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HomeMy WebLinkAboutTR-8122ESOUTHOLD TRUSTEES No. Address Z;~_~$ .~_:~~ _AM.: ~Ld~!,J THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION TOWN TRUSTEES OFFICE,TOWN OF SOUTHOLD SOUTHOLD, N.Y. 11971 TEL.: 765~1892 LONG ISLAND SOUND ,~w, 6-15-1~ 1" = 30' APPROXo LOC. OF STORM-INDUCED HION WA'ER UNE, 1 aF. AC~ ~RASS ~ASS UNF.., ~ 2010 FORMER LOCAIION OF APPR 250 - 500 LB. FIELDSTONE 3-11 ,X. 105 LF. OF ~r.2'-DIAIdETER, .OST TO 12/26/10 BUZZARD AFFROX. 103 IF. OF 2' x 2' x 6', 6,000 I.B. STACKE~ 3 COURSES HIGH TO (IN APPROX. LOC. OF LO~T RET. WALL) BLOCKS SE:T IN SAND /elD WALL OF RET. WALL LOST TO STORM LOC~ 2 STY 4' ~ /d~F-J~ BET~EEN B~.OO(S AND E~/~J~MENT BACKF~U ~ ~'1 APF'ROX, ~ CY SAND ~OR.~,d RO~ il TROPICAL STORM SANDY EMERGENCY APPLICATION Valid thru June 1, 2013 Permanent Mailing Address: 1~ ~.~.-~-~ ~"~(~ -~,~cT, %% l ol Phone Number(s): ~;~ Property Address: Suffolk County Tax Map Number: Agent (if applicable) ~ h( [~ Address: ~0 ~X 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? /~ © U~cLr~ Project Description: County of Suffolk State of New York N I~ % %lr-,~c°~5~..c~ BEING DULY SWORDNvE DEPOSES AND AFF1RMS'~HA~____~')JSHE 1S THE APPLICANT FOR THE ABO DESCRIBED PERMIT(S) AND THA~F ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST O H~}IER 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 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. (Sighature of Property~r SWORN TO BEFORE ME THIS DAY OF ~/9~'1 ] ,20 /..~ I Lorraine LaRosa NOTARY PUBLIC, Sta~ of New No. 01 LA6059257 Qualified In Suffolk CountV ~' Commission Expires May 2~, 20 ~ AUTHORIZATION (where the applicant is not the owner) (print owner ofpr~dp~rty) 'j residingat tt~3 ~ (mailing address) (Agent) / [..~.~q((~l(~ ~ k~ifl~U__./]~l to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (Owner's sign~~:::~