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Home My WebLink AboutTR-4968Board Of $outhold Town Trustees SOUTHOLD, NEW YORK PERMIT NO. /'//~ ~ aa'' DATE: ISSUED TO ....... ~.OJTt. J ..~.-..~-.0~.~.- ................. Pursuant fo the provisions of Chapter 61S of the Laws of the State of New York, 1893: and Chapter 404 of fha L.aws of fha State of New York 19S2; and the Southold Town Ord,nance 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 w~th the Resolution of The Board adopted at a meeting held on ....~.~.2]=~.~-.998 19 ~.8..., and in consideration of the sum of $......70.~,.~0 ... paid by Proper~T...Permit Services for Ma~.y.N.. Code ............................... of ...... .S~[~?[~ ...................... N. Y. and subject fo the Terms and Conditions listed on the reverse side hereof, of Soufhold Town Trustees authorizes and permits the following: Wetland Permit to construct f~xed walkway 4'X72',hinged ramp 4'X16', and floating dock 6'X20' and install two spiles to secure floating dock. 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 fo be affixed, and these ~.resenh fo be subscribed by · majority of the sald Board es of th, s daf=. Trustees TERMS and CONDITIONS Mary N. Code The Permittee , residing at 1555 Smith Dr. North, Southold~ NY 11971 N. ¥, as part of the consideration for the issuance of the Permit doe* understand and prtsctibe to the fol- lowing: I. That the said Board of Trustees and the Town of 5onthold ere rele~ed from any and al/ damages, or dnlm, for damages, of suit~ arising disecfly or indirectly as a result of any opet- atlon performed Por~ant to this permit, and the mid Permlt~e will, at his or bet own equine, defend any and all tach suiU initiated by third partie~, and the said Peemlttee asmme~ full t~aldHty with respect thereto, to the complete exclusion of the Board of Tmstee~ of the Town of 8outho!d 2. That this Permit is valid for · period of 24 mos. whkh is comtdatx-d to be the estimated time required to complete the work involved, but should circumstances wasreng request for an exce~ion may be made to the Boas'd ·t a later date. 3. 'I~]at this Permit should be retained indefinitely, or as long as the said Petmittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that auth- orization was originally obtained. 4. That the work involved will be subject to the inspection and ·ppcoval of the Board or iu ·gents, and non-compliance with the provisions of the orlgin~ttng application, may be e~,,,e, for revocation of this Permit by resolution of the said Bon~l. 5. That there wU! be no unreasonable interference with navigation as · result of the work herein au'thotized. 6. That there shall be no interference with the right of the public to [mss and t~-pass along the beach between high and Iow water mnrks. 7. That if future operations of the Town of 8o~thold require the removal and/or altecations in the loc·don of the work berdn anthorlzed~ or if, in the opinion of the Board of Tm~ee~ the. work shaU cause ume~sonable obsu'uct~on to free navigation, the said Pennlttee will be requil~ upon due notice, ~o remove or alter this work oF pcoject herein stated without expemes to the Town of 5outhold. 8. That the said Board will be notified*by the,Permlttee ot the compledun of the work anth- 9. That the Permittee wIH obtain aH other permits and consents that may be requi~d sup. plemental to this permit which may be subiect to revoke upon failure to obtehi same. Albert J. I~upski, President James King, Vice-President Hemry Smith Amtie Foster Ken Poliwoda Towll 5309t~ Main l~ad P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (~16) 765-1823 BOARD OF TOWN TRUSTEES TOVFN OF SOUTHOLD Please be advised that your auDlicatlon, dated //~/O[ has beer reviewed by this Boa~, at the regular ~ee~ing of ~}/0~ and the following action was taken: ( ~-' ) Application Approved (see below) (__.) Application Denied (see below) ( ) Application Tabled (see below) If your application is approved as noted above, a permit fee is now due. Make check or money order payable to the Southold Town Trustees. The fee ~s computed below according ~o ~he schedule of rates as