HomeMy WebLinkAboutTR-81-3-4 GFBoard Of $outhold Town Trustees
S.OUTHOLD, NEW YORK
PERMIT NO..~ ~l ~ "~:- ~-t...
Aulhorizaliou
Pursuant to the provisions of Chapter 61!S of the Laws of
the State of New York, 1893: and Chapter 404 of the Laws of the
State of New York 1952: and the Southold Town Ordinance en-
titled "REGULATING AND THE PLACING OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS and the
REMOVAL OF SAND,' GRAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN WATERS:" and Jn ac¢ord~'nce with the
Resolution of The Board adopted at a meeting held on
19 ....... and in consideration of the sum of $..~-~'~r~J~ pa~d by
of .................................................................................. N. Y. and subject to the
Terms and Conditions listed on the reverse side hereof,
of Southold Town Trustees authorizes and permits the following:
'all in accordance with the detailed speclfica+ions as presented in
the or~cjinatlncj application.
IN WITNESS WHEREOF, The said Board of Trustees here-
by causes its Corporate Seal to be affixed, and these presents ~ro
b~ subscribed by a majority of the said Board as of tJ~is daf, e.
...................................... ...................................
TRUSTEES
John M. Bredemeyer, III, President
Henry P. Smith, Vice President
Albert J. Kn]psld, Jr.
John L. Bednoski, Jr.
John B. Tuthill
Telephone (5!6) 765-1892
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
SCOTT L. HARRIS
Supervisor
Town Hall, 53095 Main Road
P.O. Box 1179
Southold~ New York 11971
Fax (516) 765-1823
Telephone (516) 765-1800
GRANDFATHER APPLICATION
, /
Address of Property:
Tax Map Number: 1000- - ~ ~ Approx.yr.of construct:
Prior owner if known:
Diagram of existing structures, including all dimensions, must be
included with this application:
Indicate on attached map: Location, ie; reference point, telephone
pole number, adjacent prop~ty owners,/jetc.~
Signature of applicant: A~~ ,~;~ Date, / ,~//?~'~/~'/f__ ~
Please note, there is a one time fee of $50.00 for filing this
application.