HomeMy WebLinkAboutTR-3815ESOUTHOLD T.RUSTEES
NO.
THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION
TOWN TRUSTEES OFFICE,TOWN OF SOUTHOLD
SOUTHOLD, N.Y. 11971
TEL.: 765-1892
Board Of $outhold Town Trustees
SOUTHOLD, NEW YORK
PERMIT
NO.
3815.
ISSUED TO ..._~d'~a~d. ',~.,~g~..~ .......................... · .........................................
Authorizaliott DEC - 5 2012
Pursuant to the provisions of Cha r 6t5 o~ tJ~e
the State of New York, 1 B93;
State of New York 1952; end h~e en-
titled ~'REGULATING AND THE PLACINC~ OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS and the
REMOVAL OF SAND, GRAVEE' OR OTHER MATERIALS FROM
LANDS UNDER TOWN WATERS;" end in accordance with the
Resolution of The Board adopted et a meeting held on .$.~p~,...2EL
19._89 and in consideration of the sum of $ ..... paid by.
of ....................................... N. Y. and subject to the
Terms end Conditions listed on the reverse side hereof,
of Southold Town Trustees authorizes and permits the 'following:
To construct 4' X 20' fixed dock, 4~ X 16~ ramp, two 6r
X 16~ floats, install 9 pilings on property located on
R.O.W. off Narth Bayview Road, $outhold.
all in accordance with the detailed specifications as presented in
the originating application.
IN WITNESS WHEREOF, The se;d Board of Trustees here-
by causes its Corporate Seal to be affixed, and these presents to
be subscribed by a majority of the said Board as of this date.
-~. S.
Dec. ~,,
TROPICAL STORM 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:
-t2..-'"3q.3
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:
County of Suffolk
State of New York
DEPOSES AND AFFIRMS TI~,~T 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, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR
REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE
PREMISES 1N CONJUNCTION WITH REVIEW OF THIS APPLICATION.
Signature o~Pr~
SWORN TO BEFORE ME THIS ~ DAY OF~X,a:~,o~ ,20I'h''-
Notary Public
CONNIE D. BUNCH
Notary Public, State of New York
No. 01BU6185050
Qualified Jn Suffolk Count
~,omm~sslon Lnxplres Apr~ 14, 2~) ~