HomeMy WebLinkAboutTR-6016ESOUTHOLD TRUSTEES
THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION
TOWN TRUSTEES OFFICE.TOWN OF SOUTHOLD
SOUTHOLD. N,Y. 11971 '
TEL.: 765-1892
Board Of Southold 'Town Trustees
SOUTHOLD, NEW YORK
PERMIT NO.----~.~.!..~ .......... DATE: ~:,. 2.~,...£~0#
~SSUEO TO __~L~_.~..~L~**°~. ................................................................. '
Pursuant 1o ¢~no 615 of f~e LIws of
provisions o( Chopter 6l$ of
ih. Sta~o of Ne~ Yo,~ ~,.~31
' State o~ New Yo~ 1952,
IH AND OH TOWN WA~S AND PUBU¢ LANDS
REtWOVAL OF SAND, GRAYG.OR OTHI~
LANDS.UNDER TOWN'WATEP, S:~ aad in ~
Resot~io, of The Board adopfed at a meding hekl ,oe ~_~....~,.~ .......
~o~ ~on
5UI~VEY OF F'JROP'EI~Ty
LOT 95 A~ E~gPIN ON
"AHIENDED MAp A OF NAS~AL/ POINT"
FILED .N.JC-U'~T 16. Iq22 A~ FILE #
51TUATE: NAURU POINT
TOi,'a,i~
50FFOL~ C(X~ITT', N'~
Z
L~
James F. I~ng, 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
HURRICANE SANDY EMERGENCY APPLICATION
Valid thru June 1, 2013
Property Owner Name: ]~,~L/~
Permanent Mailing Address: /,'~n
Phone Number(s): d~/'g~) 2.
Phone Number(s): (~31 ~¢ ir'Lb
Board of Trustee Permit Number(s):
Suffolk County Tax Map Number: 1000
Agent (if applicable) ~
Will any part of this project require a Building Permit?
How much fill will be required?
Project Description: ..~-..~t
Boa~of Trustees Application
County of Suffolk
State of New York
~'~~e~.t i. (~,c/~,n~,~x '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 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 Al,ID 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.
Signature of Property Owner
SWORN TO BEFORE ME THIS
DAY OF/~3v?.r~L,~'.r'" ,20.
Notary Public
Board of Trustees Application
AUTHORIZATION
(where the applicant is not the owner)
(print owner of property)
residing at
(mailing address) ~ ,,
do hereby authorize /~/~a~- c ,c l'~~~u~,d a-
(Agent)
to apply for permit(s) from the
Southold Board of Town Trustees on my behalf.
~Owne~s~ture)
I suRVEy OF PROPERTY
_OT 5.5 AS SHOIAIN ON
"AHEN~FD MAP A OF NASSAU POINT"
FILED AU®UST IS, Iq22 AS FILE ~ 156
SITUATE: NASSAU POINT
TOI, qN: coOUTHOLD
SUFFOLK COUNTY', NY'
SUFFOLK COUNTY TAX ~
IOOO-III-q-ID
~RVFYFO Oq-lq-02,
topo. odd~d 11-16-02,
~ro~. ~. 124q-02,
r~v. 01-0~-0~, 02-24-0~,
Foun~a~ion Oq-06-O~
FINAL ~R~ 11-16-2004
Lot #
Lot # ~
NOTES:
· MONUMENT
0 PIPF
AREA = 4~,460 SF OR O.qq6 ACRE5
GRAPHIC SCALE I"= 90'
N
Lot # 54-
141So36"ZO"E
Lot # 65
2T
LoS # ~6
21'
2 St. oc uJ
Hou~
~6GO~
FrO, me
344.~0' ' ,,
JOHN C. EHLERS LAND SURVEYOR
6 EAST MAIN STREET N.Y.S. LIC. NO. 50202
RIVERHEAD, N.Y. 11901
369-8288 Fax 369-8287 REF.-\kHp server~d~PROS\01-118FD.pro
OeI:aldine N. l~u~on