HomeMy WebLinkAboutTR-35-6-36 GFName- of Creek: Gu!l~-_ ~nd
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 728
Southold, New York 11971
GRANDFATHER APPLICATION
TELEPHONE
(516) 765-1892
bulkhead, dock
1. Name of Applicant:
2. Address of Applicant: /_~/¢ ~7
Numbe-r: ~- / ~ ~' f
3.
Telephone
4. Year of Construction: /'~ 2
5. Sketch of the work including sizeS:
e
using an X.
Signature: ~.<,~_.~(-'~J~,-~¥~
Please note that ther~ a $5.00 ml~ng fee,
fee, for this application.
Mark o££ on the map attached, where your property is located
which is a one time
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