The URL can be used to link to this page

Home My WebLink AboutTR-7947ESOUTHOLD TRUS NOe -- Issued To~]~iLt~u-~~-- Date~ Address .~.~ .~ . . c $CT~ ~ I'II--~'-Z. 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..I,.[~:.'~.':.},.~,L DATE: ...L.-. ISSUED TO .......... ~z~'c:~.~:~. .......... ..~t4~.....: ........... i ....,.;....;...,: ........................... , fllatizatiau pursmmt to the provisJom of Chapter 6IS of the Laws of the State of New YorE, 1893: and C~pter 404 of the ~ws of the Sfute of New York 19827 and the So~halcl Town Ch~lmance tiffed "REGULATING AND THE PLAClN~ OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBL~ LANDS and RrddOVAL OF SAND. GRAYEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;', and in accordance with the Resolution of The Board adopted at a meeting held on 19 ............ and in consideration of the sum of $..~p~ paid by all in accordance vdth the deta~eci spacJflcefions as presented in the o~c~i~ appli~on. IN' WITNESS WHEREOF, The said Board of Trustees here- by causes ifs Corporate Seal fo be afrecnd, and these. ~ fo be subs,~n'bed by a majorify of the said Board as of this clara. John M. Bred~rneyer, 11I. President l-lemy P. Smith, Vice President Albe~ I. Kmpski, Jr. John L. ~, Jr. John B. Tmhill ~ Telephone (516) 765-1892 BOARD. OF TOWN TRUST TOWN OF SOUTHOLD SCOTT L. HARRIS Supe~,is~ fOWN OF SOUTHOLD, 53095 Main Road · Box 1179 116) 765-1823 ($16) 765-1800 Mailing address: ~ ~)'"~5 C~J~NDFA'r- ~ APPLICATION , Tel. No: Tax Ma~ ~mr: lO00- ~ Approx.lr.of construct: U~O~ Diagram of existing stl~-ctures, lncl~dihg all dimensions, must be included with this application: Indicate on attache~ map: Location, ie; reference point, telephone pole number, adjacent proport¥ owne etc. Signature of applicant)ate: ~(~. ~l Please note, t~ere im & one time fee of $50.00 for f~ling this application. FSOUTHOIr Environment East, Inc. IL lC No. 3 - 3075 ~ndian Neck Lane l~-,mfic, New York 11958 516-? 34-7474 C)L~L. L... New York State Department of Environmental Conservation Building 40--SUNY, Stony Brook, New York 11790-;~356 Thomas C. Jodlng Comml~loner Applicant Name: Application Number: Project Location: (please print) = I hereby state, as or on behalf of the applicant, that I understand and agree that the issuance of any permit pursuant,to the above- referenced application does-not in any way mitigate and/or resolve any outstanding violations of the New York State Environmental Conservation Law ("ECL") and the rules and re~llat$ons enacted pursuant thereto at the site of the proposed projec~ Furthermore, I HEREBY SWEAR THAT I ( . DO)i( v DO NOT) HAVE ANY CURRENT OR ON-C~ING (UNRESOLVED) NEW YORK STATE DEC VIOLATIONS AT THIS PROJECT ~ '~lifpl~cani Oi Agent SCDHS Ref. Cf R10-95-0157' ~ ~ ~ ~,~ .'.:- _/ ¢~"~ X% X~, ~t:''. k¢- ,/ , ~ ~' J , A~ SSA U POINT S~T~LD I to tie lines - "~RE:~~ 'TO-~S. V. ~t.m ~~;1 ~'' ~' ' 1' ~ - . ~¢, r'= ~¢' [ ~~~~. . :~. ~U. ~ r..conou ~ . -1797 J ~ ~ BY ~Y ~:'~ ~Y~ ~ C~._ shown hereon ore fr~ field observali~ .~'~ /~ ~2 ~c.. ~ounaa~;. : ~ ~R~'~P. ~ ~ AS ~?.~ ~ /eined~ ~om ot~u. :,,Vp.:v. ~ ~ ~ nn~i ~ 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 (631) 765-6641 TO~ OF SOUTHOLD ~ ~,~ ~ ~. L, NOV 29 2012 EM ERGENCY APPLICATION HURRICANE SANDY r ~ "~ :',- Valid thru June ~, 20~3 ~ ~ .... .~, Property Owner Name: 'W---~I~/L/? Permanent Mailing Address: /~ ~c~$~C~ Phone Number(s): (~/G~ Properly Address: ~Z~ Suffolk County Tax Map Number: 1000 Agent (if applicable) ~; 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? ~ ~)¢D C ~.'/~,'(_. Project Description: Of Trustees Application County of ~ Sta~e ~,;.;p ~. ~,~_o,J BEINO 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 Signature SWORN TO BEFORE ME THIS {~-k~ DAY OF Bo~ of Trustees Application AUTHORIZATION (where the applicant is not the owner) (print owner of property) residing at '~'~ /4~q,~.qthJ ~,~7- ~o~qt_~ , (mailing address) G~'7'c4c/CYC/Oe', ~/IqXff do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (Owner's signature)