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HomeMy WebLinkAboutRay, Sam TOWN OF SOUTHOLD TOWN CLERK'S OFFICE SOUTHOLD, N. Y. SINGLE TRAILER OR HOUSECAR LOCATION PERMIT No .................... Dote ............. ~T~e...8.t....~..¢)6~ ................... Nome .. ¥~'..... ~1~..]~1~, ............................................................................................................... Street ...... .1~/.0.....~.~or.~s...D~cka e ..... ~la~le ~.. D~i.w.e ................................................... Town ....... ~l~g.t. lt~ck,.. 1~...Z .................................................................................................... Your application for a (single trailer),]J~JJJ~,,,~ permit was reviewed by the Town Board on ...................................... ~l't~e......~.t;l~ ......... , 19.~b~.., and ]Jgl~J~ (was not) approved. Denied A permit is hereby~jJjl:gl~l to locate a (single trailer) (hJJ[~]J~ license number ............................ or serial number~.]L.bc. OX..2~J~...3~c~9. .......... at......ll~/.~.....Jl~i::.~.Q~'~..~L¥~., ............................. ............... ...~....~.~.t..~.e..k..,.......,.....~.,. ................................................................................................... pursuant to application dated ........ ~1'~'1~...]..l...19.6~. ..................................... and the following conditions: . P.ermi.t...~er~Led..~d...$...~..QO.. ~as~l.. ~e~..r.e ~ne~..h~e.~l.th~ ........ TOWN BOARD, TOWN OF SOUTHOLD To~FTClerk TOWN OF SOUTHOLD TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..................................... 19 ........ Approved .................................... , 19 ........ Permit No ................. Disa~oroved a/c ............................................................................ Application No ................................... Supervisor APPLICATION FOR LOCATION OF SINGLE; AUTOMOBILE TRAILER OR HOUSE CAR, OUTSIDE OF TOURIST CAMP. Date ..... ~.....~ ................ ,19..~...~. Instructions a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Town Clerk. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or pub ic streets or areas, and giving a. detailed description of layout of property and proposed location of trailer must be drawn on the diagram which is part of this application. c. Upon approval of this application, the Town Board will issue a trailer permit to the applicant. Such permit shall be kept on the premises available for inspection: d. No trailer shall be occupied or used in whole or in part for any purpose whatever other than specified in permit. Application is hereby made to the Town Board for the issuance of a Trailer Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County New York, and other applicable Laws Ordinances or_Regulations. The applicant agrees to comply with all applicab e aws, ordinances and regulations. (Signature of applicant) ~' (Address) - r State whether applicant is owner,~..___ , / __ ,., ~ ~__..~.,., ,~lessee or age~nt.,~...~.~r...~'~rd~.-~......~~~ ~ · ........................ Nome of Owner of premises .[~...~./......-.--~..-~.~.v6~'.~.... "~"7"-~' If applicant is corporate, signature of duly authorized officer. ~/ (Nome and title of corporate officer) 1. Location of land on wh,~praposed trailer will be located i~' ''~ ~; .............................. Street and number ......~...~ ...... ~ ........................ .................................................... 2. State existing use and occupancy '~f'premises and intended use and occupancy of proposed trailer: a. Existing use and occupancy .............................................................................................................. b. Intended use and occupancy .~ ..................................................................................... c. Period of time trailer is to be located on premises ..................................... Fee ..~.~..'...~ ................... (To be paid on filing application) Dimensions of trailer, length......~..~ .~... ................ width ......... ../...~. ................. height ...... ...~......'~'...~ ............. Registration Number ............................................ Serial Number ..~......./....~-..~./....~........~...~/..~..~........':~...~'.~-/~' ,5. Size of lot: Front .......... .~.~..~...'. ...................... Rear ..... ./.~..~. ................ Depth ...... ,~_......~....., .......... 6. Date of purchase or lease of land ..... Z./.....~....~..../~......-~.. ........................................................................ 7. Zone or use district in which premises are situated ,.~~ .............................................. 8. Does proposed use violate any zoning law, ordinance or regulation?......~... ............................................ 9. a. Method of Sewerage disposal ...~-.:~....J~... ............................................................................. b. Source of Water Supp y ~.-,...~... ~ ." c. Source. of Electricity .... ~.~...~'""7~' .~..~.......3,~/~,~......~_.:~ .............................. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimen- sions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. Indicate clearly location of proposed trailer pn prem- ises, sh~wing' disi:ances from all buildings and property lines. ~' ~ STATE OF NEW YORK ~ COIJN'rY OF SUFFOLK~ss' .......................... ; ...................... 1 ...................................................... being he is the applicant named above. He is the .~....46~......~...~ ~.~ ~-J/~"c'c~ - (owner or lessee or agent) of said owner or owners, and is duly authorized to make and file this app' c0tJ0n; and that all statements con~ained in this application are true to the best of his knowledge and be el; and that the trailer will be located i~ ~he manner set forfh in the application filed herewith. ' duly swam, depOSes and says that Sworn to before .................................... da,/of ..... .............................