HomeMy WebLinkAboutTR-8073ESOUTHOLD TRUS'
Issued To ..~:~~~-~ Date~
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THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION
TOWN TRUSTEES OFFiCE,TOWN OF SOUTHOLD
SOUTHOLD, N.Y. 11971
TEL.: 765-1892
.51TUATE* Or'lENT
l"Oi~h
N
JOtlN C. EHLER,
LAND SURVEYOR
N Y.S LIC. NO ~Z02
N
James F. King, President
Bob Ohosio, Jr., Vice-President
Dave Bergen
John Bredem~yer
Michael J. Domino
Town Hall Annex
54375 M~;, Road
P.O. Box 1179
S~oid, New York 11971-0959
Telephone (631) 765-189~
HURRICANE SANDY EMERGENCY APPLICATION
Valid thru June 1, 2013
Property Owner Name:
Permanent Mailing Address:
Phone Number(s): ?/'7
Property Address:
Suffolk CountyTax Map Number: 1000 - /~ - ~ ,' ~o. I
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:
o£ T~usbees ~pplicatio~
County of ~F~)LI~
Sta~e of New York
DEPOSES ~D ~I~S ~AT ~SHE ~ ~E ~PLIC~ FOR THE ~O~
DESCRIED PE~(S) A~ ~AT ALL STA~M~ COCA'ED HE~ ~
~ TO THE BEST OF HISSER ~OWLEDGE ~ BELIEF, ~ ~T ~L WO~
W~L BE ~NE ~ THE ~ER S~ FORTH ~,~IS APPL[CA~ON ~ ~ ~Y
BE APPRO~D BY ~E SO--OLD TO~ BO~ OF ~US~. ~E ~PLICA~
AG~ES TO HOLD ~ TO~ OF SO--OLD ~D ~E TO~ ~US~ES
H~SS A~ ~EE ~OM A~ ~D ALL D~AGES ~ CL~S ~S~G
~ER OR BY ~E OF SA~ PERM.(S), W G~ED. ~ CO~L~G ~IS
~P LICATION, I ~REBY A~HO~E ~E TRUS~, ~ AG~(S) OR
~P~SE~AT~S(S), ~ ~ER ONTO ~ PROPER~ TO ~SP E~ ~E
~ of~o~ ~
Notary Public, State of New York
NO. 41-4988110
Qualified In Nassau County 1.2,
COI1WnlSslon Expires November 4, ~
ECE VE
MAR I 8 20]3
SoutholdTown
Board QfTrustee~