HomeMy WebLinkAbout2004 EI,17~J~:TH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, Ne~v York 11971
Fax (516) 765-1823
Telephone (516) 765-1800
OFFICE OF. THE TOWN CLERK
TOWN OF SOUTHOLD
RECEIVED
APPLICATION
for
PERMIT TO DISPLAY FIREWORKS ,
JUL 13 2004
$outhold Town ClerJ
APPLICATION IS HEREBY MADE, pqrsuant to the provisions of Section a,05.00 of
the Penal Law o.f the State of New York, for a permit to display fireworks as
hereinafter specified :, ' ~/~//.~/~,~,/ ~/ :/~/~( d/--'/"/,/~ '
DISPLAY IS TO BE SPO~O~E~ BY ~(
The following persons are to be in charge of the actual shooting of the fireworks:
· Experience
, '~ j ~ /.~,.) ... ~
s~,dica I Condition
Number and type of fireworks, is as follows:
The fireworks will be stored in a covered truck prior to shooting on the grounds.
Attached hereto and made a part of hereof is a diagram of the grounds on which
the display is to be held, Also attached is a certificate or policy of insurance
coverage.
06/14/2004 12:57 FAX 856 697 9557 VINELAND FIREWORKS CO. ~002
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00/14/2004 12:57 FAX 856 697 9557 VINELAND FIREWORKS CO, ~004
~E POUC~ OF IH~UG~ANCE Li~
~CIE~ A~ UMI~ ~
x ' MY~O
~splny du~e; 3qly 3, 2004
· :~-K ! iI-IC~TE HOLDER CANCELLATION
Phenix H & L Co, & Rel(ef #e~ No, 2
LCORD 2S