HomeMy WebLinkAboutTR-1605ESOUTHOLD TRUS
No. ~
Issued To~,Q~ Date_~~LT:
Address $
THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION
TOWN TRUSTEES-OFFICE,TOWN OF SOUTHOLD
SOUTHOLD, N.Y. 11971
TEL.: 765-1892
ALL f. RI:: D STAi~ES ~.~UST DisPLAY [.%OGRi;;G
ALL DCC:~ A~D BU~.~{EADS MUST DiSPlAY VISIBLE PEPJ-~IT ~.~ERS
Board Of $outhold Town Trustees
SOU~HOL., NEW YORK
~he S~afe o{ New Yo?~, lB?3; an~ Chapter 404 o{ fha Laws o{
5fa~e o{ ~ew Yor~ ~52; on~ ~e Sou~o~ Town Ordinance
flfieH "RE~ULATIN~ AND THE PLACIN~ OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS an8
RE~OVAL OF SAND, ~RAVEL OR OTHER ~ATERJALS,
LANDS UNDER TOWN WATERS;" an~ ;n accordance w~h
Resoluf[mn o~ The Boar~aoopTeo' ' ' afa meef~n~ 'he]c' on ....... ~Y....~.L
Terms emi ConJ~ions Jisfe~ on +he reverse si~e ~ereo~,
o{ SoufholJ Town Trusfees auf~orkes an~ perm~fs fha
Construction of dock consisting of a 24'X4'
'catwa.lk, 12'X4' hin~ed rmp and 16' X6' float
by 2 piles, with the provision that the dock
lg~st 15', from.,edge Of ~ighb~i~ property. ,
f~e or~gina~ing app!lcafion.
IN WITNESS W~ .... Or, The said Boar~ o~ T~usfees here-
6y causes ~s Corporafe SeaJ +o ~e a,T~xe~, an~ 9ha~e pres~nfs {o
6e subscr~6e~ 6y a ma[or~fy O~ ~e sai~ Boar~ o~ fh~S, ~af.e. '
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l~COt,,ll~
~,c~--. r--c_.x_~ Cocuw-Cg,,.
.~ec~l~ : 40 '- !"
~ = ,ton pip~
James F. King, President
Bob Ghosio, Jr., Vice-President
Dave Bergen
Town Hall Annex
54375Main Road
P.O. Box 1179
Southold, New York 11971-0959
BOARD OFTOWNTRUSTEES
TOWN OFSOUTHOLD
Telephone (631) 765-i892
Fax (631) 765-6641
HURRICANE SANDY EMERGENCY APPLIC~A~ION
Valid thru June 1,2013
Property Owner Name:
Permanent Mailing Address:
Phone Number(s):
Property Address: ~ ~ -'!. ~-
g6 O'L o~
Suffolk County Tax Map Number: 1000 -
Agent (if applicable)
Address:
Phone Number(s): -TLcD'-7_qz¥
Board of Trustee Permit Number(s): \ (,o 0 _~'
Will any part of this project require a Building Permit?
How much fill will be required? 2
Project Description: ~ ~U'I%D
Boarlf Trustees Application
County of Suffolk
State of New York
~-~'~' ~'~'~lg ~0 03 P(LC_B k)~ BEING 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 1N 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 IN CONJUNCTION WITH REVIEW OF THIS APPLICATION.
roperty Owner
SWORN TO BEFORE ME THIS
DAY 01~ O~e/~ ,201"~
No~/ary Public
JENN!FER R. HAIN
Notary Public, State Of New York
No. 01 HA6083613
Qualified in Suffolk County I~.~
Commission Expires November 18, 20