HomeMy WebLinkAboutTR-79TOWN OF SOUTHOLD
BOARD OF TOWN TRUSTEES
PERMIT NO ....... . ,/~/..~.. .....
Pursuant to the provisions of Chapter 615 of the Laws of 1893 of the State of
New York and Chapter 404 of the Laws of ! 952 of the State of New York and in accordance
with the resolution of the Board of Trustees of the Town of Southold adopted at a meeting
of said Board on .......... ~.~.p..~..~....m~..~...~.¢_o,~..~.5..~ ....... , and in considerotion of the sum of
$ ......... ~,Q,~.g.g. ........... lawful money of the United States, paid by
residing at .......... ~g,g,~,fk~...~.;K~.~.~._~,~.~.~.~.~.~.¢..~.~.,...~..~..~ ...................... , New York,
· ~he said Board of Trustees of the Town of SouthoJd, Suffolk County, New York, hereby
authorizes and permits said ........ ?.°.~,.~..~,..~...,.&..o.~,,.~.~-~.~.~i.~..~.o~ .......................................... to
buil~ a ~hape ~ock on the Mattit~c~¢ Cre~k Channel in
front of their property~ all in accordance ~i%h the
application
The said ..... ~.~...,f~..~.:~.~;,~..~.~.~-~ ................... , os part of the consideration
for the issuance of this permit does hereby release the said Board of Trustees and the
Town of Southold from. any and all damages claims for damages or suits that may arise or
occur directly or indirectly as a result of any operation cerried on under and pursuant to this
permit, and wiJJ at his own expense, defend any and all suits which may be brought by third
parties as a result of any operation carried on pursuant to or in accordance with the terms of
this permit, and assume full liability with respect thereto to the complete exclusion of
said Board of Trustees and the Town of Southold.
THIS PERMIT is subject to the following terms and conditions:
]. Thor there shall be no unreasonable interference with navigation as a result of the
work herein authorized.
2. That there sholl be no interference with the right of the public to pass and repass
along that portion of the beach between Iow and high water mark.
3. That the work shall be subject to the supervision and approval of the said Board of
Trustees or its agents.
IN WITNESS WHEREOF, the said Board of Trustees of the Town of Southold has
caused its corporate seal to be hereunto affixed ond these presents to be subscribed by
a majority of the said Board of Trustees, the day and year above written.
....... .?,,...~,,.~.,_ ......................... ~ .............. ~ ....
STATE OF NEW YORK )
SS:
COUNTY OF SUFFOLK )
ON THiS.:;~.....~....~day of ............. .O.g.~@~.~ ......................... ~ 19..~ ..... ~ be{ore me
persona~ly appeared
of La~et~ ~ and Alv~ Goldsmith~ of $outhold,affpersonaNY ',~ known
to me, who, being by me duJy sworn, severa~Jy sa~d that they each resided in the Town
of Southo[d, County of SuffoJk, State of New York, and were members of the Board of
Trustees of said Town of SouthoJd and constJtuted a majority of ~he same; that they
knew the corporate seaJ of said Town of 5outho]d; that the seaJ affixed ¢o the foregoing
[nstrument was such corporate seaJ; ¢ha¢ it was so affixed thereunto by order of the
Board of Trustees of said Town of SouthoJd and that each one signed his name thereto as
a Trustee and by JJke order.
FORi~ 1~0. 1
TO~ OF SOUT~OLD
~O~D OF TO~ TRUSTEES
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ~ ..~'.~.-.. Application No ..................................
Approved ..... ~'7~~ ....................... Permit No ...............................................................................
D'isapprove~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 dup-
Iicate.
B. Plot plan showing location cf lot a.nd buildings on premises, relation to adjoining premises, public streets,
parks, etc., and giving detailed description of proposed layout of project must be drawn, on diagram which is part of
this application.
C. The work covered by this application may not be commenced before the issuance of a l~ermit.
D. Upon approval of this application, Town Trustees will issue a permit to applicant. S~bh permit shah be kept
on the premises and available for inspection at all times.
E. Applicant shall notify the Board of Trustees upon completion of the work covered by permit.
APPLICATION IS HEREBY i~ffADE to the Board of Trustees of the Town of Southold, Suffolk C~u.nty, New York,
for the issuance of a, permit pursuant to the laws, Ordinances and regulations governing construction of: docks,
piers, bulkheads, jettys and dredging .in; under, and over the waters of Town of So~thold. The applica,nt agrees
to comply with all applicablel laws, vrdina~nces, regulations and conditions specified by said trustees, and to hold
the. Town of Southold, and all Town officials free from liability and damages o,f any kind.
Name of owner of premises .....................
S~ree,t Address of Pro,per, t,y ...............
Home address If Other Than Location ............. ~.....8...~_t_...~a.~.~..~..C..~.....~a..~..~..,..f~.,..,..~..,.. ....................................................................................................
Creek, Bay or Harbor Fronting Property ---!ia~,~U~ C~..e~ ............................................................................................................
Permit Requested. To: ................................................ ~..~.~.._4.L~..C..~ .......................................................................................................................................................................................
Size of Proposed Work: Length .~...~....~.__.~_~.% Width ____6.~. ........................... Heighth Above High Water .......... ~ .................
Depth Below Low Water ....... .~.! ................ Average Rise In Tide ........ ~.:~l .................. Yards to Be Excavated ...~o~ ................
Width of 0a:nal, Creek or Bay Frou, ting Property ........ .$~Oi .............................. Depth at Low Tide ......................... ~.! ....................
Is This For Private or Business Use? ............ ~Sir~.s.8. ............................. Area Zoning ...........................................................................
Complete plot plan to be drawn on. reverse side of this application.
STATE OF NEW YORK)
)s.s.
COUNTY OF~j~6/~ FO....~.. )
/~.....~...~..t!..,.~.....~....,.~L!.i..~...~../.'.....~.....~._ .... being d~y sworn, deposes and says that he is the appncan~: for the above de-
sc~bed permit, and that all staiements coniai'ned here~ are true to the best of his knowledge a~d belief; that the
work ~H be done in the manner set forth in the application and as approved by the Board of Trustees of the Town
of Southold, ~d the applicant agrees $o hold the Town of Southold and said trustees harmless and free from any
and aH damages and claims arising under or by virtue of said permit.
~ (applicant)
Sworn. to before me th.~s ............... ~..~.~... day o ......... 19 ........
Notary public .................................... county of ................... ~tULl~a.T. ~~