HomeMy WebLinkAboutMOELLER, RICHARD Consultant ALL '' ZIC r- l a`r
Project Name
SCTD1 #1000- /' �s
Date A
The Southold Town Loafsftta
e has determined that your
a lication for aer��inn we
and perms is
- 'urisdictiona incomplete, please consider the following
information in is regard for any required return submission:
�.�rcerF,��P � ran cr�t
tiAs v� fig ? �5 P r
Tru6,6ee Repreientativd
cc: /Building Dept.
P e„r„ ,., Doard .
i�r-r-F�— •r �-i ran Ar��r_rs�rv'rtr�+�.�'.�.:�`�i`� .. _.
This notice makes no claim with respect to .other jurisdictions
within or outside the Town of Southold with respect to permits,
permission required.
4/92
TRUSTEES ,,�:;'?o:, SUPERVISOR
John M. Bredemeyer, III, President SCOTT L. HARRIS
Albert J. Krupski, Jr., Vice President 4
Henry P. Smith ;;.. ��? Town Hall
John B. Tuthill ' 53095 Main Road
Wil yp?,. r?,%`j P.O. Box 1179
Liam G. Albertson
Telephone (516) 765-1892 ^` U- J Southold, New York 11971
Fax (516) 765-1823 BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
COASTAL EROSION HAZARD AREA
AND
TOWN WETLAND
EMERGENCY .AUTHORIZATION(S)
Application No.SCTM
Name:
Date: December 21, 1992
RESOLVED that pursuant to the Town Code in relation to Coastal
Erosion Hazard Areas, Chapter 37, Section 20, 21 and Town Code
Chapter 97, Wetlands, the Southold Town Trustees, as
Administrator, have determined that the activities proposed by
your emergency activity request are necessary to protect
property and important coastal natural resources.
DESCRIPTION OF ACTIOON:
/ ' `
e- L �C / ✓� �_, ^- i v\, rO
Reasons supporting this determination:
1. An on site inspection has been conducted by the board of
Trustees or their authorized representative.
2 The Trustees have considered the emergency request and find
hat if the work is not completed as authorized and measurable
loss of property and important coastal natural resources is
likely to occur.
This authorization is not a permit. ' You must complete the
Coastal Erosion and wetland permit process where applicable for
all authorizations given under this section.
This authorization should not be considered a determination made
for any other department or agency.
n ,
TRUSTEES ,•,y ,^._''s�. •� G,
John M.Bredemeyer,III,President
SUPERVISOR
s:
Henry P. Smith,Vice President SCOTT L.HARRIS
Albert J.Kru ski Jr.
John L.Bednoski,Jr.
Town Hall
John B.Tuthill y; 53095 Main Road
P.O.Box 1179
Telephone(516)765-1892 BOARD OF TOWN TRUSTEES Southold,New York 11971
Fax(51.6)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
jv4Wetland Permit Application
MTrustee Lands Permit Application U
/1AGrandfather
Completed Apps. Date: �.1 L''�1�� JAN 1 1 1992
AAVariance Required,
T� Neighbors notified Date:SEQRA Type TOWN OF S®UTH®�,�
rw Coord. Review-opt. .m nd. Date Rec. by O 1
Insp. comp./date: ���
�SEQRA Determin. /date:
/Apublic Hearing/date:
Findings:
Permit Vote: (Y/N) :
Special Conditions: All
(also see file) Application Fee:
Application Number; SCTM #1000- l - ice'
Project Name (If any)
,Date Prepared: ( ��
Applicant:—Ric a e m-o M,0 f tL Li✓fV,
Address: S-9 9au_ R D.
a L_L&fir S?TKEAt'i _ fy Y IISF5'o Phone
Interest: (owner, consultant,lessee,etc. )
Owner of Property: 50-MC
Address
Phone ( )
Subject ProPerty Location: 1155 A Qll,AV l EW Rif-i= .
�r`tS'f A-4-� I DI✓j���9 3 9
(Provide LILCO Pole #, llistance to cross Streets if not on
location map)
THIS IS NOT A PERMIT
Yds. to be excavated: /U A Yds. to be filled:
Manner in which material will be removed or deposited:
Width of canal, creek or bay fronting property: ova. $
Depth at low tide: 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:
Describe known prior operations conducted on premises:
Has any prior license or permit been issued to erect structures,
dredge, or deposit fill on said premises: f%,n jtC'L ,, v,
S - l�n,tfe� 4D I� G
VV
Has any license or permit eve been revoked or suspended by a
Governmental Agency: Da
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) .
