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HomeMy WebLinkAboutTR-7932ESOUTHOLD TRUSTEES No. ~~AfA~ Issued To- cit- .cJ cl Date_~~ Address ~. ' THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION TOWN TRUSTEES OFFICE,TOWN OF SOUTHOLD SOUTHOLD, N.Y. 11971 TEL,: 765-1892 James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (63~.) 76~6~41 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD NOV - 2 HURRICANE SANDY EMERGENCY APPLICATION Valid thru June 1, 2013 Property Owner Name: Permanent Mailing Address: Phone Number(s): Property Address: Suffolk County Tax Map Number: 1000 - Agent (if applicable) -~_.~,~ ~ Address: "~C) '~20"/ ~'~ ~ C~~ 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? Project Description: Bo~ of Trustees Application AUTHORIZATION (where the applicant is not the owner) (print owner of property) residing at 1,o % © ~94MT_.-Y_~.._I~ ~U,~,~_'~. I~'~-_) (mailing address) do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (Owner's signature) 23'-9" - WALL P-.EF'LAd. F__MEN-F 20'-3" ',, /, '., '/ '/M INd:;:~ PAMA~.~E~.-/ / /////// ////////.'///. ×××××× ×××××××× ××××× ///× ××××/××× ××/,5 ×, /////////////// /. ××××××/×/××× ,'/××/×××/ ////////~/ 20'-6" 8' , 10'-6" WALL P-,.P__PLAd-'I=MENT t=L.P-.VATION 10' 8'-11" ////////// //////// //////////// /////////////// /////////////// //////////////// 7., //× × ×///I/////,, ~ '~ ,- r/////MINOR. PAN4ACcP__/,,,' '~ / //// ~0~ ~,:::~.f=-F'. //// ,', //////////////~ // 20' P'XI~-I-IN~ LAYOUT- I 21' NOV I NO-FI=: All W'¢;:~'<, Will ~ PONF IN I<,INP ANP IN F'LA~E, N~I-MIN~ d-MANC-C-C-C-C-C-C~_~ Pt~ OP-.I~INAI_ LAYd:~I'-. MAY RP-~UIRE MINd.- All NEW W¢~;P d o~ ~ '>