HomeMy WebLinkAboutTR-7968ESOUTHOLD TRUSTEES
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THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION
TOWN TRUSTEES OFFICE,TOWN OF SOUTHOLD
SOUTHOLD, N.Y. 11971
TEL.: 765-1892
SURVEy OF
A 1, DOWNS
LAL RFiL
Nathan Taft Corwin III
Land Surveyor
James F. King, President
Bob Ghosio, Jr., V/ce-President
Dave Bergen
John Bredemeyer
Michael J: Domino
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall Annex
54375 Main Road
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765.6641
HURRICANE SANDY EMERGENCY APPLICATION
Valid thru June 1, 2013 ..-~/Ee'~' /~.~,
Property Owner Name:
Permanent Mailing Address:
Phone Number(s): ~, -~/--
Property Address: ,~.~
Suffolk County Tax Map Number: 1000
Agent (if applicable) ~///~
Address;
Phone Number(s):
Board of Trustee Permit Number(s):.
Will any part of this project require a Building Permit?
/VD
How much fill will be required?
Project Description: ~°~'~g,~,%v ~.
Bogd o£ Trustees Applioatlon
County of Suffolk
State of New York
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AG~ES TO HOLD ~E TO~ OF SO~O~ AND ~E TO~ ~US~ES
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~PLICAT[ON, I ~REBY A~OR~E ~E TRUSSES, ~E~ AGE~(S) OR
~P~SE~ATWES(S), TO ENTER ONTO ~ PKOPER~ TO ~SPECT ~E
PRESSES ~ CONJ~ION ~H REVIEW OF THIS APPLICA~ON.
~ Silage ofProp~y O~
SWO~TOBEFO~ME~IS ~ DAYOF~ ,20 ]~
Notary Public