AA e-s i v e- v►1 ( �
Authorization (Where the applicant is not the owner)
I residing at
(Print-owner of subject property) (Mailing address-phone)
do hereby authorize to apply for
Coastal Erosion permit( s) from the Southold Town Trustees
Signature
THIS IS NOT A PERMIT
County of Suffolk )
State of New York )
Rl G1+g2 D G. O Et- L�R 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 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 REPRESENTATIVE( s) , TO ENTER ONTO MY PROPERTY
TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS
APPLICATION.
S GN T RE
SWORN TO BEFORE ME THIS DAY OF ,19 �
FRANCES ABINME
NOTARY PUBLIC,State of New York
No.4734358
Aj Qualified in Suffolk County
62—
Y PUBLIC Commission Expire
Suggested space for location Map
THIS IS NOT A PERMIT
l
FEB - 8 1993
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14-16.4 Q187)—Text 12
PhIECT I.D.NUMBER 617.L+ SEQ R
Appendix C
State Environmental Quality Review
SHORT. ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART 1—PROJECT INFORMATION (To be completed by Applicant or Project sponsor)
1. APPLICANT/SPONSOR 2. PROJECT NAME
( c(-tA-a- t oeLLE_l2
3. PROJECT LOCATION:
Municipality j Wr R" u-0-vl ez.) ave. l . H6At av-,, County v Lfi f) !�
4. PRECISE LOCATION(Street address and road intersections, prominent landmarks,etc.,or provide map)
5. IS PROPOSED ACTION:
❑New ❑Expansion ❑Mod ification/alteration
6. DESCRIBE PROJECT BRIEFLY:
(� re uvv 4- r t e-C
� t✓ °s+0.t.-rs -Ib beo-aN
7. AMOUNT OF LAND AFFECTED:
Initially acres Ultimately acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR.OTHER EXISTING LAND USE RESTRICTIONS?
9WYes ❑No If No,describe briefly
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
Residential ❑Industrial ❑Commercial ❑Agriculture ❑Park/Forest/Open space ❑Other .
escnbe:
10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING,NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL,
STATE OR LOCAL)?
Yes ❑l No If yes,list agency(s)and permit/approvals am- L` Dec
H v U g
11. DOES ANY A111S���P-CT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
❑Yes No If yes,list agency name and permit/approval
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION?
❑Yes ❑No
CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant/sponsor name: RICktftfeD v HOP_ I— Date:
\ P
\ Signature:
1
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
„ -”' I �I v c- c;01l1Dt(-:112d by Agency) _
A. DOES ACTION EXCEED ANY TY� THRESHOLD IN 6 NYC11R, PART 617.12? It yes,
El Yes No Lnalo the review procoss and use Ira FULL L`A`❑
B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.67 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)
Ct. Existing air quality, surface or groundwater quality or quantity, noise levels, existingtraffic patterns, solid waste
potential for erosion,drainage or flooding p production or disposal,
9 g problems?Explain briefly: - •
`/V0
C2. Aesthetic,agriculturaal,�archaeological,historic, or other natural or cultural resources:or community or neighborhood character?Explain briefly:
IU U
C3. Vegetation or fauna, fish,she 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.
VU 0
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•C5? Explain briefly.
/V
C7. Other impacts(including changes in use of either quantityor type of energy)? Explain briefly.
/V V
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)
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;
irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference Supportadeua teria(ls duration; (d)
explanations contain sufficient detail to show that all relevant adverse impacts
q acts have been identified and d Ensure that
tely addressed. -
:❑. Check this box, if you have identified one or more potentially large or significant adverse im
occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. pacts which MAY
❑ Check this box if you have determined, based on the information and analysis above and.
documentation, that the proposed action WILL NOT result in an any supporting
AND provide on attachments as necessary, the reasons supporting
significant adverse envi.ronn1ental im
pporting this determination: Pacts
N•,mc ur LeaJ Agency
Ynnt ui lype N.inie Ur KcspumiUlu Uilicer in Lcdd Agency
title ul Responsible Umcer
]ignalure of Hesponsible Ulhcer in Leed Agency
— - 51gn"lure of 1'reparer(if dillerem from res onsiole oih p serf
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