HomeMy WebLinkAboutTR-1799 ALL MOORINGS AND STAKES MUST DISPLAY VISIBLE MOORING NUMBERS
ALL DOCKS AND BULKHEADS MUST DISPLAY VISIBLE PERMIT NUMBERS
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Board Of Southold Town Trustees
SOUTHOLD, NEW YORK Ip
Mooring # N/A
PERMIT NO. 9 5, 1
1799 ATE. ................................... :8
D . March 1
B. .r Ix.... .... r./..Le.ah....Indelm
ISSUED TO
athe Bxic Muehlbaue
'.Y.
I 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
AEI State of New York 1952; and the Southold Town Ordinance en- !i
, 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
t 1 11 ! "'
V Yn
LANDS UNDER TOWN,WATERS; and in accordance .with the
Resolution of The.Board adopted at a meeting held on Feb........2.7..,..
'� _
�� 19 84..., and in consideration of the sum of $..••22. 00 paid by _
......
Esther•.•.&_••,Eric..,.Muehlbauer./.L•eah.•.Lnce,l ................
Cutcho ue.... Y
of ............................g.. ...... .. N. Y. and sub ect to the
.
.Terms and Conditions listed on the reverse side hereof, 1Q.
4���r•` �; of Southold Town Trustees authorizes and permits the following:
Approved to construct a catwalk, ramp and
Float dock, in East Creek, Cutchogue, as per t
application submitted. r,; `••'
#'11 all in accordance with the detailed specifications as presented in
�"a. the originating application.
Y n 6 1 F7t
�{
IN WITNESS WHEREOF, The said Board of Trustees here- - e<
sl
I 3t� by causes its Corporate Seal to be affixed, and these presents to '.�
b a ma'orit of the s 'd Board as of
is
be subscnbed y 1 y � .
> G '
Cr ....... ......... l.....i .. .......... ... ........ !' .
' I (t ..O . .... c�
Trustees
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A.
5'• ./ d (-. d 1 a`�J A ' S',S x �=":1Y.Q _Vstyfdai°`l� -'.s�Wds: 'ry 1
Please tear off and return to the Trustees
BOard of Southold Tovvin Trustees
o\` SOUTHOLD, NEW YORK
\� MOORING NO.
PERMIT NO. 1799 DATE: March 15 , 1984
ISSUED TO Esther & Eric Muehlbauer/Leah Indelman
I certiry that the work as authorized
in this permit has been completed and 'is now ready for your inspec-
tion. also, the number required on this project is clearly visible.
I further understand this permit is not valid until this tear sheet
is returned to the Trustees.
"r .
TERMS and CONDITIONS
The Permittee Esther & Eric Muehlbauer/Leah K. Indelman
residing at Fleetwood Road, Cutchogue N. Y., as
part of the consideration..for the issuance of the Permit does understand and prescribe to the fol-
lowing: 1 . That the Southold Trustees Permit. must be prominently
displayed on the premises effected thereby during the period of
That the said Board of Trustees and the Town of Southold are released from any and work;
all damages, of claims for damages; of suits arising directly or indirectly as a result of any oiler- untie
the
motion performed pursuant to this .permit, and the said Permittee will, at his or her own expense,
e,defend any and all such suits initiated by third parties, and the said Permittee assumes full liability permit
with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold
3'' That this Permit is.valid for a period of 12 mos. which is considered to be the
sufficient time required to complete the work_ involved, but should circumstances warrant, request
for an extension may be made to the Board at a later date.
4•: That this Permit should be retained indefinitely,or as long as the•said Permittee wishes
to maintain the structure or project involved, to provide evidence to anyone concerned that auth-
. , orization was originally obtained. _..
5: 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.
6, That there will be no unreasonable interference with navigation as a result of the work
herein authorized.
T. That these shall be no interference with the right of the public to pass and .repass along
the beach between high and low water marks.
$, 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 Trustees, the
work shall cause unreasonable obstruction to free navigation, the said Permittee will be required,
Upon due notice, to remove or alter this work or project herein stated without expenses to the Town
of Southold.
