HomeMy WebLinkAboutTR-95TOWN OF SOUTHOLD
BOARD OF TOWN TRUSTEES
PERMIT NO .........
Pursuant to the pro.visions of Chapter 615 of the Laws of 1893 of the State of
New York and Chapter 404 of the Laws of t952 of the State of New York and in accordance
with the resolution of the Board of Trustees of the Town of Southoid adopted at a meeting
of said Board on Jax~.~ar~? loc 29~0 and in consideration of the sum of
$ ........... { ..................... ~awfu] money of the United States, paid by
residing at ........ ~k.}f~-~-]~..;~?~}~.~_.~?~s)¢~;~(~}~,~...;-~.~.~ ................... ~ New Yor~,
tho said ~oord of TruSteeS of the ToWn of Southold, Suffolk County, New York, hereby
authorizes and permits said Lf$t~O.re61 ,- ~ ~, -~
preperty ....~
H,~;~..~ CreeT.~.all in accordance with the
application submitted.
The said -~-~ ...................... ~ ....~.~
...................................................................... , as part of the consJderatio.n
far the issuance of this permit does hereby release the said Board of Trustees and the
Town of Southold from any and ali damages claims for damages or suits that may arise or
occur directly or indirectly as a result of any operation carried on under and pursuant to this
permit, and wiJJ at his own expense, defend any and oil 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 perm[t, and assume full liability with respect thereto to the complete exclusion of
said Board of Trustees and the Town of Southo[d.
TH~S PERMIT is subject to the following terms and conditions:
1. That there shall be no unreasonable interference with navigation as a result of the
work herein authorized,
2. That there shall be no interference with the right of the punic 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 and 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...¢~;~.~f~,...day of ........... ~~.~ .......................... , 19...~f;.Q .... , before me
to me, who, being by me duly sworn, severally said that they each res]ded Jn the Town
of 5outhold, County of Suffolk, State of New York, and were members of the Board of
Yrustees of said Town of Southo[d and constituted a majority of the some; that they
knew the corporate seal of said Town of Southold; that the seal affixed to the fore~oin~
instrument was such corporate seal; that it was so affixed thereunto by order of the
Board of Trustees of said lawn of Southold and that each one signed his name thereto as
a Trustee and by like order.
'I
FOR~V~ ~0~ 1
TOWN OF SOUTHOLD
BOARD OF TOWN TRUSTEES
TOWN CLERK'S OFFIOE
SOUTHOLD, N. Y.
A ........ :??..~,,~ ......... ~_~ .... ~pplio~io~ ~o ..................................
..... .............
........................ ...... .......................................................................................... ...................... ................................................
.... ................................................................................................................................
~- ...... ~ ..- ..... -- ........................ ' , , Bo~r~ o~ T~stees
.... / ~FPL~C~TIO~ FOR PER~IT
~a~s, etc., a~,d ~i~g ~e$~J]ed deso~tjo~ of ~ro~os,e~ 1~yo:~$ o,~ ~o~eot ~s$ ~e dra~n on ~a~a~ w~1c~ ~s pa~ of
D~ Upon approval of ibis applica.tion, Town Tru.slees will issue a permit to applicant. Such per'~ shall be ke,~t
o.n the premises and availa~ble for inspection at al! tim.es.
E. Applicant sha~l notify the Board of ~r%ts.tees upo,n, compleiion of lhe work covered, by permit.
APPLICATION iS HE,~E,B~ ~ADE, to the Board ~f Trestles o.f the Town of So~iho~d, SUffolk C~o,u~.ty, ~ew Yotk,
for She issuance of a permit pur'sua.nl to the ~aws, Ordinances and regulations goveruing construction o,f: docks,
piers, bulkheads, jeiiys and dredging in; un.der, a~.d ore r lhe waters of Town of ~.o~tho~d. The applican.t agrees
to co.mp~y ~lh a~l appl.icable~ laws, erdiaances, reg~a.iions an~ conditions specified by said trustee,s, and t~o. hold
lhe, Town of Southeld, and a~ free '~s of kin.d.
Name o,f owner of premises
Sire,et Address o,f Propetty
t/o,me address If Other, Tha,n, L,o, ca,tion,
Creek, Bay or' Harbor Frontin2>Pro.perty
P 't
Si~e of Proposed Work: Length
.. Heighth Above High Water ~.
Depth Below Low Water ,.,~/~ ~/~r_ Average Rise /~' ~' ' .......
............................. - ................................. Yards to Be Excavated
W~dth of Canal, Creek .Gr Ba,y Fro,nting Pr perry 'J~ p " De~ ~ '~ .... ~"'"';' ....................
~Is Th~s For Private or Business Use? .... ~'.~.7 ' ~'""~- ............................................. ~ th ~.~ Low,.~ide ,z/~'/)~,~ '
~'~'"zz ' '~'~':f"~ -'~ ......... Area Zoning x. -..~ -,- ~ "'
IComplete plot plan to be drawn on reverse side of this application.
~TATE OF NEW YORK)
..................... ~--..~ ........... ~y.x ........................ : ....... g y worn, ~e~oses an~ sa. s that he is the, app]ic.ant; £or the above de-
~oribe£l permit, a,n.~tttfhai all state,ments co,ntai'ned hereto re true to t;~ best of his kaowledge and belief; that the
~o,rk will be done in the ma;nner set forth in. the applioation and as approved by the, Board of Trustees o,f the Town
S.o,uthold, a~d the a,pplioant agrees ~:o hold. the Town. cf So,uthold and said trustees harmless an,d free from any
all damages an,d claims arising under or by virtue of said permit.
...........................................
rn to before me this ~ - da-, of //~'~-'~:~/ -~/ ~' /j/ { / ' '
Notary p
ub.c, State of New Yor~
No. 30-6432~25
Qualified in NaSsau County
ii Commission Expires March 30, 1960
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