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HomeMy WebLinkAboutULRICH, JOSEPH P~ay 29, 1964 I~ORI~ NO. 1 TOWN OF SOUTHOLD BOARD OF TOWN TRUSTEES TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........................................ 19 ............ Application No ............................... Approved ................................................................................. Permit No ........................................ Disapproved a/c ......................................................................................................................................................................... ................................................................................. chairman, Board of Trustees APPLICATION FOR PERMIT INSTRUCTIONS A. This application to be completely filled in by typewriter or in ink and submitted to the Town Trustees in, duplicate. B. Plot plan showing location of lot and .buildings on premises, relation to adjoining premises, public streets, parks, etc., and giving detailed description of proposed layout of proje, ct must be drawn on, diagram which is part/~)f/this appli- cation. C. The work coyered by this application may not be commenced before the issuance of a. permit. Upon' approval of this application, Town Trustees will issue, a permit to applicant. Such permit shall b.e kept on the premises and .available for inspection at a~ll times. E. Applicant shall notify the Board of Trustees upon completion of the work covered, by permit. APPLICATION IS HEREBY MADE to the Board of Trustees of the Town of Southold, Suffolk County, New York, for the issuance of a permit pursuant to the I,aws, ordinances and regulations governing construction of: docks, piers, bulkheads~ jettys and dredging in; un,der, .and over the waters of Town of Southold. The applicant agrees to co.mply with all appli- cable laws, ordinances, regulations and conditions specified by said truste.es, and to hold the Town, of Southold, and all Town officials 'Free from liability and damages of any kind. Name of owner of premises ..... ..~,~.'~.~..Z2t..~.~..~.~.~.~..:~.;..'...~J.~.~.~.~. .................................................................... ...... ,:. ..................................... :~ ...... :..~ ............................................................................................. Street Address of Property }faili Home Address If Other Than Location Creek, Bay or Harbor Fronting Property ..... f~f:f.~ ............................................................................................................. Size of Proposed Work: Length 450' Width'CH ..... ~. ............... Heighth Above High Water...~ ...................... D~Dth~Belaw Low Water 4 ~ 7~e~e~t~ .......................... Average Rise In Tide .......................... Yards To Be Excavated ..~.~.~]]J .......... Pro ert Width of Canal, Creek or Bay Fronting~P y~e~ Depth ,at Low Tide~.[~. ........................ Js This For Private or Business Use? ........................................................ Area Zoning ......................................................... Complete plot plan. to be drawn on reverse side of this application. ~/i/er.,m~%/,and that all statements contained herein are true to the best of his knowledge and belief; that the work will be done fL/in the manner set forth in the application and as approved by the Board of Trustees of the. Town of Southold, and the appl.ican.t agrees to hold the Town of Southold and said trustees harmless and free f~rJ~ and ail damages and cJaim,~ arising under or by virtue of said permit, /~-~x~ ~/,~.~//~~ /~ ~ / /~ (,applicant) Swo , to b fo. thi .... .... day of " ~OTA~Y PUBLIC. S~ato cf ~s~v York ~o, 52-3233~20 Sc4fGk '" ' ..... /'J2. ,,'~ i' C.5 ? , .t Jr >, . .. ..'"7 .:::, ':; ,5. ; - ! /c; ',:. /_.:. 0