9 , That the said Board will be•notified by the Permittee of the completion of the work auth-
orized. (See tear `off sheet. ) - ,.,
10 . That the Permittee will obtain all other permits and consents that may be required sup-
plemental to this permit which may be subject to revoke upon failure to obtain same.
1
TELEPHONE
(5161 765-1892
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 728
Southold, New York 11971
October 1, 1984
Mr. Eric Muehlbauer & Ms. Leah Indelman
65-20 Austin Street
Rego Park, New York 11374
'RE: Dock Permit 1799
Dear Ms. Indelman & Mr. Muehlbauer:
Your request to move your dock was approved at
the Trustees meeting held on September '27,. 1984.
Very truly yours,
Henry P. Smith, President
Board of Town Trustees
Ilene Pfifferling
Secretary
cc: Trustees
File
r
TELEPHONE
(516) 765-1892
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 728
Southold, New York 11971
February 28, 1984
Mrs. Judith T. Terry
Southold Town Clerk
Town Hall
Main Road
Southold, New York 11971
Dear Judy:
Transmitted herewith is the action taken by the Board
of Town Trustees at a regular meeting held on February 27 ,
1984 :
RESOLVED to recommend to the Southold Town Board Approval
of the Wetland Application #180 submitted by Esther & Eri-c
Muehlbauer and Leah K. Indelman to construct a Catwalk and
floating dock, in East Creek, Cutchogue, as per application.
Very truly yours,
Board of Town Trustees
Henry P.&12')-,J,r
President
ip
� f�
.o � Esther & Eric Muehlbauer /
a 8� Leah Indelman
65-20 Austin St.
Rego Park, NY 11374
August 23, 1984
Mr. Henry P. Smith, Town President
Board of Town Trustees
Town Hall
Main Road, Southold, NY 11971
Dear Mr. Smith:
On March 15, 1984, we received permit number 1799,
from the Board of Southold Town Trustees , in order to
construct a catwalk, ramp and floating dock, on our
property in East Creek, Cutchogue. The floating dock and
ramp have now been constructed and positioned as was
indicated in our architect ' s Uanning map that was sent to
you with our application.
After completion of this work, our neighbors ,
Mr. and Mrs . A. Weiss , have made us aware that our dock
and ramp overlap their property by about 6 feet. Surveyor
Mr. R. Van Tuyl, of Greenport, has confirmed this situation
last week. Mr. and Mrs . Weiss would therefore like the
dock and ramp moved as soon as possible. With your permission,
we would like to move these structures to the edge of our
own property on East Creek. This would involve a simple -
relocation of the dock and ramp, and would comply with all
other specifications of the original application.
We would appreciate hearing from you immediately on
this matter, and thank you for your time and concern.
Sincerely yours ,
Esther and Eric Muehlbauer &
Leah Indelman
Ya �
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SOUTHOLD TRUSTEES .
NO. qq
EsfAr�t f E•t�e.M��b/6.ca�e
- Issued To "oA sN.W<<mAA1 Date maxaA Is: 19Bse
Address-rl.eci"Jodd- /4eaW- . r- ulGLIeQUG Al. V.
THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION
TOWN TRUSTEES OFFICE, TOWN OF SOUTHOLD
SOUTHOLDs N. Y. 11971
TEL.: 765-1801
r TOWn Of Southold
Town Clerk's Office;
Southold, N. Y.
APPLICATION FOR WETLANDS PERIUIT
Application No. ... �I.. ................
Date of Application ......�/. 1„ �},,,,, ..............
�/ A/� I_ y T�� I
Identity of Applicant .....1�?t�er......�!...!:.........!:,:��r � ... .. '!►�lh.............
Address of Applicant .....Y1: .....&Q.....
�.I.!�t5 b...1. N/..l.! /...... ..................
INSTRUCTIONS FOR PERMIT
A. This oppiication is to be completely filled in by typewriter or ink and submitted to the Town
Clerk in quadruplicate, accompanied by written permission from the owr;cr of the property if not
the some as the applicant.
