HomeMy WebLinkAboutNORRIS, SUSAN (2)Albert J. Krupski, President
James King, Vice-President
Henry Smith
Ar%ie Foster
K~n Poliwoda
Town Hall
53095 Main Road
P.O. Box 1179
Southold, New York 11971
Telephone (516) 765-18~2
Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
BOARD OF TRUSTEES: TOWN OF SOUTHOLD
In the Matter of the Application
of.
_._ _J___ N_ _ _ _e_
COUNTY OF SUFFOLK)
STATE OF NEW YORK)
AFFIDAVIT OF POSTING
I, ~OHN ~, ~7~LL~ , residing at ~ ~FOX~;
being duly sworn, depose and say:
That on the I~Whday of ~A~ , 199~, I personally posted the
property known as ~A~ ~RR~
by placing the Board of Trustees offidial poster where it can
easily be seen, and that I have checked to be sure the poster
has remained in place for seven days prior to the date of the
public hearing. (date of hearing noted thereon to be held ~,~
~ oe_ ~4~7, 7~/~,~.
Dated:
Sworn to before me this
~7%day of ~0~ 199~
No~'t ary~Pub~lic~ ~/
gnatur6) -
SUSAN E. LONG
Noisry Public, State of New York
No. 01 LO4958343
Qualified in Suffolk County
Commission Expires November 6,
Albert J. Krupski, President
James King, Vice-President
Henry Smith
Artie Foster
Ken Poliwoda
Town Hall
53095 Main Road
P.O. Box 1179
Southold, New York 11971
Telephone (516) 765-18/~2
Fax (516) 765-1823 '
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
May 29, 1998
Susan Norris
2790 New Suffolk Ave.
Mattituck, NY 11952
RE: SCTM 9123-9-1
Dear Ms. Norris:
The following action was taken by the Southold Town Board of
Trustees on Thursday, May 28, 1998:
RESOLVED that the Southold Town Board of Trustees grants an
amendment to Permit 94479 to allow for the installation of boat
lift on the east end of her dock.
This is not an approval from any other agency.
If you have any questions, please do not hesitate to contact
this office.
Sincerely,
Albert J. Krupski, Jr.
President, Board of Trustees
AJK:jmd
COSTELLO MAI{INE CONTI ACT NG COI PORATION
DOCK BU)LDiNG * JETTIES - EPJLKHEAD)NG o STEEL & WOOD PILING · FLOATS
423 FIFTH STREET, P.O. BOX 2124 - GREENPORT, NEW YORK 11944 o (516) 477-1199/477-1893/477-0652
April 24, 1998
Albert J. Krupski, President
Board of Trustees
P.O. Box 1166
Southold, NY 11971
Re: Susan Norris
per~±t ~4479
Dear Mr. Krupski:
Ms. Norris has retained our office to apply for an amendment'
to the above referenced permit to allow the installation of a boat
lift on the east end of her dock. The lift will be attached to
the existing dock; no additional pilings are needed.
Enclosed please find project plans and application fee in the
amount of $40.00. If you have any questions or require further
information, please call me.
Thank you for your review and assistance.
Very truly y~rs,
Permit Manager
Enc.
P~AM
f
/
~ '~ cosTI~LLO MAI~I'qE COiXtTRAC'I'IN~ CORI'ORA'I'ION
N A"FT I-C U 0...t~.
StAtE Of NEW YOrK
DEPARTMENT OF STATE
ALBANY, NY 12231-0001
l: vv SOUT
ALEXANDER F, TREADWELL
SECRETarY Of STATE
Ms. Susan Long
Permit Manager
Costello Marine Contracting Corp.
P.O. Box 2124
Greenport, NY 11944
Re:
Dear Ms. Long:
July 18, 1995
F-95-231
U.S. Army Corps of Engineers/New York
District Permit Application #95-03660-L2
Susan Norris
Town of Southold, Suffolk County
DEC #1-4738-01064/00002-0
The Department of State has completed its evaluation of your Federal Consistency
Assessment Form and certification that the above proposed pernfit activity complies with
New York State's approved Coastal Management Program, and w/Il be conducted in a
manner consistent with this program.
