THE PECONIC EASTERN CORPORATION o�vS�FFO�,��o Albert J. Krupski,President � Gy Town Hall John Holzapfel, Vice President c .�� 53095 Main Road P.O. Box 1179 Jim Kin g py Southold,New York 11971 Martin H. Garrell Peter Wenczel ��j �`a�! Telephone(516)765-1892 Fax (516)765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD - OF TRUSTEES: TOWN OF SOUTHOLD ----------------------------------- In the Matter of the Application of ---'V bv�;c.t-------- COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I _7amPc F._ Fit-7.rraralA , Jrresiding at385 Haywaters Drive- Cutchogue, NY, 11935 being duly sworn, depose and say: That on the20th day ofMarch , 1996, I personally posted the property known as 175 Clearwater Lane, Cutchogue, NY 11935 by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for seven days prior to the date of the public hearing. (date of hearing noted thereon to be heldZ9,� Dated: March 27, 1996 (signature) Swo�Vn to before me this a� day of l'ylke-J J 1996. Notary P li 4USAfV .NAGY N61t y Public,State of Novi �6 EC�l1V p No.4896735 Qualified in Suffolk County�q,� commission Expires May 26, J-E FIT GERALD PHOTO A: Looking NE. ,.... Orange stakes mark in- side and outside corners of proposed patio. (3/12/96; 1500 hrs) PHOTO B: Looking S from vicinity of house. The orange stake marks the most southerly corner of the proposed patio. (3/12/96; 1500 hrs) 4 '�y , � K x PROJECT SITE PHOTOS Application regard' the pprroperty of Elaine McDuffee, SC #1000-11$-5-2.2 Represented by PROPER-T PERMIT SERVICES P.O. Box 617, Cutchogue,NY 11935 James E. Fitzgerald, Jr. 516-734-5800 March 5, 1996 -- A o• . PHOTO A: Looking NE. ••. Orange stakes mark in- side and outside corners of proposed patio. (3/12/96; 1500 hrs) .r N PHOTO B: Looking S from vicinity of house. The orange stake marks the most southerly corner of the proposed patio. ++� (3/12/96; 1500 hrs) ..t, ... �..... r` h. •i q 7. 2�'11•ham __ PROJECT SITE PHOTOS Application regarding the roper ty of Elaine WDuffee, SC #1800-118-5-2.2 Represented by PROPER-T PERMIT SERVICES P.O. Box 617, Cutchogue,NY 11935 James E. Fitzgerald, Jr. 516-734-5800 March 5, 1996 IIIIIIII IIIIII(� -- PHOTO A: Looking NE. ... - - _ Orange stakes mark in- side and outside corners kb of proposed patio. (3/12/96; 1500 hrs) y T I M S. ` - PHOTO B: Looking S from vicinity of house. The R, orange stake marks the pt most southerly corner of the proposed patio. - �' (3/12/96; 1500 hrs) i ONWMM Me-: C_ YFw yi�, 4 IR• :l x PROJECT SITE PHOTOS Application regard' the pproperty of Elaine McDuffee, SCR #1U00-11$-5-2.2 Represented by PROPER-T PERMIT SERVICES P.O. Box 617, Cutchogue,NY 11935 James E. Fitzgerald, Jr. 516-734-5800 March 5, 1996 Proper-T Permit Services POST OFFICE BOX 617,, CUTCHOGUE, NEW YORK 11935-0617 (516)734-5800 March 27, 1996 N ..� President �'�� MM z7� G Board of Town Trustees r,Y T Town of Southold ;TO��; i' �.v:,;"„ tr Town Hall, 53095 Main Road Southold, New York 11971 ` Re: Elaine MCDuffee, SCTM#1000-118-5-2.2 Enclosed are three sets of Project Site Photos for this project. Also, the Affidavit of Posting concerning the notice of public hearing is attached. S' erely, es E. Fitzgeral r. a subsidiary of THE PECONIC EASTERN CORPORATION DATE: March 6, 1996 TO: John Spicer Joseph Flotteron 443 Highbrook 69 Roanoke Road Pelham Manor, NY 10803 Belle Mead, NJ 08502 BOARD OF TRUSTEES, TOWN OF SOUTHOLD NOTICE TO ADJACENT PROPERTY OWNER In the matter of ELAINE McDUFFEE, SCTM#1000-118-5-2.2 YOU ARE HEREBY GIVEN NOTICE THAT: 1. An application is being submitted to the Board of Trustees for a permit to: Construct bluestone patio on two-level elevated bed, not exceeding 18" above grade; stones set in sand base with mortared joints; with steps to grade. Total area approximately 517 sq. ft. 2. The project described above is proposed on property adjacent to yours. The street ad- dress of that property is as follows: 175 Clearwater Lane, Cutchogue 3. The project, which is subject to Environmental Review under Chapters 32, 37, or 97 of the Town Code, is open to public comment. You may contact the Trustees Office at 765-1892 or in writing if you wish to comment. 