B. Pilot Plan must be drawn to scale on .the reverse side pf this application show;ng the locoti:n
of property, the names and locations of owners of adjoining properties, and a detc1led drscr;,oticn
of prcposed project. (Note: Copies of the Pilot Plan may be made by a copy machine and cttac-ed
to the Permit Application.)
C. No operation shall be initiated by the applicant until all permits that are required are issued.
D. A detailed statement of the rehabilitation and prcposed condition of the premises after the
work is completed must be given, including a survey if required.
E. If permit is being sought for a more sizeable excavation than the construction of a private
single dock or jetty, then this application must be accompanied by a survey and topographical map
certified by a registered land survey or Professional Engineer. The horizontal control of survey
shall be based upon an approval local coordinate system. The vertical control for elevotion and sound-
ings shall be based upon United States Coast and Geodetic Survey and/or United States Geological
Survey datum.
F. A statement must accompany the application describing any known prior operations ed
conduct on the premises in question and whether any prior licenses or permits have been issued to erect i
structures or to dredge or deposit fill on said premises and whether any such permits or licenses
were ever revoked or suspended 'by a .governmental agency.
G. A filing fee of Jaej
shall accompany the application. This filing fee includes one inspection;
there is a $5.00 fee for each additional inspection.
H. 'The Town Board upon requcst,q �7 applicant for a permit, may waive in whole or in par;,
the provision: of Article II, Section = , subdivisions (b, and (69-where it firid5 that nature of the
,oropo-.cd operations are such that the requirements of such provisions are not necessary for a
prc;.er consideration of a permit application.
I. Upon =prcral of this application the Town Clerk will issue a permit to the applicant. Such
ermir shall be available for inspection at any time, upon request.
Examined -.7", ...a .............. 19.
Approved ... .K ......... ..........
Discpproved ............................................................
C'-n.+iticn-, ;F cin'! ..... ....... ......... . ..... .. .................. ...........
................................................................................_.......................................................,........................
..................................................................................................................................................................
ExaminingBody :...... .. .4- .. ......... ...................... ....................................................
Signature of Ci^cirman ...... ........ ......... .... ..... a .....................
t • r s
APPLICATION IS HEREBY MADE to the Town Board of the Town of Southold, Suffolk Cur-, y,
New York, fir the-issucr.ce of a permit pursuant to the Laws, Ordinonces and Rcguicticns Scvern-
ing the Ccastal and Interior Wetlands, Flood Plains
l_and Drc:nage Areas
f of the Town of'Sout-;ola:
Perrrit requested t0 ...... ... ...4-..r!.�c.../..:Ix�'�II��X�I�J�. /- °-0` 1......�.:�r .�:� r�Gt%1.............
..................................................................................................................................................................
Location of property for which permit wanted..... 1!�� `"1(t.✓1„�/..J.!S, I.� `�t�.. .�.:'��i� ` .... -
o!�...k� s{-... r j...lA. .....0fpie......6usz......a..!..... Clio q �U
Hcrne ed-ress of permit eppiiccni if different from aforescid Ircct?cn ...ay-..a.Q......4l.t:5-+k..5L
��Ja...��r �... .��....11.3. .......................................................................................................
Creek, Bay or Harbor fronting property ..... 0.5 r....Cry. .............................................................
..................................................................................................................................................................
Size of proposed work:
Length ...6.�.....Qw.K............ .............................................................................................................
Width .... ........:�
...............................................................................................................
HeightAbove High Water ....... IOO� !Vl. .......................................................................................
Depth Below Low Water .............. ....................._...................:............................................................
Yoresto be Excavated ...................................... ...........................:............................... ........................
Yardsto be Filled ................................................ .................................................................................
Width of canal, creek or bay fronting property......... 30..................................................................
1
D,�ath at Low Tide .....................01
............................................
................................................
r.vera,e ills= in Tide ................ . ...................................................................................................
. `.
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' Is |h/s for private or business uso. ---[ .].g/jP......
ArcoZoning ........ ---------------_--..~_____,,___---__.___
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Mcnn:r in which nnorcho| will be rcnnovc6 or dcposi!cJ ....... ...................................... .
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~—~' ``^—^~^^^'^~~—^'~—~—~`------''--------~^~----'`—^—~^~~—''~~^^``
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Intended use of p,o�o,�y .-.-'�-\�id�^��---����l.—.�[m.�����/ .....................................