act forth in the ins=ruction sheet. The following fee must be paid within 90 days or re-application f~s will b~ COMPUTATION O? PE~ilT FEES: TOT SU : $ BY: PRESIDENT, BOARD OF TRUSTEES ~ERK, BOARD OF TRUSTEES Albert J. Krupsld, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 February 22, 2001 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Ms. Mary N. Code 1555 Smith Dr. North Southold, NY 11971 Re: 1555 Smith Dr. North, Southold SCTM#76-2-4 Dear Ms. Code: The following action was taken at the Southold Town Board of Trustees meeting held on Wednesday, February 21, 2001: RESOLVED, that the Southold Town Board of Trustees Approve the request for an Amendment to Permit #4908 for the extension of the catwalk towards the dwelling by 22'. This is not a determination fi.om any other agency. If you have any questions, please call our office at (631) 765-1892. Sincerely, P,l[~ert J. Klupski, Jr. President, Board of Trustees DEC Telephone (631) 765-1892 To~t Hall. 53095 Main P,,oad P.O. Box 11'/9 ,~outhold. Ne~ Yo~k I1971 SOUTHOLD T0vrN CONSERVA. TIO[~ ADVISORY COUNCr[, At the meeting of the Southold Town Conservation Advisory Council held Thursday, February 15, 2001, the following recommendation was made: MARY N. CODE 76-2-2 to Amend Permit ~-4908 for the extension of the catwalk towards the dwelling by 22'. 1555 Smith Dr., North, Southold The CAC did not make an inspection, therefore no recommendation was made. Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Po]iwoda Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (616) 765-1823 BOA_RD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: ~ZU O. ~o~ ~ Please be advised that your application, dated~ has been reviewed by this Board, at the regular meeting 6f ~L~.~%! }~q~ and the follgwing action was taken: ( W~ Application Approved (see below) (__) Application Denied (see below) (__) Application Tabled (see below) If your application is approved as noted above, a permit fee is now due. Make check or money order payable to the Southold Town Trustees. The fee is computed below according to the schedule of rates as set forth in the instruction sheet. The following fee must be paid within 90 days or re-application fees will be necessary. COMPUTATION OF PERMIT FEES: ~'~/~ ' = Z~/' ,/ '~,] ' -- ~/~ ~ T01'(~I ~ * 552 ~ PRESIDENT, BOARD OF TRUSTEES CLERK, BOA~ OF TRUSTEES 4/98 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 James E. Fitzgerald, Jr. Proper-T Permit Services P.O. Box 617 Cutchogue, NY 11935 October 22, 1998 Re: Mary N. Code SCTM #76-2-4 Dear Mr. Fitzgerald: The following action was taken by the Board of Town Trustees during its regular meeting held on October 21, 1998 regarding the above matter: WHEREAS, PROPER-T PERMIT SERVICES on behalf of MARY N. CODE applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated October 13, 1998, 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 October 21, 1998, 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 considered 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 grant a Wetland Permit to MARY N. CODE to construct a fixed open walkway 4'X 72', hinged ramp 4'X 16' and floating dock 6'X 20' and install two spiles to secure floating dock. BE IT FURTHER RESOLVED that this determination should not be considered a determination made for any other Department or Agency which may also have an application pending for the same or similar project. Permit to construct project will expire two years from the date it is signed. Fees must be paid, if applicable, and permit 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: 4'X 16' = 64'X $3 = $192.00 6'X 20' = 120'X $3 = $360.00 Total: $552.00 Very truly yours, Albert J. Krupski, Jr. President, Board of Trustees AJK/lms cc: DEC Dept. of State ACE Telephone (516~ 765-1801 Town Hall. 53095 Main Road P.O. Box 1179 Southold, New Yo~k 11971 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Monday, October 19, 1998, the following recommendation was made: No. 1598 ~. COI)E 76-2-~ to construct fixed open walkway I~. x 72', hinged ramp ~' x 16', and floating dock 6' x 20'; install two (2) spiles to secure floating