HomeMy WebLinkAboutTR-8179ESOUTH:OLD TRUS'
Issued To ~'ehn~A~r,'o, Oi~-~__~/ 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
James F. Kt~ Pr~dd~t
Bob Ghosio, Jr~ Vic~Pr~i~nt
Joh~ ~r
Micba~! J. Domino
Town Hall Annex
54375 Main Ro~d
P.O. B~ 1179
So~hold~ N~w York 11971-09~9
?~L%~on, (631)
Fax (631) 76~6641
HURRICANE SANDY EMERGENCY AP~._~ICATI _(;l~.~°.t_~ ~
Valid ~m Ju~ 1, 2013 ~r= 0f Tr~
P~Num~s): ~/~ Y~ ~ ~/~~/
Pm~d~: ~ ~ ~. ~~ ~//~7 /
S~olk~u~T~MapNum~l~- ~.~ ~,~ ~ ~
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: '~/or~4.
Bo~d o£ T~usheos ~plication ~.
County of Suffolk
State of New York
DF, POSES ~D ~F~S ~T ~S~ ~ ~E ~PUC~ FOR ~ ~O~
D~ED P~(S) A~ ~T ALL STA~ ~~ ~ ~
~ TO ~ B~T OF SI~ ~OWL~GE ~ BEL~F, ~ ~T ALL WO~
~L BE ~NE ~ ~ ~ S~ FOR~ ~.~IS ~PLICATION ~ ~ ~Y
~ ~o~ ~ ~ SO~OL~ TO~ ~O~ O~ ~U~m. ~
AG~ ~ SO~ ~ TO~ OF SO~O~ ~ ~ ~ ~US~
~I.F~S ~ ~E ~OM ~ ~ ~ D~AG~ ~ CL~S
~P~CATION, I~BY A~O~ ~E ~U~, ~ AGES) OR
~P~A~(S), ~ ~'1'~ O~ ~ PROPER~ ~ ~SP~ ~
P~ ~ coN~o~ ~ ~w OF ~ ~PL~CA~ON.
SWORN TO BBFORB MB THIS ~ DAYOF ~ ,20 )~
Notary PuBlic
CONNIE D. BUNCH
Notary Public, State of New York
No. 01BU6185050
Qualified in Suffolk County ,.~
Commission Expires April 14.2._~_~1
Orive'~oy
2-STORY
FRAME
HOUSE
EX. LIMIT
DF CLEARING
PROP. 4' PATH
EX.
1' = 40'
Z
z
PROP. 4' x
FIXED T~IMBER
VAI..KV~Y VITH
RANP & STAIRS
PRDP. 4' x 12'
FIXED
III
· MONUMENT
I PIPE