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---^-----'--'----^---------^----'-------^----^-----'---'--~~-^
VVri,�on consent of owner of propc,ty\ if not t�e sorre as the cpp|.cont ........................................
--'-----''-----~-----'---'~--^'-----------''—^—'-----`^^`'—'-^-^``
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---^----^--^^---'~—^--'—`—^--^---'--'—'------~~~—^~''^---^'—'—~'-~`
CCC,UWTY OF 5UFFDLK )
ST,,�TE OF NEY/ YORK )
__.._________________.__.._____________.—.----. being d-. |y sworn deposes
ord scys tho, he is the cpp|lcont for the obovti duscribcJ oonnit, ond thot oU statements contained
herein orc true to the b �e� of his know|e�ge -and beiicf; thot thc work m|| be drne /n the mcnner s��
fcrch in this opPSccricn ond as rnoy be approved by the Town of the Tcnn of Southold.
The =p(icc:r og,ces to ha|6 he Town of Southo|j and the To-an t_-ord horn|aEs cnd free frcm
on7 ond oil oonnoges onuni c/o(rns arising under or by vi,,ue of soid perrnit, if d
______,__,_
Signature of A
Sworn to before rnu this ................................ �� ~
�Cy of ..................................................... 19--.- �
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- - -7W Town Hall, 53095 Main Road
P.O. Box 728
®� Southold, New York 11971
JUDITH T.TERRY TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR 01:VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
6
January 6, 1984
Mr. Henry P. Smith, President
Board. of Southold Town Trustees
Southold Town Hall
Southold, New York 11971
Dear Mr. Smith:
Transmitted herewith is application no. 180 for a Wetland Permit
submitted by Esther 8 Eric Muehlbauer and Leah K. Indelman.
Please prepare a written report of findings and recommendations
with respect to this application.
Very truly yours,
Judith T. Terry
Southold Town Clerk
Attachment
Please Note: Original application is being returned for notarization.
5
' T01'r'Tl OF SOUTHOLD
4
SHORT EtdVI ROHME1 L A%L ASSE`_, rM1:11T I C01.1
INSTRUCTI0tIS :
ta ) In order to answer tho qu-:, tion:, ir, t1,is short El,f it is as� ur^U-
that the p r e p o r e r will use eu:•rently avui10b.1u inForincit i.r. , cc,r,._r. rr,,nr��the
project and the likely impacts of ti,u action . It z.; not cr.t;(:ctr_•(-j that
additional studies, research or other inv!_stig0tiuns v+il } br ur.uerta'�en .
(b') If any question ha'; been an :.wcccd Yes the prof, _ t in br_
significant and a completed Environrn,.•nLul As:.esnment Form is nr cQ nary .
(c ) If all quc• tions have hewn answered No i t i-,; like I t;:ut this
project is not significant .
{d ) Environmentnl Assessrnent
1.— vliii project rc:iu t in a lurcle
to the project ::itu or F-!;y:•.ic:ully ul +.;:i' mull.
