HomeMy WebLinkAboutTR-4504ESOUTHOLD TRUS
Issued
Address~
THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION
TOWN TRUSTEES OFFICE,TOWN OF SOUTHOLD
SOUTHOLD, N.Y. 11971
TEL.: 765-1892
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Board Of $outhold Town Trustees
SOUTHOLD, NEW YORK
PERMIT NO. L/~""O.~/
ISSUED TO V~.g.~Q~i...a. ~l~/,~h* 131gglC. : ;~5~. 7~ .............
ulh lzalia
Pursuant fo t~ provi*;ons of Cha 615~F~
the Slate ~ New Yo~, 1893; and ~
State of New York 1952; end ~e To~
rifled "RE~U~TIN~ AND ~E P~CIN~ OF OBSTRUCTIONS
IN AND ON TOWN WA~RS ~D PUBLIC ~DS and
REMOVAL OF SAND, ~VEL OR OTHER MATERIA~ FROM
~NDS UNDER TOWN WA~RS;, and in acco~a~ wffh
Resolution of ~e Boa~ adored ~ a meeting held on .8.J~1./.95 .......
19..9.5...., and ;n cons;deration of the sum of $ 67~.00 .... ~;d by
. .Yict0r. ~..~ Be,ck
o~ .._.5~thold .............................................. N. Y. a.d ~ubie~
Terms a.d Co~ifions Iided o. the ~vene slde
o~ Sou~ho[d Town TruCes authorizes and pertain }he {ollowing:
To construct a 3' X 10' platform, a 3' X lg' rmp ~d a 5' X
~oat as ~r dra~g subleted.
Gorey Creek
all i. acco~a.ce wi~ %he ddai~d ~eci~ca~io.s as preened
IN WITNESS WHERE., ~e ~id ~ard ~ Tr~es
by ~use. ih Corporate S~I to ~ a~ed, a.d ~e. p~se.~
be ~ub~rlbed by a maioH~ o{ ~ said ~ard as o~ ~hls
NOV 12 20~2 : 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
BOARD OF TOWN TRUSTEES
TOWN OF $OUTHOLD
Telephone (631) 765-1892
Fax (631) 765-6641
NOV I 2 2012
APPLICaTiON .... ~: ~ .....
HURRICANE
SANDY
EMERGENCY
Valid thru June 1, 2013
Property Owner Name: ~//
Permanent Mailing Address:
Phone Numbers): ~ /
Pmpe~yAddress: ~ ~ ] ~
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?
How much fill will be required?
Project Description:
BO~ of Trustees Application
County of Suffolk
State of New York
~/[C_-~-~/~ ]3/z- ~--~ 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 AND ALL DAMAGES AND CLAIMS ARISING
UNDER OR BY VIR~rUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS
APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, TI~IEIR AGENT(S) OR
REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE
PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION.
~ignature of lbroperty Owner
SWORN TO BEFORE ME THIS
DAY OF 20__
Notary Public