Pursuant to 15 CFR Section 930.63, and based upon the project information submitted, the
Department of State concurs with your consistency certification subject to the following
agreed upon condition:
Department of State approval applies to the modified plans stamped "APPROVED"
by the NYS Depa~'tment of Environmental Conservation and dated May 22, 1995 in
NYS DEC permit number 1-4738-01064/00002-0.
This concurrence is without prejudice to, and does not obviate the need to obtain all other
applicable licenses, permits, and approvals required under existing State statutes.
A copy of this decision has been sent to the Corps of Engineers.
GRS/VB/jtb
cc: COE/NY District - Marc Helman
NYS DEC/Region 1 - Robert Greene
Town of Southold - Albert Krupski
Board Of $outhold Town Trustees
SOUTHOLD, NEW YORK
ISSUED TO .........
Pursuant +o 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 "REGULATING AND THE PLACING OF OBSTRUCTIONS
IN AND ON-TOWN WATERS AND PUBLIC LANDS and the
REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN WATERS;" and in accordance with the
Resolution of The Board adopted at a meeting held on ....6./2.9./ 95. .....
19..?.~, and ~n consideration of the sum mc $..!50.,.~0 paid by
...Cost ~llc~...Maz:in.~ .. C.c~n.t~_.,.... f~.. ~.U ~.A~I ~ (~.g~.~ .................................
of ...~a!~i~ ................................................... N. Y. and subject to the
Terms and Conditions listed on the reverse side hereof,
of Southold Town Trustees authorizes and permits the following:
Reconstruct an 8' X 70' timber dock and add a 10' extension
to it. Great Peconic Bay
all in accordance with the detailed specifications as presented in
the originating appJlcafion.
IN WITNESS WHEREOF, The said Board of Trustees here-
by causes its Corporate Seal to be affixed, and these presents to
be subscribed by a majority of the said Board as of this date.
Trnstees
Albert J. Krupski, President
John Holzapfel, Vice President
William G. Albertson
Martin H. Garrell
Peter Wenczel
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall
53095 Main Road
P.O. Box 1179
Southold, New York 11971
Telephone (516) 765-1892
Fax (516) 765-1823
June 30, 1995,
Costetlo Marine Contr.
P.O. Box 2124
Greenport NY 11944
Re: SUSAN NORRIS
SCTM %123-9-1
Dear Mr. Costello,
The following action was taken by the Board of Town Trustees
during its regular meeting held on June 29, 1995 regarding the
above matter:
WHEREAS, Costello Marine, on behalf of SUSAN NORRIS, applied to
the Southold Town Trustees for a pezmit under the provisions of
the Wetland Ordinance of the Town of Southold, application dated
March 29, 1995, and,
WHEREAS, said application was referred to the Southold Town
Conservation Advisory Council for their findings and
recommendations, and
WHEREAS, a Public Hearing was held by the Town Trustees with
respect to said application on June 29, 1995, at which time all
interested persons were given an opportunity to be heard, and,
WHEREAS, the Board members have personally viewed and are
familiar with the premises in question and the surrounding area,
and,
WHEREAS, the Board has c6nsidered all the testimony and
documentation submitted concerning this application, and,
WHEREAS, the structure complies with the standard set forth in
Chapter 37-18 of the Southold Town Code,
WHEREAS, the Board has determined that the project as proposed
will not affect the health, safety and general welfare of the
people of the town,
NOW THEREFORE BE IT,
RESOLVED, that the Board of Trustees approves the application of
SUSAN NORRIS to reconstruct an 8' X 70' timber dock and add a
10' extension to it.
Permit to construct project Will expire two years from the date
it is signed. Fees must be paid, if applicmhle, and peE~f~t
issued within six months of the date of this notification.
Two inspections are required and the Trustees are to be notified
upon completion of said project.
FEES: None
Very truly yours,
Albert J. Krupski, Jr.