than 10 acres of land? . YrslNo
2 . Will there be a major ch�.,nrje to nny unique or /
unusual land form found on thcr sit,:'? . . . . . . . . . ._ Yr.S_✓ Ito
3 . Will project a ter ar ir.jve a Iurr;c of fcect on
existing body of water? . . . . . . . . . . . . . . . . . . . . . . Yc s _✓;Io
4 . Will project have a potc:rr 'LiUlly lade impact
on groundwater quality? . . . . . . . . . . . . . . . . . . . . . . '(., - ,/No
5 . Will project significantly effect d -ainugc:
floe on adjacent site? . . . . . . . . . . . . . . . . . . . . . . r �'
rl0
6 . Will project affect any tk,rr.cUtened or ^—
endangered plant or ani;nal :;pec.ics? . . . . . . . . . . . Ye:;—Zo
7 . Will project rrsulL in a majol au'vursr e: fi ec: t
on air quality? . . . . . . . . . . . . . . . . . . . . . . . Yc: s �io
8 . Will project have a r;a ;cr effect on vi s_uuI —+
character of the commur,i Ly or scenic vieti,rs ur
vistas known to be ir;;portunt to the: cL,rr,rnur,ity ? Y ss A 0
9 . Will project advers^ly irrt)-::ct any i to or
structure of historic , or
paleontological impor tcnce or rsny situ
designated as a critical environm�_nLul area
by a local agency? . ... . : . . . . Ycs�No
10 . Will project have a major effe-cL on existing
or future recreational oPportunitics? . . . . . . . . . Yr.st�0
11 . Will pr;-,ject result in nru jur t ref f is
or ca:,se a major effect to cxi .> t.ir,g /
trun:;portotion system:;? . . . . . . . . . . . . . . . . . . . . . . 'rr. ✓ 1Fto
12 . Will project regularly cause objectionuble
odors, noise, glare , vibration, or- el=:ctricul
disturbance as a result of L11c ;,roject ' s
operation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ._ It-10
13 . Will project have any impact on public h,_c,] t.h
orsafety? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .--Y�• s�i�o
14 . Will project affect Lie exi •stinc� cor ^unity EJ,
directly causing a grQWL11 in pL,rr;ur)-nt
population of more than 5 Pc!r*cer;t ov r a one
year period or haves -i rnujor r,c%ativ- r:ffec- t
on the character of th(-• co,;ununity or /
neighborhood? . . . . . . . . . . . . . . . . . . . . Y V_t-lo
15 . Is thcrc pc:f.)lic controvc r ;y conccr nine; t�,r -!
project ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _� .:_:�!0
P,REFJAR-R S SIGNAT LIP E qq p
RE=I.-HkTING_ l �a�i���ta� .� � r �''�='s�'� A�,�� Cy DATE ll1 � ___
T
TELEPHONE
(516)765-1892
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 728
Southold, New York 11971
October 1, 1984
Mr. Eric Muehlbauer & Ms. Leah Indelman
65-20 Austin Street
Rego Park, New York 11374
'RE: Dock Permit 1799
Dear Ms. Indelman & Mr. Muehlbauer.:
Your request to move your dock was approved at
the Trustees meeting held on September 27,. 1984.
Very truly yours,
Henry P. Smith, President
Board of Town Trustees
Ilene Pfifferling
Secretary
cc:- Trustees
File
10,
r
Town Hall 53095 Main Road
P.O. BOX 728
Southold, New York 11971
JUDITH T.TERRY r, TELEPHONE
TOWN CLERK '` 't
(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
NEGATIVE DECLARATION
NOTICE OF NO SIGNIFICANT EFFECT ON THE ENVIRONMENT
Dated: March 27, 1984
Pursuant to Article 8 of the Environmental Conservation Law
State Environmental Quality Review and 6NYCRR Part 617, Section
617.10 and Chapter 44 of the Code of the Town of Southold, notice
is hereby given that the Southold Town Board, as lead agency for
the action described below, has determined that the project , which
is unlisted will not have a significant effect on the environment .
DESCRIPTION OF ACTION
Application of Esther and Erick Muehlbauer and Leah K. Indelman for a
permit under the provisions of the Wetland Ordinance of the Town of Southold
to construct a catwalk and floating dock at the south side of Fleetwood Road,
on East Creek, Cutchogue, New York.
The project has been determined not to have a significant effect --
on the environment- for the following reasons:
An environmental assessment has been submitted which indicated
that no significant adverse effect to the environment are likely to
occur should the project be implemented as planned.
Because there has been a response. from the. Board of Southold
Town Trustees and Southold Town Conservation Advisory Council indicating
that this project would not have a significant effect to the environment.
Because there has been no response in the allotted time from the
New York State Department of Environmental Conservation and the Southold
Town Building Department , it is assumed that there are no objections nor
comments from those agencies.
Further information can be obtained by contacting Mrs. Judith T.
Terry, Southold Town Clerk, Southold Town Hall, Main Road, Southold,
New York 11971. j.