dock. 1555 Smith Drive North, Southold The CAC did not make an inspection, therefore, it has no comment. Proper-T Permit Services if' i POST OFFICE BOX 61Z CUTCHOGUE, NEW YORK 11g -061 I576) 734-5800 October 2, 1998 President Board of Town Trustees - Town of Southold Town Hall, 53095 Main Road Southold, New York 11971 Re: Aoplication for Permit on Behalf of Mary N. Code. SCTM #1000-76-2-4 Dear Sir: Attached are documents which have been prepared in support of the application for a permit to construct a dock on the property of Mary N. Code in the Town of Southold. Proper-T P=,afit Services represents Mrs. Code in this matter, and a letter of authorization is part of this submission.. ffthere are any questions, or if additional information is needed, please call me. Enclosures: Application Fee ($150) Letter of Authorization Notarized Statement of Applicant Application Form (3 copies) Short EAF (3 copies) Vicinity Map (3 copies) Tax Map (3 copies) Survey of Property (1 copy) Project Plan (3 copies) Section View (3 copies) Project Site Photos (1 copy) /~s E. Fitzgerald~ a subsidiary o! THE PECONIC EASTERN CORPORATION October 2, 1998 APPLICANT: Mary N. Code PROJECT LOCATION: 1555 Smith Drive North, Southold SCTM# 1000-76-2-4 PROJECT DESCRIPTION: Construct fixed open walkway 4' x 72', hinged romp 4' x 16', and floating dock 6' x 20'; install two spiles to secure floating dock. Albert J. Krupski, President James King, Vice-President Henry Smith Arkie Foster Ken Poliwoda Town Hall 53095 Main Road P.O. Box 1179 $outhold, New York 11971 Telephone (516) 765-18q2 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD JAN ;I LETTER OF REQUEST FOR AN AMENDMENT ADDRESS TAXraAP NO. /~ ? ~ - L- ~ I/We //~/~-? C_C~l~' requcst an Amendment to Permit # ~d) a° x._ / Signed By: Name: PROOF OF MAILING OF NOT] ATTACH CERTIFIED MAIL RE( Address: STATE. OF NEW ~ORK COUk.~Y OF SUFFOLK _~P._u__37~?J~__C~. ____~__,~_~__ .... , b~ing ~uly ~worn, deposes ~nd ,:aat c~;. ~ .-Z~__ :!al; of ~~__,~O/, deponent ma~3_e.~ a true cc:[' ~f the Notice set fort~ in the Board of Trustees A~piicanicn, directed to each of the ~ove n~ed persons at the addr~gses set opposite there respective n~es; that the ~ddx'esses ~t o.ot:os;.te %ha namos cf said persons are the cf said parsons 8s sho~vn on the current assessment roll of the Tow~ of S~ "~ -id Notices were mailed at the .... c~ ?ost Office at ~0~ f~C~ , that said Notices were mailed to each of salu persons by (certified) {registered) mail. Sworn to day /..,/' ""~ thi _ /0 6 Albert J. Krupsld, President James King, Vice-President Henry S~ ~ith Artie Fo ~ter Ken Poll, zoda BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall · 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I, .~.~ AJ. ~-~J , residing at ~ ~ ~. ~/~~ being duly sworn, depose and say: That on the ~ day ofy~ , 200,, I personally posted the property known as by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of_the Dublic hearing. Date of hearing noted thereon to be held ~,~ Dated: ~- / ~-O/ Sworn to before me this /~ day o_f ~ 2001 Notary Public (signat~e) Albert I. Kmpski. President John H61zapfel. Vice President Jim King Martin tt. Gan'ell Peter Wenczel BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Main Road P.O. Box I 179 Southold. New York 11971 Telepho.e (516/765-1892 Fax (516) 765- 1823 office Use Onl~-%,~, · Coastal Erosion Permit Appllcatiq~n~--'--~-~ttt ~ Wetland Permit Application Grandfather Pe~it Application . Waiver / ~en~ent / Changes [I .. / ~Receive9 ~ppl~at~on: /O-/~- ~ KReceive~ ~'ee: ~[~ ~ ' - ~Completed Application /~ * ~J- ~ Incomplete . SEQ~ Classification: ~e I__~e II Unlisted Coordination: (date sent) ~CAC Referral Sent:~-/.