HomeMy WebLinkAboutApplication for Access - Town Owned Property Highway Department PETER W. HARRIS ~.~ ~ JAMES McMAHON Public Works Department
APPLICATION APPLICATION FOR ACCESS THROUGH AND OVER TOWN OWNED PROPERTY IS SUBJECT TO THE
FOR PERMIT: APPROVAL AND BONDING REQUIREMENTS OF BOTH TOWN HIGHWAY & DEPT. OF PUBLIC WORKS.
1. Name of Applicant (Use Full Name) Telephone Number (daytime)
3. Applicant is a/an: (check as many as apply)
["-q Owner [~ Operator [~ lessee [~] Municipality/Governmental Agency
Owner or Agent / Contact Person E~ Owner ~-1 Agent / Contact Person Telephone Number (daytime)
5. Project/Property Location/Road End/Hamlel: Suffolk County Tax Map #:
E) Is this Policy or Certification on file with the Town of Southold? [] Yes [] No
Permit Authorization by the Highway Department
Required
Bond Amount: To Be Determined by the Highway Department
Peter W. Harris
Release of Bond
Date:
Approval By the Town Highway Department
Permit Authorization by the Department of Public Works
Required
Bond Amount: To Be Determined bythe Department of PublicWorks
James McMahon
Release of Bond
Date:
Approval By ~he Department of Public Works