4. The project described above will be reviewed by the Board of Trustees of the Town of Southold. The project may require independent review and approval by other agencies of the Town,;State, or Federal governments. PROPERTY OWNER'S NAME: Mrs. Elaine McDuffee MAILING ADDRESS: 175 Clearwater Lane Cutchogue, New York 11935 PHONE NO.: 734-5223 A copy of a sketch or plan showing the proposed project is enclosed for your convenience. Z 027 776 932 Z 027 776 9301 Receipt for EDG a� Receipt for _ - Certified Mail Certified Mail No Insurance-Coverage Provided No Insurance Coverage Provided NamE „ES Do not use for International Mail Ad U„nE ? Do not use for International Mail' POSTN SERVICE yJ (See Reverse) I PoSTA1 s—cE (See Reverse) �othn Spicer "oseph Flotteron a a 44'�-Iftghbrook `ado""°snoke Rd P&Thatf''M� ffior NY 10803 ��`9e�"d1 e�d's� _NJ 08502 Postage $ -3 Postage $ Certified Fee O�-/ Certified Fee V Special Delivery Fee Special Delivery Fee Restricted Delivery Fee Restricted Delivery Fee a C.) Return Receipt Showing Return Receipt Showing to�Wh- D'ate-.Delivered 0) to Whom&Date Delivered T t Ae36in'Receipt Showing to Whom, Z Return Recpp��0 Showing to hom, �t Date,and Addressees Address Date,and�'Ad` s ' Ad s k �.TOTAL Posta6�� to TOTA test° e /� &Fees ° — LLin &Fee r. i, ,;�o $ + ® qs rWf or Date ; O Post crrk r Date j" LL LL (Al a STATE OF� NEW-- YORK - _ COUNTY OF SUFFOLK James E. Fitzgerald, Jr. , residing at 385 Haywaters Drive, u c ogue being duly sworn, deposes and says that on the 7th day of March , 1996 , deponent mailed a true cbpy 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 Cutchogue NY t said Notices were mailed to each of said persons �Ysy (cer fiE. r etc$ mail.. Sworn to fore me this day of ,19 y N ar i SUSAN J.NAGY Public,State of New YArk No.4896735 iaal'ified in Suffolk County,�c melon expires tray 26,.�„c;✓ 6 i u �G ,:,. �.��a�.+° Neck i ' (1` ( �y yVS w i Ail pQ `9 Bay _ EAST *t CUTCHOGUE j { curcmm CEMETERY h' Q H 0 G N E C �f—1 B A Y e°b � ;: W: enD ' ' F CK NL' 2©° DE aa� nus cDCo E Ftf ue D " LI1"f[.E Marsh PC. : 9��. c 'Fo ,+°tw 1lOG NECK C CC. , o •Narsrchoe � ,,'rl� " ✓// qD 9 CUTCHOGUE Z NASSAU HAR(30R POINT o Da("� Old COVO •' I ,, oMU„p� Y.C. , o a W odd weld THE AREA OF THE PROPOSED i.:`:.. PROJECT IS CIRCLED NEW SUFFOLK I 'c M. i 9TH `. kRACE ; s , I • I { Nassau.Point 1 r VICINITY MAP Application regarding the properw of Elaine cDuffee, SCTM#1000-11 5-2.2 L �' '�� � Represented by f; I PROPER-T PERMIT SERVICES P.O. Box 617, Cutchogue,NY 11935 James E. Fitzgerald,Jr. 516-734-5800 March 5, 1996 a MAR — 8 19 175 Clearwater Lane Cutchogue, New York 11935 March 5, 1996 President Board of Town Trustees Town of Southold Town Hall, 53095 Main Road Southold, New York 11971 Dear Sir: Please be advised that I hereby designate and authorize James E. Fitzgerald, Jr. of Proper-T Permit Services to act in my behalf as my agent in the submission and processing of a permit application for the construction of a patio on my property located at 175 Clearwater Lane, Cutchogue, and designated by Suffolk County Tax Map No. 1000-118-5-2.2, and to furnish, upon request, supplemental information in support of the application. Yours truly, Elaine McDuffee STATEMENT TO THE SOUTHOLD BOARD OF TOWN TRUSTEES County of Suffolk ) State of New York) L Elaine McDuffee, being duty sworn, depose and affirm that I am the owner of the prop- erty located at 175 Clearwater Lane, Cutchogue, New York 11935, and identified by Suf- folk County Tax Map No. 1000-118-5-2.2, and that all work will be done in the manner set forth in the present application and as may be approved by the Southold Board of Town Trustees. I agree 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. I hereby authorize the Town Trustees or their agent(s) or representative(s) to enter upon my property to inspect the premises in conjunction with the review of the present application. Elaine McDuffee Sworn to before me this ....... .... day of..................��.��rG. ...., 19.A Notary c MARY JANE WADDELL Notary Public,State of New York No.4948216 Qualified in Suffolk County gq Commission Expires Mar,6, 19= A1bF J. Krupski, President jY�C� C7G Town Hall '�' �,'�� J► 53095 Main Road Hol Jcl zapfel, Vice President William G. Albertson v, f�•1�� r.4' P.O. Box 1179 Martin H. Garrett v ,` ;' Southold, New York 11971 Peter Wenczel O� Telephone 516) 765-1892 %,'� ��• � r� Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD office Use Onlyl Coastal Erosion Permit Applicationi ;: ; Wetland Permit Application i s Grandfather Permit Application 7 Trustee Lands Permit Application Waiver Received Applica 3i n• Clerical Review. F- G Completed Applica i n �- Incomplete SEQRA Classificat' on: type I Type IIUnlisted Coordination: (date se it) CAC Referral Sent: 3 g- Date of Inspection: / _ Receipt of CAC Report: da e) Lead Agency Determination: Technical Review: (date) Public Hearing: (date) -? b I MAR Decision: Approved (Y/ ) date) Application Fee: $ /eS`�, v J lJ Name of Applicant Elaine McDuffee Address 175 Clearwater Lane, Cutchogue NY 11935 Phone Number: ( 516) 734-5223 Suffolk County Tax Map Number: 1000. - 11875-2.2 Property Location: 175 Clearwater Lane , Cutchogue (provide LILCO Pole # , distance to cross streets, and location) Agent: Janes E. Fitzgerald, Jr. / Proper-TPernit Services ( If applicable) Address: P.O.. Box 617, Cutchogue, NY 11935 . 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