HomeMy WebLinkAboutTR-377TOWN OF SOUTHOLD
BOARD OF TOWN TRUSTEES
Pursuent to the provisions of Chapter 615 of the Laws of 1893 of the State of
New York and Chapter 404 of the Laws of J952 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 ...~e~e~£~e~.o~,~....~8~ ................. and in consideration of the sum of
$ ..... 3..zk~.25 ................ lawful money of the United States, paid by .... ~..i..s.:~..n...e....~.~. .......
Wi s s oma nn
residing at ......... ]qe~l~..~J~%%~...,e.@.~7.?;;~Q,&.~....~.~.e.,~ ............................. , New York,
the said Boc~rd of Trustees of the Town of SouthoJd, Suffolk County, New York, hereby
· ,~ · ~
authorizes and permits said ............ ~.~Z~..~,.~f~....~. ..... .¥.~.f~,~.~..fft..~.D. .................................. to
in f~ont of net property er Jockey Creek~
ail in accordance witl% the application submitted~
The said ......~,~.~.D.~...~.%..:?,~.J~.~..~.~..~ ........... , as 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 ail d~mages c!aims 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 will at his own expense, defend any and all suits which rnay 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:
1. That there shatl 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 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 and these presents to be subscribed by
majority of the said Board of Trustees, the day and year above written.
sea]
STATE OF NEW YORK )
SS:
COUNTY OF SUFFOLK )
ON THIS..3.['.~. ...... day of ............. .O..q.~.~h~.~?. ........................ , 19 ..... ~..., before me
personally appeared Atvah Bo C-~ot~s~ith, Frank Da~son~ John F.
Mc~utty~ ~eo~ge Si~Dson and Douglas Robertson~
all personally known
to me, who, being by me duly sworn, severally said that they each resided in the Town
of Southold, County of Suffolk, State of New York, and were members of the Board of
Trustees of said Town of Southold and constituted a majori~ of the same; that they
knew the corporate seal of said Town of Southold; that the seal affixed to the foregoin~
instrument was such corporate sea[; that Jt was so affixed thereunto by order of the
Board of Trustees of said Town of Southoid and that each one signed his name thereto as
a Trustee and by like order.
~il~d~
Notary Public ......... i~' .................
FORM NO. 1
TOWN OF SOUTHOLD
BOARD OF TOWN TRUSTEES
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined .............................. 19 ...... Application No ..................
Approved .... ,>~;"~L-~/,),~' '~-¢~7.- ./.¢ ~. -/'~ ............. Permit No. .~.
Disapproved a/c ................ ~.~ .... )?" ;"~i.Ef~' ',,' ~ ..... ~.ff_ ..................... T ....................
/ f ?- .~< ,'~ ~,') ~ ~ ~'~ ,z7~ *
............... ~../~._,~.~.'~.~,~..,/..Z'. '~-~.,~XEi .f~.':XE~" ....... chmrman, Board of-Trustees
APPLICATION FOR PERMIT
INSTRUCTIONS
A. This application to be completely filled in by typewyiter or in ink and submitted to the Town Trustees in dup-
licate.
B. Plot plan showing location of lot and buildings on preinises, 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 perm2.
D. Upon approval of this application, Town Trustees will issue a permit to applicant. Such permit shall 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 MADE to the Board of Trustees of the Town of Southold, Suffolk County, New
York, for the issuance of a permit pursuant to the la~vs, Ordinances and regulations governing construction of: docks,
piers, bulkheads, jettys and dredging in, under, and over the waters of Town of Southold. The applicant agrees
to comply with all applicable laws, ordinances, regulations and conditions specified by said trustees, and to hold
the Town of Southold, and al~ T~p~n o~cial~%/ree f!2om [i~b~lig~.~ amok d~Wa~es o_f~any kind.
Name of owner of premises :~. ~/~,:?I~.'*C~///~ /~ ~/~/qfir~~5 '
Street Address Of Property'"~'~';~')"""'--~--.'P"' .....................~........~........................~(...~....'~..~.....`.*.F.--.~.~`~..~...............~............~...........`~.....~...........~..
Home address If Other Than Location .......... ...~. ........... ).: .... ~....' ....: ......... ~ . . .
Creek, Bay or Harbor Fr°ntingr~, ~, ,, -~,~ ~,~ ,., 'Prgpczrtx' '' ~'g' ~/~'''' '~':'/~ ~.~.~.~.~ *................................,..... ,....C'ff~ ~2' ~ ''~ ..... ' ............... ~'
Permit Requested To:' '~""~'/~'~2'~;~'~" '~'~' '"T';~ ...... .... .."2'....'i'.'.""""""'"'""'"'""i'}'""'""-
.... .... , ...... ._.'~Heighth Above High Water ..............
Size
of
Proposed
Work:
Length
~iPdt~h Bo~lZa~7'~r~2~t~;'~' ~;~7i~7 '~Av;?ge ~ ~*~InT~t~' "~' ' ~"~' '" ;;;~a~rdLs0t; ~'dEexcavated ..............
Is This For Private or Business Use? i'?~.~..r'??.~..~., i;:: :::::::::::i:-:: .Arle~ ~o~'iing. ;.. ::::::::::::::::::::::
Complete plot plan to be drawn on reverse side of this application.
STATE OF NEW YORK )
)s.s.
COUNTY Ob' )
................................ being duly sworn deposes and sav§':that he is the applicant {or the above de-
scribed permit, and that all statements contained herein are true to the best of his knowledge and belief; that the
work will be done in the manner set forth in the application and as approved by the Board of Trustees of the Town
of Southold, and the applicant agrees to hold the Town of Southold and said trustees harmless and free from any
and all damages and claims arising under or by virtue of sai~p~rmit. .
to before me th~s -~' ~ da o/"~~, ...... 1 ~
(applicant)
Ut`/ ~A,R]OI¥ A. REGENT
NOTARY PUBLIC, State of New York
No, 52-3233120 Suffolk Court.ky
Term Expires March 30, 19~