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HomeMy WebLinkAboutNORRIS, SUSAN TRUSTEES �-�'� ,,..' : •� �'©Gy John M.Bredemeyer,III,President ,. SUPERVISOR Henry P. Smith,Vice President cc SCOTT L.HARRIS Krupski,Jr.Albert J. ' =w' John L.Bednoski Jr. =°� >©� Town Hall John B.Tuthill 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 letland Permit Application rustee Lands Permit Application U randfather J Completed Apps. Date: �'II l FEB f 71993 Variance Required, to Neighbors no ' fied Date. �- SEQRA Type r Miff -Jdl� To IN OF S9 UTHO •atvMCoord. Review-opt ,mand. a Res e C " Insp. comp./date: D,11 j143 ll=� SEQRA Determin. /date: . Public Hearing/date: FEB 719M Findings: Permit Vote: (YIN) : Special Conditions: (also see file) Application—Fee.- Application Number; SCTM #lobo- //_— -.4 Project Name (If any) Date Prepared: a�j� �cJ Applicant: %�. S�cr��� �` / i✓vfiv' S �r � Address: Al /v /CCcfes'is /I'cf i i Fhone Qr/C Z�P 6a Interest: (owner, consultant,lessee,etc. ) /'A/ Cot,f] Owner of Property: ,70resi7 Address { j Phone Subject Property Location: d7z5 �.tie �v'YY`� 04 (Provide LILCO Pole #, Distance to cross Streets if not on location map) THIS IS NOT A PERMIT f: 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: / =J-1 Depth at low tide: Aver. rise in tide: r � Distance to nearest channel: '' Distance project extends beyond similar projects in area: 2�0 Area zoning: /Z". 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 dredge, or deposit fill on said premises: Has any license or permit .-ever been revoked or suspended by a Governmental Agency: Project Description The project description must also include plans for reclamation.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) . 42 oe �.t-�'vt� of ,,•6- r f!!� ,� .�=`iliJ� Authorization (Where the applicant is not the owner) I residing at (Print-owner of subject property) (Mailing address-phone) do hereby thobize to apply Jfor stal ro*s ' permit(s) from the Southold Town Trustees n Signature THIS I NOT A PERMIT County of Suffolk ) State of New York )• JA>4*7 ,61, BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS) 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. r- SIGNATURE SWORN TO BEFORE ME THIS DAY OF _ .��. ,19 UNDAJ.COOPER Notary Public,State of Mew Yor Ett 822563,Suffolk Co Term urtly, c�� Expires December 3f.19� NOTARY PUBLIC Suggested space for location Map THIS IS NOT A PERMIT c i t r trl It V � i JUL-ir h y' t.174504V 6revf Peconi•c ` i IV 0 '\ �✓ I�,�=' �,5 tail t���4�slon v �.� llcr�s �'' �'/rl.Lf cup.^✓[-:/;' � 'J.S' 111 -IVOR rt_s .su p h j PC M.� cV�J p - a rf rs' A dd 4a t4a e l st/n i >ra h rcp� 0s d /'PC '/Y 1 Sd!"rYt dG7r�� p a� i r7l ,CS'�.;.r P `, o ��c/if/orIS vrR rn return car'pirS r �'U�f�, �EP"nGd AM Fr'// or Ure'cI` r) i1 I H. G E I D E MI A N ! 7o A,)Id ear h y F 1 GsJC'c1 k cI7.Ci~.�` byarr�i. ;. NEW YOR1( !!93 j- D4f�� { -- ......................... ..... .,.;......................:�_ Y. State Liz, Lard Surveyor. Date //ZFIg3 1 • Ir , 1-t-;64(2/87)—Text 12 - . PA6JECT I.D.NUMBER 617•; SEO F Appendix C State Environmental Quality Review �- SNORT 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 3. PROJECT LOCATION: Municloallty l��`« .LC[•C�/_ Countyl= 4. PRECISE LOCATION(Street address and road intersections,prominent landmarks,etc.,or provide map _ /L �j iGr� �21" CK��IyZ tJv1 (t�07J / /e) Ci-L 5. IS PROPOSED ACTION: try New ❑Expansion ❑Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: A 7. AMOUNT 6F LAND AFFECTED: Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? 'FerYes ❑No If No,describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? X;Residential ❑!ndustrial ❑Commercial ❑Agriculture ❑Park/ForesVOpen space ❑Other Describe: ' ��.. 10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING,NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL, STATE OR LOCAL)? Yes ❑No If yes,list agency(s)and permit/approvalsj/` ti 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes xNo If yes,list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? ❑Yes El No CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TnUE TO THE BEST OF MY KNOWLEDGE r�Gi,/ r L nt/sponsor name: '-' ti`� Date:re: I 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 A. DOGS ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCnR, PART 617.12? If y`= �ordlnato the rowew proc esa ono use tf•.a FULL----- y, It El Yes ❑No B. WILL ACTION RECEIVE COO. REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? r may be superseded by another involved agency. If No,a negative declaration ❑Yes ❑No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten,if legible) Cl. Existing air quality, surface or groundwater,qualityor quantity, noise fovels, 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. C5. 