President, Board of Trustees
AJK/djh
cc. CAC
A~
Albert J. Krupski, President
John Holzapfel, Vice President
William G. Albertson
Martin H. Garrell
Peter Wenczel
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hail
53095 Main Road
P.O. Box 1179
Southold, New York 11971
Telephone (516) 765-1892
Fax (516) 765-1823
May 26, 1995
Edward Sawicki
P.O. Box 66Mattituck, NY 11952
RE: Susan Norris
SCTM 123-9-1
Dear Mr. Sawicki:
The following action was taken by the Southotd Town Board of
Trustees on Thursday, May 25, 1995:
RESOLVED that the Southold Town Board of Trustees grants an
amendment to permit ~4438 to leave concret rip rap that was
placed at the western end of property.
If you have any questions, please do not hesitate to contact
this office.
incerely,
Albert J. Krupski, Jr.
President, Board of Trustees
AJK:jmd
TOW~ OF
To:
NOTICE
Police Dept. - Bay Constable
Town of Southold
Peconic, New York 1.1958
NOTICE OF VIOLATION
Date:--L---~.-_
[Owner or authorized agent of owner)
(Address of owner or authorized agent of owner)
Please take notice there exists a violation of the Code of the
Town of Southoldt Chapter 97 Article---= ........ Section
at premises hereinafter described in that
You are therefore directed and ordered to co~ply with the
following: ....... ' ' ~
on or before day cf , 19
The premises to which this Notice of Violation refers are situated at:
Town of Southold,
Suffolk County, N~¥. (Suff. County ?ax ~Iap Desi9-nation: Dist.
Section: ....... -=---Block: ........ Lot: ....... k
Failure to comply with the applicable provlsions of the law may
constitute an offense punishable by fine or imprison~ent or both.
NOTICE: You have the right to apply for a hearing before the Board
of Trustees of the Town of Southold, provided that ~ou file a written
request with the Clerk of the Trustees within 10 days after service'of
the Notice of Violation. Such request shall have annexed thereto a
copy of the Notice of Violation upon which a Hearing is requested and
shall set forth the reasons why such notice of violation should be
modified or rescinded,.
Bay Constable, Town of Southold, NY
Board Of $outhold Town Trustees
SOUTHOLD, NEW YORK
DATE: ...4./.27/.95 .........
ISSUED TO ......$~$AN.. ~9.~!~ ................................................
Pursuanf fo fhe provisions of Chaplet 615 of fhe Laws of
fhe Sfafe of New York, 1893; and C. hapfer 404 of the Laws of fhe
Sfafe of New York 1952; and fhe Soufhold Town Ordinance en-.
rifled "REGULATING AND THE PLACING OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS and fhe
REMOVAL oF SAND, GRAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN WATERS;" end in accordance wifh fhe
Resolufion of The Board adopfed afa meefing held on . .~13.7./95. ....
19.95.., end in conslderafion of fhe sum of $ ]..00.,.0.0 paid by
Gos.tetlo.,Mari~e...for. S.USAN.. NQ~I~S ..................................................
of ........ .~J;~i.t~,c.~: N.Y. and subiecf fo fhe
Terms and Condlfions Iisfed on fhe reverse side hereof,
of Soufhold Town Trusfees au~'horlzes and permlfs the following:
Grandfather Permit to reconstruct rock and timber jetties.
Great Peconic Bay
all in accordance wlfh the derailed specifications as presenfed in
fhe orlginafing application.
by
be
IN WITNESS WHEREOF, The said Board of Trusfees here-
causes ifs Corporafe Seal fo be affixed, and fhese presenfs fo
subscribed by a maiorH'y of fhe said Board as of fhis daf,e.
....... .......
SUE LONG
COSTELLO MARINE CONTRACTING CORP.
P.O. Box 2124
Greenport, NY 1i944
(516) 477-1199
Meeting of ~t/20/95
The CAC recommends disapproval because it is an ill conceived plan of that
location and the cesspools are a problem. The CAC is concerned with the
pollution from an inadequate septic system. ,
Vote ~3f Council: Ayes: All
Motion carried.
No. 1258
Moved by Robert Keith, seconded by Bruce Loucka, it was
RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL
WITH CONDITIONS of the Wetland Application of JOHN F. PETERSEN
31-12-5.2 to enlarge second floor of house for more living space.
