HomeMy WebLinkAboutTR-4731ESOUTHO LD TRUSTEES
IsSued To~ Date~
Address
THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION
TOWN TRUSTEES OFFICE,TOWN OF SOUTHOLD
SOUTHOLD, N.Y. 11971
TEL.: 765-1892
Board Of $outholdTrustees
SOUTHOLD, NEW YORK
PERMIT NO. 473! ......
ISSUED TO ..... ~gqr~. An:~i~a~ ....................
Pursuant to the p~vlslons of Chapter 615 of the Laws of
the State of New York, 1893; and Chapter 40~ of fha L.aws of the
State of New York 1952; and the Southold Town Ordinance eh-
tholed "REGULATING AND THE PLACINC~ 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 with the
Resolution of The Board adopted afa meeting held on .._Ap~
19 97 , and in consideration of the sum of $. 150.00 paid by
.... L. Spa,~g~!. or~...~.~hal~ ~ G,. A~o!an
of N.Y. and subiect to the
Terms and Conditions listed on the reverse side hereof,
of Southold Town Trustees authorizes and permits the following:
to replace approx. 4' X 160' catwalk acroes wetlands.
all in accordance with the detailed specifications as presented in
the orlglnatin9 application.
IN WITNESS WHEREOF, The said Board of Trustees here-
by causes ;ts Corporate Seal to be affixed, and these presents to
be subscribed by a major;fy of the said Board as of this data.
....
ROD_j~ICK 'dAN TU.Y~,J~.C. ~
L,CE.SED L^.O
SERVICES FOE APPROVAL OFI
CONSTRUCTION ONLY
DATE
SEAL
James F. Eing, President
Bob Ghosio, Jr., Vice-President
Dave Bergen
John Bredemeyer
Michael J. Domino
Town Hall Annex
54375Main Road
P.O. Box 1179
Southold, New York 11971-0959
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Telephone (631) 765-1892
__Pax (631) 765-6641
,lAN I 8
TROPICAL STORM SANDY EMERGENCY APPLICATION
Valid thru June 1,2013
Permanent Mailing Address:,/~,'~_~
Phone Number(s):
Suffolk County Tax Map Number:
Agent (if applicable)
Address:
Phone Number(s):
Board of Trustee Permit Number(s):
Will any part of this project require a Building Permit?
How much fill will be required?
County of Suffolk
State of New York
-- ~ BEING DULY SWORN
DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE
DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE
TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK
WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY
BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT
AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES
HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING
UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS
APPLICATION, 1 HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR
REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE
PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION.
~' Si~Vamre of 1~' Owner
SWORN TO BEFORE ME THIS
"-~otary Public
I Niklt~ P Jadhllv I
Notary Pttblk:. State of New York