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HomeMy WebLinkAboutTR-5rev. 3/28/88 YOUR ORIGINAL PEP=HIT NUMBER BOARD OF TOWN TRUSTEES Town of Southold Ma,:n Road Southold, New York 11971 APPLICATION FOR SPECIAL !CE DAMAGE PERk4!T INSTRUCTIONS: Fill out form below and return to above address. You should have this application approved and returned to you within a week° 1. Applicant s ame & Address: 2. Contractor's Names & Address: ~D%.~on-7 ~. 3'. The purpose of this application: Redr±v±ng or replacing openwork dock or openwork pier piling, and mooring piles, removal of damaged piling, repair, resetting or replacement of floating docks, ramps, or decking, all necessitated by ice and storm damage resulting during 1987-1988 winter. SPECIAL CONDITIONS 1. No dredging or filling is permitted. 2. Repairs to. existing structures shall be limited to replacement of timbers without change in design or dimension. 3. No repair or replacement of bulkheads is permitted under this permit. 4. No freshwater or tida~ wetlands are to be disturbed under any circumstances. '~:~ .~5. A yellow permit sign provided by this office shall be displayed on the pro~ect at all times while under replacement. 6. Original permit numbers (3 '~ hi~h)~:~ust be permantl~ displayed on project. (Tear off and return) 'I, , certify that the work ab authorized in this permit has been completed and is now ready for your inspection. Also, the permit number requir~d on this project is clearly visible. PERMIT NU~IBER . ~