970 Trumans Path, East Marion
The CAC approvals provided the applicant use hay bales and silt fence during
construction,
Vote of Council: Ayes: Ali
Motion carried,
RECOMMENDATION OF GRANDFATHER PERMITS
GF-1
Moved by Stephen Angell, seconded by Bruce Loucka, it was
RESOLVED to recommend to the Southold Town Board of Trustees
DISAPPROVAL of the request for a Grandfather Permit by SUSAN NORRIS
123-9-1 to reconstruct jetties and dock structures. Existed prior to 4/6/76.
2790 New Suffolk Avenue, Mattltuck
The CAC recommends disapproval because it is a substantial project with
additional new work included. A Wetland Permit should be required and the
application should include plans for the dock.
Vote of Council: Ayes: All
Motion carried.
CF-2
Moved by Stephen Angell, seconded by Bruce Loucka, it was
RESOLVED to recommend to the Southold Town Board of Trustees
DISAPPROVAL of the request for a Grandfather Permit by JUNE DUFFNER
123-3-11.1 to remove a dilapidated 32" x 347 fixed dock, replace with a 37 x
34~ fixed dock, reconstruct existing 3~ x 12~ ramp and reinstall existing 67 x
20~ float.
915 Bungalow Lane~, Mattituck
The CAC recommends disapproval of the Grandfather Permit request. The
Council feels this project warrants a Wetland Permit and would approve as
follows:
No. 1259
Moved by Stephen Angell, seconded by Bruce Loucka, it was
RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL
AS SUBMITTED the Wetland Application of JUNE DUFFNER 123-3-11.1 to
Page 7
SECRETARY Off STATE
STATE Of NEW YORK
DEPARTMENT Of STATE
ALBANY NY 12231-OO01
Department of the Army
New York District, Corps of Engineers
arten: James W. Haggerty
Chief, Eastern Perm/ts Section
Jacob K. Javits Federal Building
New York, New York 10278-0090
April 18. 1995
Dear Mr. Haggerty:
Re:
F-95-231
U.S. Army Corps of Engineers/New York
Application #95-03660-L2
Susan Norris
Town of Southold, Suffolk County
Letter of Coordination Comments
Thank you for forwarding to the Department of State a copy of your Letter of Coordination
dated April 12, 1995 regarding the possible issuance of a Letter of Pe~ mission authorization
for the above-proposed project.
It may not be necessary to reconstruct ali jetties and still attain beach nour/shrnent
objectives. Some of the shorter, timber structures may not need to be rebuilt. Would newly
reconstructed jetties be significantly higher that the surrounding beach after reconstruction?
If so, what would the downdrift effects of the higher structures be on downdrfft beaches?
If the jetties are not functioning, they should not be rebuilt. The shoreline at the project
site appears to feature existing flood and erosion protection in the form of a vertical wall
and beach area.
Please call me at (518) 474-6000 if there
are any qm stions about this letter.
i~!1 ~si cerely,
vance A. Bart
Coastal Resources Spec/al/st
Div/sion of Coastal Resources and
Waterfront Revitalization
VAB/
cc: Southold Trustees - A. Krupski
~ Drinte~ on recycteo PaDer
ALEXANDER F. TREADWELL
SECRETARY OF STATE
STATE Of NeW YOrK
DEPArtMENt OF STATE
ALBANY. NY 12231-000!
April 18. 1995
Susan Long
Costello Marine Contracting Corp.
P.O. Box 2124
Greenport, New York 11944
Re:
F-95-231
U.S. Army Corps of Engineers/NY
Application #95-03660-L2
Susan Norris
Town of Southold, Suffolk County
Request for Additional Infomation
Dear Ms. Long:
Pursuant to 15 CFR 930.58, the following data and information are necessa~ to enable the
Department of State to adequately assess the coastal zone effects of this proposed project.