Copies to: David DeRidder, DEC, Stony Brook
Commissioner Williams, DEC, Albany
Southold Town Building Department
Southold Town Trustees,/
Southold Town Conservation Advisory Council
Town Clerk' s Bulletin Board
Esther 8 Eric Muehlbauer/Leah K. Indelman
ALL DOCKS AND BULK-
o P/1 -•
HEADS MUST DISPLAY 3Aw(
VISIBLE PERMIT NUMBERS. BOARD OF TOWN TRUSTEES
TOVJN>.OF SOUTHOLD ✓LJ a 9 (p0�
ALL MOORINGS AND Main Road Telephone
STAKES MUST .DISPLAY (516-765-1892)
VISIBLE MOORING NUMBERS. Southold, New York 11971
NOTICE OF ACTION - NOT A PERMIT
To. . . . Esther ,&.Eric,Muehlbauer/Leah. K: . Indelman,coo,James,Mason,. , , , ,. ,.
1. Your application, dated. .. 10/8 4, , ,,,, , ,,, , , , , ,, , , , ,has been reviewed by
this Board, at a meeting of the Trustees held on. . . FQ VY.27)r. 19.Q 4. . . .. ..
and resulting in the action, as indicated below:
(XXXX) Application approved.
(. . .. .) Application denied.
(. .. ..) Application tabled.
2. Comments and remarks:
Application approved as per specifications on application.
3. If your application is approved above, a Permit Fee is now due, and
should be made payable to'the order of the Board of Southold Town
_ Trustees. This fee is computed below according to the Schedule of
Rates as set forth in the Instruction Sheet (Form 1/1) . This fee must
be paid within 90 days or reapplication and additional fee will- be
necessary.
If the Permit Fee is paid in person to the Clerk of the Board, the Permit
will be obtainable at the same time. If the fee is paid by mail, the Permit
will be mailed in reply.
4. Computation of Permit Fee:
6ft. x 8ft. = 48 sq. ft. @ . 25 per sq. ft. _ $ 12. 00
2 piles holding the float @ $5. 00 each $ 10. 00
Total amount due before issuance of permit $ 22. 00
Total Fee for this application. . . . . . . .. . . . . . . . . . . . . . . . .. . . .$. .v�a?-. . . . . . . .
Signed. l/,54; °e
President, Board of Soutft d Town Trustees
of f Clerk, Board 0
f Sout �ol . own Tr �stees
NAI-L CF C?.=:EK L5- Cre-e-K ALL DOCKS AND B(. U�-`IH FADS MUST
0/ J9d DISPLAY VISIBLE PERMIT NUMBERS
BOARD
T^ '�' r
OF T& iV TRL ST
/ Town Of Southold 0
Mziin Road s
Southold, iNew York 11971
APPLICATION FOR FI1LD and/or FLOA=1,G DO01.S
1. Applicant's name and address: ... �r..Y..�!�........ I�O �.�' _ �wtq;•o
......... ...?.7.A5..i�!..<5 R! .d..Pq0. � N.`1...
1.13. .`I....................:..Te l.:. �a:.. ��.:..`l.��r�
2. Ccntrector's name and address: .......)�! &s......Mal . .......... .... -........... ,-J .l ... Q . .. ...C.K a.. K i.. .....1.1�/3.5.............................Tel.. 1. .:. Y::k6 W
3. Briefly explain the purpose of this application: ...... �....0 ? a1::1. . ?^;Y!�I . . .....
....... ak15 r! .L ..... t....S.�V1.ClI1......9.0C ?`f!t�
........... �. ` :� ....a ...... :�s f: r.�.� Q:.
. ... �. .. 4.�..N y....................................
......................................................................................................................
d. A_`ter issuance o= a Per—mit, work must be comnpleted within one year.
LARGE
5. Secure the correct Area Mop from the Clerk of this Beard, and by using a/X WITHIN
A CIRCLE indicate as closely as possible the location of this deck. On the. reverse side of this
mop, provide a SCALE DRAWING which will show Ordinary High Water Mcrk, the shape
end size of the dcck and any supplemental pilings which ere needed to hold a floating deck
or tie-uo a boat. Give all dimensions necessary to determine the area of the r4x4: surf^ce
p,HTCH E.X'TENDS OFFST--7OF.E from the O. H. W. M. If adjacent property owners have
docks , specify location and length to scale.
