HomeMy WebLinkAboutTR-7966ESOUTHOLD TRUSTEES
NO.
Issued To~ Date_L~~
Address zSoa ~ . '
THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION
TOWN TRUSTEES OFFICE,TOWN OF SOUTHOLD
SOUTHOLD, N.Y. 11971
TEL.: 765-1892
i
TROPICAL STORM SANDY EMERGENCY APPLICATION
Valid thru June 1, 2013
Suffolk County Tax Map Number: 1000
Agent (if applicable) ~\c~ C[
Phone Number(s): (~ St -"~3L{ -"~
Board of Trustee Permit Number(s):
Will any part of this project require a Building Permit?
HOW much fill will be required7 ~¢:)0 CU. L.~C[S
ProjectDescdption: ~v~uve-J~_ J~ %1'~.-~,.~ ~¢~'q.
JAN-3-2013
15:07 FROM:NSPL
TO:18669176G54
P. lXl
Coumy of Suffolk
S~te of New York
D£SCRmF-D PF. RlmT(S) AND'
WILL BE DONE 1
BE APPROVED BY TtIE
AGREES TC
~ER OR BY ~ OF
APP~ON,
PREMISES I~ CONJUNCTION'
BEING DULY SWORN
; TIIE APPLICANT FOR THE ABOVE
~, ~-D BEL~. AND T~AT ALL WOR~
' ~OR~ IN ]~qlS AP~L~CAT~0N AND AS MAY
) TOWN BOARD OF TRUSTEES, TH~ APPLICANT
) AND THE TOWN TRUSTEES
' AND ALL DAMAGES AND CLAIMS ARI$INO
IF ORAN'tED. IN COMPLETINO THIS
; TRUSTEES, ~ AOENT(S) OR
ONTO MY PROPERTY TO flqSPECT THE
OF TI-~S APPLICATION.
SWORN TO BEFORE
Notary Public
DAY
/
JAN-3-201~
15:0~ F~M:NS~L
TO:186691T6G54
P.I/1
TI:IORIZATION
(mailing address)
do h~'eby aufl~riz~ David Cichanowicz, Pm-<,
Creative