Would the reconstructed jetties be significantly higher in finished elevation that the
surrounding beach area? Th/s may effectively stop downdrffr nourishment of downdrift
beaches. Can the applicant's beach nomSsbment objectives still be realized by reconstructing
fewer jetties (i.e. the longer, rock ones)? For effective sand capture, it is recommended that
jetties be placed at/ntervals of between one and four times their length along the shoreline.
Jetties built between these intervals effectively become bypassed and serve no purpose.
Please provide the information requested above to the Department of State w/thin thirty
days from the date of this letter. Pursuant to 15 CFR 930.64 (d), if the necessary data and
information are not provided, the Department of State may object ro your consistency
certification on the grounds of insuffic/ent information.
Any additional information which you believe will facilitate our consistency review of this
project would be appreciated.
A copy of this letter has been sent to the Corps of Engineers.
~'~ printed on recycled paper
Ms. Susan Long
Page 2
i
Coastal Resources Specialist
Div/sion of Coastal Resources
and Waterfront Revitalization
VA~/
CC:
COE/New York District - Sophie Ettinger
NYS DEC/Reg/on I - Robert A. Greene
Southold Trustees - Albert Krupski
Albert J. Krupski, President
John Holzapfel, Vice President
William G. Albertson
Martin H. Garrell
Peter'Wenczel
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall
53095 Main Road
P.O. Box 1179
Southold, New York 11971
Telephone (516) 765-1892
Fax (516) 765-1823
March 29, 1995
Stephen Angeii, Chairman
Southold Town Conservation Advisory Council
Southold Town Hall
Main Road
Southold, NY 11971
Dear Mr. Angell:
Transmitted herewith are the following applications for a Wetland
Permit:
Susan Norris SCTM%123-9-1 (Grandfather)
Thomas G. Rafferty SCTM% 20-3-11.8
Alexander Harvey SCTM% 11-1-12
Andrew Fohrkolb SCTM% 137-4-30
Please prepare a written report of findings and
recommendations with respect to this application.
Very truly yours,
Albert J. Krupski, Jr.
President, Board of Trustees
AJK:djh
f
¢.; ¢/ /
/
/CAP
COST]~LLO MARINI~ CONTRACTING CORPORATION
DC~K BUIt. OINQ ' Jb-'rTIE~. BUL.KHEADiHG * ~TIEIEI., & WOOD PILING ' FLOAT~
......... ~ I I ' I IIIIIIIII I I ..... , ....... .
423 FIFTH gTRBET, P,O, BOX 21:~4 '* GREENPOFtT, NEW YORK T 1944 - (516) 477-11gg/4~rT-l~47743682
TOTAL P. 01
Albert J. Kmpski, President
John Holzapt~l, Vice President
William G. Albertson
Martin H. Garrell
Peter Wenczel
Town Hall
53095 Main Road
P.O. Box 1179
Southold, New York 11971
Telephone (516) 765-1892
Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only
Coastal Erosion Permit ApplicatJ
%¢¢~etland Permit Application
~fr~randfather Permit Application
Trustee Lands Permit ApplicatioI
Waiver ~/
~Re~-~ved Application:
~__'Clerical Review: ~./'~/~
~__Completed ApplicationF~/~/~'~
~Incomplete ' '~'
SEQRA Classification:
Type I Type II_~Unlisted
Coo~-~i~-~tion:(da~ sen~) '
~CAC Referral Sent:
~_Date of Inspection: ~r~/~a.-..
~ Receipt of CAC Report:f~a~e)--~0/q~
Lead Agency Determination:
Technical Review:(date) .
~ Public Hearing:(date) ~/~)/g~'~ ~/¢~------~'
Decision: Approved (Y/~) ~re) ~
~Application Fee:$/~O. ~
Name of Applicant .~_
Address
~ q
Suffolk County Tax Map Number:
Property Location:
iooo -/ga- !
(provide LILCO Pole ~, distance to cross streets, and location)
(If applicable)
Board of Trustees AppliC~on
GENERAL DATA
Land-Area (in square feet): d~ ~C~ ~_~
/
Area Zoning: ~5~(~~ ~L
Previous use of property: ~ID~t ~l-~
Intended use of property: ~O C ~1~ ,~
Prior permits/approvals for site improvements:
Agency Date
L) ha K OOcO
No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspended by a
governmental
agency?