6. Will any portion of this construction extend offshore into Town Waters beyond an imegin--
line or boundary far-led by other similar structures along the area's shoreline? YES o' 0'
If it does extend beyond this so-called do6 line indicate by how for, approximately,........., t.
7. Prcvide the following documents:
(a) A Licensed Engineer's Su?vey of the property involved.
(b) A copy of the Contractor's Plons and Specifications.
((c Short Environmental Assessment Form.
(d Wetlands Application
8. Wi I this ccnstruction require the Filling of any land offshore of the Ordina igh Water
Mark or the Dredging of any material from Town Land, under water? YES orl�0. If it does,
Form A/4: (Application forDredging/Filling) must be completed cnd attached as part of this
opplicaticn.
9. In requesting approval of this cpplicotiori, I submit that: the inform ition presented 'herein
is true and correct to the best of my knov led^,c and belief; I am the person cccauntable for
the performance of the work in cccordonce with the plans and specifications attached; I have
read or am familiar with the provisions of any Southold Town Ordinance pertinent to the work
involved; and further, I intend to achere to and abide by the Terrns and Ccnditicns of the
Permit, when and if issued to me.
10. To expedite finding specific location for inspection, indicate
by using a temporary markers
\� _.. . A/2 Rev. 2/82 L. S. ....................:.......................................: ...........
TOWN OF SOUTHOLD
SHORT ENVIRONMFJ AL ASSESSIMENT FORM
INSTRUCTIONS•:
a In order to answer the questions in this short EAF it is assumed
that the preparer will use currently available information concerning the
project and the likely impacts of the action . It is not expected that
additional studies, research or other investigations will be undertaken.
(b) If any question ha.s been answered Yes the project may be .
significant and a completed Environmental Assessment Form is necessary .
(c ) If all questions have been answered No it is likely that this
project is not significant .
(d) Environmental Assessment
1 . Wi 1 project result in .a large physical change
to the project site or physically ,altex more
than 10 acres of land? . . . . . . . . . . . . . . . . . . _Yes -/No
2 . Will there be a major change to any unique or �
unusual land form found on the , site? . . . . . . . , . Yes "'No3 . Will project alter or have a large effect on
existing body of water? . . . . . . . . . . . . . . . . . . . . . . Yes ✓No
4 . Will project have a potentially large impact
on groundwater quality? . . . . . . . . . . . . . . . . . . . . . . Yes '✓No
5 . Will project significantly effect drainage
flow on adjacent sites? . . . . . Yes ✓No
6. Will project affect any threatened or
endangered plant or animal species? . . . . . . . . . . . Yes ✓No
7. Will project result in a major adverse effect
on air quality? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes ✓No
B . Will project have a major effect on visual
character of the community or scenic views or
vistas known to be important to the community? Yes ✓No
9 . Will project adversely impact any site or
structure of historic, prehistoric or
paleontological importance or any site
designated as a critical environmental area
bya local agency? . . . . . . . . . . . . . : . . . . . . . . . . . . . Yes V No
10 . Will project have a 'Major effect on existing .
or future recreational opportunities? . . . . . . . . . Yes /No
11 . Will project result in major traffic problems
or cause a major effect to existing
transportation systems? ..: . . . . . . . . . . . . . . . . . . . . Yes ;�No
12 . Will project regularly cause objectionable
odors, noise, glare, vibration, or electrical
disturbance as a result of the project ' s
operation? . . . . . . . . . . . . ... . . . . . . . . . . ... . . . . . Yes /No
13 . Will project have any impact on public health.
or . safety? . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . ... . .
Yes No
14 . Will project affect the exis-ting community .by
directly causing a growth in permanent
population of more than 5 percent over a one
year period or have a major negative effect
on the character of the community or
neighborhood? . . . . . . . . . . . . . . . . . . . . Yes ✓No
15 . Is there public controversy concerning the
project? . . . . . . . . . . . . . . Yes ZNo
PP.EPARER ' S SIGNATURE a =
REPRESENTING^ DATE _ IT