HomeMy WebLinkAboutTR E 98-5-13Board Of $outhold Town Trustees
SOUTHOLD, NEW YORK
PERMIT NO. ~ ~::~.::..~ DATE: ../s~.::~.!'~2..--..
ISSUED TO ...........
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Pursuant to the provisions of Chapter 615 of the Laws of
the State of New York, 1893; and Chapter 404 of the Laws of the
State of New York 1952; and the Southold Town Ordinance en-
titled "RESULATING AND THE PLACINC= OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS and the
REMOVAL OF SAND, C=RAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN WATERS;" and in accordance with the
Resolution of The Board adopted at a meeting held on
19 ........... and in consideration of the sum of $ ..................... paid by
of .......................................................................................... N. Y. and subject to the
Terms and Conditions listed on the reverse side hereof,
of Southold Town Trustees authorizes and permits the following:
all in accordance with the detailed specifications as presented in
the originating application.
IN WITNESS WHEREOF, The said Board of Trustees here-
by causes ifs Corporate Seal to be affixed, and these presents to
be subscribed by a majority of the~said Board as of this dat,e.
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Trustees
TRUSTEES
lohn M. Bredemeyer, III, President
Henry P: Smith, Vice president
Albert I. Krupski, Ir.
John L. Bednoaki,
lohti B. Tuthill
Telephone (316) 765-1892
Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
SUPERVISOR
SCOTI~ L. HARRIS
Town Hall
53095 Main Road
P.O. Box 1179
Southold, New York 11971
COASTAL ERosION MANAGEMENT PERMIT APPLICATION
TOWN WETLANDS PERMIT APPLICATION
TRUSTEE LANDs PERMIT ~PPLICATION
a~CoaS%ai ~'r ~" Office Use Only
E oslon Permit Application
~Wetl&nd permit Application
/_6hTrustee Lands Per~it Application
~Grandfathet ~/~TL~/2~
~ompleted apps. Date:
fVariance Required,
Neighbors not~ified Date:
SEQRA Type ~
Coord~ Review-opt.,ma~d.
neD.. comp. /gate : ~/~
~SEQ~ betermin./dat~:
~Public Hearing/date: Findings:
Permit VOte: (Y/N):
special Conditions:
(al~0 see file)
Date Rec. by Office
Application Fee:
Applicati0h N~er;
ProjeCt Name (If any)
Date PrePared: ~ &?[ ~i~-
Applicant: ~.. O.S T ~fL~
Address:
lO00-
Interest: (owner, consultant,lessee,etc.)
Owner of Property: F/%T~ i C i~ ~O~ob
Address ... ~iM ~A ~ ~3 ~ C~ ,k ~ ~ ~ , PaCo
~ Phone
Subject Property Location: ...cllk)~lA~ k)~c~ ~_A ~%~
(Provide LILCO Pole ~, Distance to cross Streets if not on
location map)
THIS IS NOT A PERMIT
Yds. ,to be excavated: 6~ ~ Yds. to be filled: qO
Manner~in which material will be removed or deposited:
Wid ~Ci~ H~ ~ ~ ~
· th of canal, 6reek or bay fronting property:
Depth'at lOW tide: DI~ Aver. rise in tide:
Distahce~{O nearest c~'~nnel:' ~ . Distance project
extends b~yOnd similar projects in ~rea.
Area Zoning: ~S~b~I~At Land..area in acres: 3~
Is project for private or business use: o~Ai~
Intended use of property: ~x(~I~ ~
Describe known prior operations conducted on premises:
Has any prior license or permit been issued to erect structures,
dredge, or deposit fill on said premises:
Has any' license or permit ever been revoked or suspended by a
Governmental Agency: ~00~ ~
Project Description
The projeOt desdription must also include plans for reclamation
of land,diSturbed during construction of the principle and
accessory structures and underground structures. (i.e., pipeline
ahd~septiC system; make additional attachments if necessary).
Authorization {Where the applicant is not the owner)
I residing at
(Print-owner of subject property) (Mailing address-phone)
do hereby authorize ' ' ' ' to apply for
Coastal'Erosion permit(s) from the Southold Town Trustees
Signature
THIS IS NOT A PERMIT
County of Suffolk )
State of New York )
JoH~ ~, COSTE H~-~ BEING DULY SWORN DEPOSES AND
AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED
PERMIT(S) AND TH~ ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO
THE BEST OF HIS/HER K~IOWLEDGE AND BELIEF, AND THAT WORK WILL BE
DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE
APPROVED BY THE souTHOLD .TOWN BOARD O~ TRUSTEES. THE APPLICANT
AGREES TO HOLD THE TOWN-OF SOUTHOLD AND THE TOWN TRUSTEES
HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING
UNDER OR BY VIRTUE OF 'SAID PERMIT(S), IF GRANTED.
IN COMPLETiN~ THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES,
THEIR AGENT(s) OR REPRESENTATIVE(s), TO ENTER ONTO MY PROPERTY
TO. INSPECT THE PREMISES IN CONJUNCTION .WITH REVIEW OF THIS
APPLICATION.
swo TO BEFORE MS THIS
NOTARY PUBLIC
SUSAN E. LONG
Notary Public, State of New York
No. 01L04958343
Qualified in Suffolk County
Commission Expires November 6,
Suggested space for location Map
THIS IS NOT A PERMIT
FORM
I --~A-~ M(ooI> owner of , /~=~,
' ' ..BUstfless/property name
do'h~by 9tV~.CO~t~ilo Marine contracting corp. the authority to
a~t a~ ~g~t ~. my behalf in applyi.g for all of the necessary
p~rmit~ in order for work to be done o~ my property described
above, ~
Coeletlo Marine
Contracting Corp.
P.O. Box 2124
~ NY 11944-0976
!
PECONIC
11958
0
EAST
CUTCHOGUE