HomeMy WebLinkAbout1760 Crown Land LnDate: 09/11/06
Town Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Receipt~: 381
Transaction(s):
1 I
Permits
Reference Subtotal
462 $150.00
Check~: 381
Total Paid: $150.00
Name:
Verizon, Communications
501 N. Ocean Ave
Patchogue, NY 11772
Clerk ID: LINDAC Internal ID: 462
03/24/2006 FRI 16:27
TOWN OF SOUTHOLD
HIGHWAY DEPARTMEI~ .T ·
peconio Lane
pocord¢: I~e~ York 1.1958
' ,&ND REPAIR
~Ai~pLtCAltION/P£,RMIT, ,FOR HIGHWAY. E~GAVAT. ION
e~n~d~t of High~y~ ~ ~e Town
~da ~.~e Sup . of ~e
p~I~T~DN IS HEEE~ ........ ~ ~; uu~nt to ch~r~,
~_~_ ,~ t~ TOW~ of S~t~ld, Suf~k ---: ~f .... ~---~b~. The ~B~t
~Hz~ Insp~ ~ ~ke] ~ry msp~mns T
Print or
" ~ddre~
. ~mc ~ AP~{~nt
'
El~r}~=~'~ Uc~ No._ . . Other T~d~s L;~n~ Ho.~
5)'
:7)
'.. _~ . ~..L~4 ex.c~vat~n ~nd rel~tioh~hlp' ~
a) ~nln~ P~ ~ publlc'S~ or a~, --- ~ -
~ of ~ of ~vatlon. . ;. ~. ,
A~ all ot~r ~es;W per~ and I{~s~ for ~{s'p~J~t.
b) * ~ ~- ~ a-~i~ m~ ~t ~mm~ ~fo~ ~ of a : ,*: .
Highway ~va~on Pe~n W me ... ,
Start;ng Date: CompleUoh ~ ,-
Estimated Cost of P~po~ Wor~: ~ .... -
,11)
F~gg~. I ot' 3
~/03 '0~ ~1) ~L3:58 FA][ ~31 ?68 6141
'iq)
Inauratlee Covoracj.: (Attach c.~:~)
a} Ineurance Company:
b) Pdlc~ ~ . '
c) S~ie whe~er ~11¢y ~ ce~ifl~tloh off fild wl~ ~e Highway
d) ~ge r~uired ~t~d~ W ~e Town:
B~lly ~nJU~ and p~p~Y ~ge: $3Q~QOO/$SQO,OOO B~il~
and $sg, og~ p~ damage. .
a} 5ure~ 80~ . .~r G=~fi~ Ch~k .
to~l amc,unt ~ $
b) ~lnt~e~e ~nd provide: '~ y~ or ~ ymrl,
for app~J~tlo~s and permi~: ~ ....... ~150.00
~IOG I.f, =Sta. OO'
Additi~
F. Nc'ti'`& to publlc'utltP.'e~ proof must be pr~Yided and attached to
t~l; 'eppilc"St;oh prior to is.~uence of Permit,'
Authorl;dtlo~ Is here. by granted to tho
Is-;-uc a Highway Exc=vatiGr~ permit 'to:
In'accordance with thls'applicat[ol~.
Town Cle'k of the ToWn of S~ut}~d to
SUPERINTENDENT OF HIGRWAYS
~e~r/W. Berrie
ReceNe~ by the Town Cterk
Date
Note: P~it ~piras one (1) y~r from D~e
- ' No work to ~ wight M ~uff notice to the 5uperln~d~t ~ Highways-
pe~'mus~ ~ available for Ingp~Uoh.
Page 2 of 3
Notification of Request For
Emergency Permit
Elizabeth Brady
Cell Phone:
ead ~'~ County Road
rvice n'-~Temp Service
Spedfy: ~oad
~Emergoncy
n---~Village Road
I_nfom~atlo~ /
~. Neareat cf~ street
2. Distance to nearest crom~ street /.'~"~
3. Approx. size of excavation
4. Excavating on: (check elto)
5. Called for Tone & Mar~
6. ~.~ ,ocat~o. o,,p.ce .it ( F,ont of ho,,a.
NOTE'"' ,=~' work being performed in the ~own of Srookhav~.n.
please indJcate customers 9roper~ line.
d
SPECIAL CONDITIONS:
** TOTAL PAGE.02 **
SOL~fEOLD TO~ CLERK
Co~y D~ctrlbutlo~:
Hlghway Department
Applicant
T~Wn Clerk
~'d
i H Sp E, CT O R,.S R E C OR D
Ins~>ectJon Date
Findings (use code)
Applicant Noti~od
RE~L&RKS
CODE
ia '- Improper barri~d~
IL .Improper IleJ~U
ST - Sunken trenr~, m' excaYctio?_ '-Il'ri' ·
UTM Unable te measure (due to ~ac~ ~ g~
BUC - Bulld;n~ under Constr~ct/oh
WIP - Work n'progree;
DB ~ .Improper backfl! ' (boo h gh) (not sufflcJe~t)
HFS -' IMspea~or ho~difl~ far t~n~l saltier of ~vat~n
RFR - R~ to repair
Page 3 of 3
P~GE. C6