/
/ No__ Yes
If yes, provide explanation:
Project Description (use attachments if necessary):
Board of Trustees Applic~on
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: .~.~-~
Area of wetlands on lot: ~4 square feet
Percent coverage of lot: ~/~ %
Closest distance between~nearest existing structure an~ upland
edge of wetlands: ~/~. feet
Closest distance between nearest proposed structure and upland
edge of wetlands: ~//~ feet
Does the project involve excavation or filling?
/
~/ NO Yes
If yes, how much material will be excavated? ~ ~- cubic yards
How much material will be filled?
cubic yards
Depth of which material will be removed or deposited:
feet
Proposed slope throughout the area of operations: ~
Manner in which material will be removed or deposited:
Statement of the effect, if any, on the wetlands and tidal
waters of the town that may result by reason os such proposed
operations (use attachments if appropriate):
IPROJECT I.D. NUMBER
Gt~..21
Apper~dlx C
Slale iEnvlronmenlal Quality Review
SttORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS o~ly
'~ART I~ROJECT INfoRMATION (To b~ completed by Appllc~nl or Project sponsor)
APPLICAN T,ISPOHSOR 2. PROJECT
";COstello Marine Contracting Corp.
PROJECT LOCATION:
See Attached area map.
SEQR
IS PROPOSED ACTION:
line, E]~p~,sio,, []Modl,,~I,o./~iie,.IIo. ~E'PhlES) ~ECo~T~UCTI O~
bock ~Nb EXT~Mb b~C~ tO~,
7. AMOUNT OF LAN.~[,) AFFECTED:
0
U
Initially ~lme~l Ultlm,tely
8 WiLt PROPOSED ACTION COMPLY wire EXISTtrIG ZONING on OTNEn ExtsrlNG LAND USE RESTRICTIONS?
[] Ye~ [] No If No. describe briefly
g. WttAT IS PRESENT LAHD USE IN VICINITY OF PROJECT?
WATERFRONT
[] Agriculture
[] PaiklFore~UOpeu apace [] Other
10. DOE~ ACTION INVOLVE A PERMIT APPROVAL. OR FUNDING. NOW OR ULTIMATELY PROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL.
~TAIE OR LoCAL)?
[] Yee [] No Il y,~, ll~l agencylel end permtl/~pprov~l~
Lt.
NYS DEC, ACOEz TbL~3b0 OF
souwH0ab
DOES ANY ASPECT OF THE ACTION HAVE A CURREN1T[~ VALID PERMIT 0R APPROVAL?
12 A~ A RESULT OF PROPOSED ACTION WILL EXtSTIHG PERMITIAPPROVAL REDUmE UOD,FICAtION?
J CERTIFY T~AT THE INFORMATION PROVIDED ABOVE lB TRUE TO file BE~T OF M~ KNOWLEDGE
COSTELLO MARINE CONTRACTING
II th~ action Is In tim Conelal Area, and you are e slate agency, complete Ibc
Coaslal Assessment Form before proceeding wllh.thl~ esse,smenl
OVER
1
county of suffolk
State of New York
~.G~O~ b- COST~L~L0~ ~ BEING DULY SWORN DEPOSES AND
AFFIRMS THAT HE/SUE IS THE APPLICANT EOR THE ABOVE DESCRIBED
PERMIT{S) AND THAT 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 OF 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 ~{E PREMISES IN CONJUNCTION WITH REVIEW OF THIS
APPLICATION.
SWORN TO BEFORE ME THIS
S~GN~TU~E -
NOTARY PUBLIC
SUSAN E, LONG
Ho. O~ LO4~5~3q3
~n ~ms Novembe~
Suggeshed space for location Map
Tills IS NOT A PERMIT
AUTilORI'ZRTION LETTER
owner of
Business/property name
, do hereby give Costello
Marine Contracting Corp. the authority to act as agent in my behalf in applying.
for all flecessary permits in order for work to be done on my property described
above.
~/v ~'~t~nature