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 DE,CONTAOVERSY RELATED 70 POTENTIAL ADVERSE ENVIRONMENTAL IStPACTS? ❑Yes ❑No If Yes,explain briefly i PART III—DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial.tar Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); b large,importarit or otherwise significant. irreversibility; (e) geographic scope; and(f) magnitude. If necessary, add attachments or reference sup 0f occurrin explanations contain sufficient detail to show that all relevant adverse impacts g: (c) duration; (d) P have been identified andrade materials. Ensure that . adequately addressed. •❑ Check this box if you have identified one or more Potentially large occur. Then proceed directly to the FULL EAF and/or prepare a oor significant adverse impacts positive declaration. pacts which MAY ❑ Check this box if you have determined, based on the 'information and analysis above and an documentation, that the proposed action WILL NOT result in any significant adverse environ AND provide on attachments as necessar y supporting Y, the reasons supporting this determination: mental impacts Name. Agency ?tent u1 I ype Na111e of Keiyunswie U111cer m'Lcad Agency floc of KCsponsrWe U111cer ]lgnature ur Responsible UlhCrr 1n Lead ngrncy __.. �1KnalUre Or "(eparer 111 different from responsIble u111 cerl • Da1r 2 J t r r TRUSTEES SUPERVISOR John M. Bredemeyer, III, President ;t. ;. SCOTT L. HARRIS Albert J. Krupski, Jr., Vice President Henry P. Smiths,. Town Hall John B. Tuthill 53095 Main Road William G. Albertson '��,( ��� P.O. Box 1179 Telephone (516) 765-1892 Southold, New York 11971 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 30 year Maintenance Agreement Erosion Protection Structures Chapter 37 Southold Town Code Southold Trustees as Administrator I (we) type or print name(s) the owners of record of property at: (type or print street address) SCTM #1000- in applying for a Coastal Erosion permit for an Erosion Protection Structure do hereby agree to a 30 year maintenance program for a structure commonly known as a of as shown on the attached feet of length licensed survey of the as-built structure. It is my/our understanding that we are to maintain this structure with materials designed to endure 30 years and or equivalent to the original approved structure- and that for any maintenance which involves more than 5% in length of this structure we are to give prior written notice to the administrator, waiting for their approval in all but true emergency situation's which would seriously endanger life, property and important coastal natural resource features such as bluffs or wetlands. We further understand that failure to maintain the structure could result in a requirement to post a bond and or have the repairs ordered as a lien against the property upon a finding by the Trustees that said lack of maintenance would risk life, property or important natural resources features including protected, rare or threatened animals and plants. Notarized Signature of owner of record SWORN TO BEFORE ME THIS DAY OF ,19 NOTARY PUBLIC Please submit three copies of a licensed - land survey made within one year of the original construction. This maintenance agreement shall only be valid upon the final approval of the administrator. _Subsequent owners may apply to the Southold Town Trustees to re-authorize this maintenance agreement. t , Civil Marine JOHN H. GEIDEMAN Consulting Engineer P.O. Box 416 E. Marion, L. I. (516) 477-2421 New York 11939 To Whom It May Concern, I, G�Gf/leA / Sv authorize *John H . Geideman to act .ns my ngent in appling for permits to construct a?7Gv - on my property at i . ignc.,d : wner IncludingyN.Y.S Dept. of Envircniaenta Coris rvst1on U. S . ArmvT Corps of Fnaineers ` =y Town o f. r�® IJ.Y, ,,9-6/c Lit. Lind S.vrveyo r consultant /G Project Name /Var" `/S SCnI #i000- Date The Southold Town Trustee office h� ned that your application for a a n = etland perm& is __o - 1/Zomplet , please consider the following information in thiscur for any requ&red return submission: a' A% �IiieV;l"�7 ustee Representative cc: pt. 1 .g J V 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 Y -- „BA y AVE PRIVATE ROAD 1 O f '\ C— 7 ` O { ? O n'»c I su O . O I ? (9 cp i O O NOTE: I- =MONUMENT O r, 2. SUFFOLK COUNTY TAX MAP I cv � DIST. 1000 SECT. 115 BLK.9 LOT 4 I 3. PADDOCK FENCES NOT SHOWN HEREON. 4. TOTAL AREA = 45. 3494 ACRES 1fY fYd hi vse I sovr e m LD `Oi —woad fences !NOTE Nt THIS SURVEY AMENDED FOR TRUSTEES UNDER THE WILL OF BRUCE NORRIS ON MARCH 3, 1992. �, pool xr ` f4 s10'•15 YOUNG & YOUNG I .rZ//7 P 9 3, 19192 400 OSTRANDER AVENUE', RIVEHr1EAU. NEW YORK :�_ � �� � �� - 6eoch �G�y;-e�p=ck q cola ALDEN W YOUNG HOWARD W. YOUNG ' U } 1 n0l«C Q y ' PROFESSIONAL ENGINEER AND LAND SURVEYOR L �`- XIMATE H.W M• - t - ' �j• �� 1 ` TIED_ NE ALONG APPR-0 ._ LAND SURVEYOR. N Y.S. L.IC. NO. 12li45 N.Y S. uC NO. 4ab3i5 1 L\ 1 1 �,,,,oa b••�k — _ - 62 a: f �_� -- t_ SURVEY FOR: ._,_ ' �,��y1(n -ts0oo 40 _ - - ---- -. w BRUCE NORRIS HE* � ___— o J - - 6/1 o,?� yC PECCIVI CAT lib To B� Y w MATTITUCK TOWN of SCUTHOLD �F =:`�"�+' s t� 2, IP 4!7r r.. � �. r E: