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Home My WebLink AboutTR-1023 PIt Rev16i72 ,',:......'; BOARD OF TOWN TRUSTEES Town of Southold :Main Road Southold, New York Jl971 To: ... ......p.~~~.E?~ ...T.~. ..~m~.t.0:.... ..~4.Q.. .~~.Ç.h-.<=;1.~,i,.ç...êJ;¡;.E?~.t.I. ...~.9.\A~n.9.1Ç!.¡.. ..J;'J.~ .Y..~......+J .~.7. .~. 1. Your application, dated ............!:1:~X..}.?'....~.~.?:+............................... has been reviewed by this Board, at a meeting of the Trustees held on ......................J.1,1);1.ç....3.,...J.8.7.4:.......................................... and resulting in the action, as indicated below:' (..~....,) Application approved. .:; C........;..) Application denied. c...........) Application tabled. ~ 2: Comments and remarks: 3. If your application is approved above, A Permit Fee is now due, and should be mode poyabìe to the order of the Boord of Southold Town Trustees. This fee is computed below according to the Schedule of Rates as set forth in the I nstruction Sheet (Form 1/ n. If the Permit Fee is paid in person to the Secretary of the Board, The Permit will be ab'minable at the same time. If the fee is paid by mail, the permit wi!1 be mailed in reply. Computation of Permit Fee: Dock - 2 ft. by 8 ft.- 16 sq. ft. @ 10¢ sq.ft.= $1.60 (amt. below H.W.M.) Ramp - 4 ft. by 10 ft. - 40 sq. ft. @ 10¢ sq. ft.= 4.00 Float - 5 ft. by 10 ft. - 50 sq. ft. @ 10¢ sq. ft.= 5.00 $10.60 Less filing fee---------- 5.00 $ 5.60 DUE Total Fee for this application ............................................................ $ ..;:?~J~Q......................... Signed ..... A~V.·?·H~ ..J?~....9.9;ç.,PR~~.TI:J;................... ELIZABETH A. NEVil.LE TOWN CLERK ~~ ~ .:::;) :..c:. , o - N CJ') :ï!:' ~ ", c:=>. ~. ~y Town Hall, 53095 -Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD APPLICATION FOR PUBLIC ACCESS TO RECORDS INSTRUCTIÒNS: Please complete Section I of this form and give to Town Clerk's Office (agency Freedom of I nformation Officer). One copy will be returned to you in response to your request, or as an interim response. ===================================================================================== SECTION I. TO: (7¿us-fees- (Department or Officer, if known, that has the information you are requesting.) RECORD YOU WISH TO INSPECT: (Describe the record sought. If possible, supply date, file title, tax map number, and any other pertinent information.) -r~s~ J":pcr p~ ¡O()o- 70~ /2 -13,¡J33~~ / .'-",:: Signature of Applicant: ~ ~ ~ ~ Printed Name: 111.11 ßy ~ L-< ,;::ô ¿{T Ç' ¡J t¥ tf¡ ? iId-vtL.-ð (J~ /V 1 Ii 7 :IJ 1/ /r/5' 7 I / Address: Mailing Address (if different from above): Telephone Number: '7 , y--Gð ¿);J Date: ==================================================================================== [ ] APPROVED [ ] APPROVED WITH DEu\Y* [ ] DENIED* q£~s:-np" NOY 5 1999 Date 'own Clerk Southold .~a~ Eli eth A. Neville Freedom of I nformation Officer * I f delayed or denied see reverse side for explanation. Al2 .. Rev.· 6/72 . BOARD OF TOWN TRUSTEES Town Of Southold Main Road Southold, New York 11971 APPLICATION FOR FIXED and/or FLOATING DOCKS 1. Applicanes name and address: )).!:!:fI.¡~l:.....T....:ffJ::1.../z::/:!..................................... .... ..I?: /1.: t....f!1.. !'!..~. í:!..ð.f!/f... ..-.. .2._C..:...... ....QQ..';1,; ?::I£f..~; 4.... .¿¡¡T.......................... 2. Contractor's name and ,address: .. .3.tf:!.l:í;:~.. ............ .... ......... ........... ....... ......... ........ ........ ........ ... .. ~ . . ... . ... . ,...... . ... . ... . ....... .. ... . .. I ... . . .. ..... ... .,..... .. ........ . .".... . . . ... .. .. .. ..,... . ...... .. .. .....,.. .. 0.. . ... ......., ........ ......... . I ....... . . 3 B· fl I· thf thO I·· ¡2Jh/p ~,ß.-R:¿iL'fvÆ~~~Æ . ne. '!. exp am ~ purpose ~ IS app Icatlony:t.K.I{'r::·:;:~·""it~·"··"""""··""·"";"7"~~ /J d4:t1!l#~If!~~·~·.~~1f.·;td~·f?A~~f:1···rftf.v..~···7.e4!t~ ßæ~~.dM/L~~£!d.Jf.~.............................................................. ,. . .:. . .. . . . ,. .. .. .. .. .. . .. .. .. .. .. .. .. .. .... .. .. .. .. .. .. .... .. .. .. .. .. .. .... .. .. . .. . .. .. .. .. .. . .~.. .. .... .. .. .. .. .. .. .. .. .. .. . '.1 .. .. .. .. .. .. . .., .. .. .. .. .. .. .. .. .. .... .. .. .. .. _" .. .. .. .. .. .. .. .. .. .... .. .. . .. .. .. .... .. .. .. .. .. .. ... .. .. .. .. .. .. .... .. .. ... .. . .. .. .. .. .... .. . .. . .. .. .. .. .. . I .. .... .. .. 4. After issuance of a Permit, I expect to: (mark by an ~) (a) Commence work - AT ONCE ..X.....; ASAP ............; UNKNOWN ............. (b) Complete work in - 1 DAy:...........; 1 MO. ..x,.....; 1 YR. ............; FUTURE ............. 5. Secure the correct Area Map from the Secretary of fhis Board,ç/nd by using an X WITHIN A CIRCLE indicate as closely as possible the location of this dock. On the reverse side of this map, provide a SCALI:: DRAWING which will show Ordinary High Water Mark, fhe shape and size of the dock and any supplemental pilings which are needed to hold a floating dock or tie-up a boat. Give all dimensions necessary to determine the area of the dock surface which extends offshore from the O. H. W. M. 6. Will any portion of this construction extend offshore into Town Waters beyond an imaginary line or boundary formed by other similar structures along the area's shoreline? YES )í'r NO. If it does extend beyond this so-called dock line indicate by how far, approximately,../'\f.ct.ft. 7. Provide the following documents: (a) A Licensed Engineer's Survey of the property involved. (b) A copy of the Contractor's Plans and Specifications. ~. .., ../ ,.¡ 8. Will this construction require the Filling of any land offshore,'of the Ordinary High Water Mark or the Dredging of any material from Town Lands under water? YES or NO. If it does, Form A/4 (Application for Dredging/Filling) must be completed and attached as pa,rt of this appl ication. IV 0 9. In requesting approval of this application, I submit that: the information presented herein is true and correct to the best of my knowledge and belief; I am the person accountable for the performance of the work in accordance with the plans and specifications attached; , have read or am familiar with the provisions of any Southold Town Ordinanèe pertinent to the work :..-~......I~.._-I. ___.-I L. ....,J.JL__ I ~._"'_.-..-I ,.....~ _.-11__.__ .1.._ _._.-1 _L!-'_ L.. ....1_ _ -r___ I ,.... sour HOLL """, - .;i£ ~ ~: ~ Ge((})]['ge W. Smith aJrltd §((})Jrlt§9 IJrlte. LINOLEUM - TILE - CARPET - WALLPAPER ALUMINUM PRODUCTS 50800 Main St. . 516· 765-3663 . Southold, N. Y. 11971 1~ "ç / ~ f. 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