~~ Date of Inspection ~L~_~__ Receipt of CAC Report: Lead Agency Determination: Technical Review: ~--gublic Hearing Resolution: Nmne of Applicant Address Mar7 No. Code 1555 Smith Drive North, Southold NY 11971 Phone Number:(516) 765-1185 Suffolk County Tax Map Number: 1000 - 76-2-4 Property Location: 1555 Smith D~ive No~th~ Southold See attached maps. (provide LILCO Pole #, distance to cross street~, and location) AGENT: James E. Fitz~erald, Jr. / Proper-T Permit Services (If applicable) Address: Post Office Box 617, Cutcho~le, NY 11935 Phone: 734-5800 FAX#: ~oard of Trustees Applica~ GENERAL DATA Land Area (in square feet): Area Zoning: Previous use of property: Intended use of property: 19,088 s.f. R-40 Private residence .Private residence Prior permits/approvals for site improvements: Agency Date X No prior permits/approvals for site imDrovements. Has any permit/approval ever been revoked or suspended by a governmental agency? X No Yes If yes, provide explanation: Project Description (use attachments if necessary): PROJECT DESCRIPTION: Construct fixed open walkway 4' x 72', hinged ramp 4' x 16', and floating dock 6' x 20'; install two spiles to secure floating dock. ~ard of Trustees Applicat2 WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Provide dockinK for boat and ~ee~ss to water for ~rivate recreational Durposes. Area of wetlands on lot: appr0x 2000 square feet Percent coverage of lot:_~L~__% Closest distance between nearest existing structure and upland edge of wetlands: 1Q5 feet Closest distance between nearest proposed structure and upland edge of wetlands: -Q- feet Does the project involve excavation or filling? ~ No Yes If yes, how much material will be excavated? How much material will be filled? N/A Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: N/~ Manner in which material will be removed or deposited: M/A cubic yards cubic yards N/^ 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): It is expected that the project will have no significant effect on the wetlands and tidal waters of the Town. PROJECT I.D. NUMBER 617.21 Appendix C stere Environmental Quellly Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I--PROJECT INFORMATION (To be comDleted by Applicant or Project sponsor) 1. APPLICANT/SPONSOR 2. PROJECT NAME James E. Fitzgerald, Jr. Code dock 3. PROJECT LOCATION: Municipality Southold Courtly Suffolk SEQR 4. PRECISE LOCATION (Street address and road Intersections, prominent landmarks, eta., or provide map) 1555 Smith Drive North Southold NY 11971 See attached maps. 5. IS PROPOSED ACTION: [] New [] Expanslort ~-] Modillcatlon/alteratlon 6. DESCRIBE PROJECT BRIEFLY: PROJECT DESCRIPTION: Construct fixed open walkway 4' x 72', hinged ramp 4' x 16', and floating dock 6' x 20'; install two spiles to secure floating dock. 7. AMOUNT OF LAND API'EGTEU: Initially N/A ,a~,, UIIImltely N/A ,cra, 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? [] Yes [] No If NO, de~crlba briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? [] Residential [] InduMrlal [] Commercial [] Agriculture [] Park/Forest/O~e~l aOice [] Other Describe: Medi~-size private waterfront residences. 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOV/OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? ~]Yes []No Ilyaa, llstagency(s) andpermlt/approvMs No approvals to date. Required: NYSDEC, NYSDOS, USACoE,-Southold Trustees 1 I. DOES ANY ASP;(,T OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [] Yea ~ NO If ya~, list agency name and parmll/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? [] Yes C~ No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE James ~/~tz.~,,eald, Jr. Appllcanll,p~e:~Proper,~l" ~r~ ~rvices ~ D,te. 10/2/98 r' OVER 1 CONIC SOUTHOL, \, BA THE AREA OF THE PROPOSED PROJECT IS CIRCLED LITTLE NECK NASSAU POINT HOG NECK BAY Cedar ./soO' ./ CORPS OF ENGINEERS DATA PURPOSE: Conslxuct fixed open walkway, hinged ran~ and floating dock for private recreational pm~eses. DATUM: MI~W IN: Goose Creek AT: Southold COUNTY: Suffolk STAT~: New York Application regarding the property of ~ N. Code, SCTM #1000-76-2-4 Represented by PROPER-T PERMrF SERVICES P.O. Box 617, Cutchogue. NY 11935 James E. Fitzgerald. Jr. 516-734-5800 October 2. 1998 THE SITE OF THE PROPOSED PROJECT IS SHADED CORPS OF ENGINEERS DATA PURPOSE: Constant fiy. M open ~, hinged ran~. ~ and fl~tln5 dock for pm'ate ~xca~ional purposes. DATUM: MLW IN: Goose Creek AT: Southold COUNTY: Suffolk STATE: New York TAX MAP Apl~icaion rer~i~g tl~ prope~y of MmyN. Cod~, SCTM #1000-76-2-4 PROPER-T PERMIT SERVICES P.O. Box 617, Cutchogue, NY 1193~ James E. Fitzgerald, Jr. $16-734-$800 Octc~er 2. 