HomeMy WebLinkAboutTR-204 TOWN OF SOUTHOLD
BOARD OF TOWN TRUSTEES
PEEMIT NO ....... ..2,..0~,,, ......
Pursuant to the provisions of Chapter 615 of the Laws of 1893 of the State of
New York and Chapter 404 of the Laws of 1952 of the State of New York and in accordance
with the resolution of the Board of Trustees of the Town of Southoid adopted at a meeting
of said Board on ....... ~.e.~...~.(...~.?..~.~. ........... , and in consideration of the sum of
$...~..5..,.Q.0.,., lawful money of the United States, paid by.....C~r, ic..-E..,..tE~.~,,a~ .........
residing at ..... ~,~,.~;L~;~;~DI¢~..4~.I ................................................................... New York,
the said Board of Trustees of the Town of Southold, Suffolk County, New York, hereby
authorizes and permits said ...............C..e.~.~.~..q...~..~...~..~.,c[.~.~. ....................................... to
erec~ a ~ulkhea~ ~ Corey Creek ac~o~s ~he £r~.~ of
proper~y at Laughing water, Soul, hold, ~.¥. all in
~ce wi~h ~e agplica~i~ ~
The sa d ........ .C~'4,C..~,...W,%c]~am ...................., 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 all damages, claims for damages or suitsthat 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 may 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.
TOWN OF SOUTHOLD
TOWN OF SOUTHOLD
BOARD OF TOWN TRUSTEES
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Examined ~..~.~.~ 19..~..~. Application ~o ..............................................
D~s~prov~ a/c .................................................................. ~ .......... . ..........................................................................
~.....~ha~n, BoarA of Tr~tees
/ ~PLICATION FOR PERMIT
I~ST~UC~ZO~S
A. Th~s ~pp~ca~on to be completely fi~ed ~ by type~iter or ~ i~ an~ sub~tted to the ToWA ~stees ~ dup-
~c~te.
B. PlOt p]~ showing location of lot a~d b~Idings o~ ~2re~ses, re~tion to a~oizdng premises, public s~eets,
parks, etc.. And g~g detailed 8esc~ption
this ~ppHc~tion.
C. The wor~ covered ~y thi~ app~cation ~y n~t be comme~ce~ before the issu~ce of a ~er~t.
D. U~on approv~ o~ ~his applic~tion, To~ Trustees ~ issue ~ per~ t~ appA~aAt. Such per~ sha~ be ke~t
on the ~re~ses an~ available ~or i~ection at
E, Ap~]ic~t shah notify the Bc~d o~ ~ustee~ aport comp~etio~ of the ~ork covered by pe~t.
APPLICATION iS HEREBY ~E to the Board of Trustees of the Town of Soul,Id, S~fo~ County, New York,
for the issuaAce of a p~mit pursuit to the laws, Or~ances and regulations gove~ing construction of: docks,
piers, b~eads, jettys ~d ~ed~ng in; under, ~nd over the waterz of To~ of Sou2~old. The appHc~t a~ees
to comply ~th ~ applicable laws, o~ances, relations and con~tions specked by s~d tr~tees, and to hold
the Town ~f Southold, and aH To~o~ci~s ~ liability a~d~da~ges of any ~d.
Street Address of Prape~y _.._..~,~~~...._~._._~ _~ ...........
He.~e address ,f Other ~an Locstlon _.~~~... -'" ~
Creek, Bay or H~rbor Fronting Prope~y
. ................ ~ .................................................. ~ .............................................................................................
8~e o~ ~o~s*a Work: ~e~ Wia~h ................................. ae~g~ ~bo~e aig~ W~er ...._~_~.~.__: ..........
t~ ~8 ~or ~va~e or ~s~e~ ~e? ....... ~ ................................. ~ea ~oning ..........................................................................
Complete plog ~lan to be ~am on reverse side of this a~pllcation.
STATE OF NEW YORK)
/~ ~ ~)s. s.
COUNTY OF~~)
...~~being duly sworn, deposes and says that he ~ the app~cang for the above de-
sc~bed permit, ~d that a~ statements contained herein ~e true to the best of h~s kAowle~e ~d belief; that ~e
w~k ~ be done ~ the manner set forth in the application and as approved by the Board of ~stees of the Town
of Southold, amd the appAcan~ a~ees ~o hold the To~ cf Southola ~nd said trustees harmless and free from any
and aH damages and claims ~isi~ under or by vi~ue of s~d per~t.
(applicant)
.............................
~qa~ PcS~[c ~.~te o, kew Y~r~ ~ ~