1998 i + \ "'¥~.,gbxe'° \ · 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 TOVfN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of £_ ........ COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I,James E. Fitzgerald, Jrresiding at 385 Havwaters Drive CutchoKue NY 11935 being duly sworn, depose and say: That on thelJth day of Oct , 1998, I personally posted the property known as 1555 Smith Drive North. Southold NY 11971 by placing the Board of Trustees official 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 (~C-~ Dated: 10/21/98 Sworn to before me this ~_~ day of o=ro~r~199~ (~nature) ~ Public JANE R. MINERVP, NOTARY PUsLIC, State of New York No 4853108, Suffolk Coun~ C~mm~mn Expires February TO: ~l~ate: October 12, 1998 Adjacent Property Owners (addresses listed on attached sheet): Madeline Walden Herbert HolTl~an BOARD OF TRUSTEES, TOWN OF SOUTHOLD NOTICE TO ADJACENT PROPERTY OWNER In the matter ot~ Mar~ N. Code. SCTM #1000-76-2-4 YOU ARE HERI:.I~Y GIVEN NOTICE THAT: 1. An application is being submitted to the Board of Trustees for a permit to: Construct fixed open walkway 4' x 72', hinged ramp 4' x 16', and floating dock 6' x 20'; install two spiles to secure floating dock. The project described above is proposed on property adjacent to yours. The street ad- dress of that property is as follows: 1555 Smith Drive New York 11971 [ North, Southold, I The project, which is subject to Environmental Review under Chapters 32, 37, or97 of the Town Code, is open to public comment. A public heating will be held at Town Hall, 53095 Main Road, Southold, New York 11971 at or about 7:00 PM on Wednesday, October 21, 1998. You may contact the Trustees Office at 765-1892 orin writing if you wish to comment. The project described above will be reviewed by the Board of Trustees of the Town of Southold. The project may require independent review and approval by other agencies of the Town, State, or Federal governments. PROPERTY OWNER'S NAME: MAILING ADDRESS: PHONE NO.: Mary N. Code 1555 Smith Drive North Southold, New York 11971 516-765-1185 A copy of a sketch or plan showing the proposed project is enclosed for your convenience. MARY N. CODE: ADJACENT PROPERTY OWNERS 1000-76-2-3 Mary Code 1555 Smith Drive North Southold, New York 11971 1000-76-2-4 Mary N. Code 1555 Smith Drive North Southold, New York 11971 1000-76-2-5 Madeline Walden 1635 Smith Drive North Southold, New York 11971 1000-76-2-34.3 Herbert Hoffinan 1325 Smith Drive North Southold, New York 11971 1555 Smith Drive North Southold, New York 11971 President Board of Town Trustees Town of Southold Town Hall, 53095 Main Road Southold, New York 11971 Dear Sir: Please be advised that I hereby designate and authorize James E. Fitzgerald, Jr. of Proper-T Permit Services to act in my behalf as my agent in the submission and processing ora permit application for the construction of a dock on my property located at 1555 Smith Drive North, Southold, and designated by Suffolk County Tax Map No. 1000-76-2-4, and to furnish, upon request, supplemental information in support of the application. Yours truly, Mary N. Code STATEMENT TO THE SOUTHOLD BOARD OF TOWN TRUSTEES County of §~ff61k ) State of~Ne?rS~qrk..~ ) I, Mary N. Code, being duty sworn, depose and affirm that I am the owner of the property located at 1555 Smith Drive North, Southold, New York 11971, and idemified by Suffolk County Tax Map No. 1000-76-2-4, and that all work will be done in the manner set forth in the present application and as may be approved by the Southold Board of Town Trustees. I agree to hold the Town of Southold and the Town Trustees harmless and flee from any and all damages and claims arising under or by virtue of said permit(s), if granted. I hereby authorize the Town Trustees or their agent(s) or representative(s) to emer upon my property to inspect the premises in conjunction with the review of the presem application. swomto before me this ..~......~.~.. day of...'.~.'...._~/~.& ........ , 19....~... i. ( ....... : ..... l'~otary Pubhc ' vic Ki KELLEY MYCOMI~i~C~413~aO II