HomeMy WebLinkAboutTR-324 TOWN OF SOUTHOLD
BOARD OF TOWN TRUSTEES
NO .....
Pursuant to the provisions of Chapter 615 of the Laws of 1893 of the State of
New York and Chapter 404 of the Laws of 1952 of the State of New York and jn accordance
with the resolution of the Board of Trustees of the Town of Southold adopted at a meeting
of said Board on ...... ~~...~..,~,~.. ................ , and in consideration of the sum of
$ ................. lawful money ,of the United States, paid bY...J~l~4~,,.~l~b,,~ ...........
resid,ing at ........ ~~..~ ................................................ , New York,
the said Board of Trustees of the To~ of Southold, Suffolk Count, New York, hereby
authorizes and permits said ................. ~..~..~ .................................... to
100 ~ee~ ~ tenth. ~! tn ac=~ce w~ ~e a~lt=at~
The said ......... ;~Ja '-;.~i~[..~,~,a:l;,~-.Q~ .................. , as part of the consideration
for the issuance of this permit does hereby release the said Board of Trustees and the
Town of Southold from any and all damages, claims for damages or suits, that may arise or
occur directly or indirectly as a result of any operation carriedOn Underand pursuant to this
permit, and wjllat his own expense, defend any and all suits which may be brought by third
parties as a result of any operation carried on pursuant to or in accordance with the terms of
this permit, and assume full liability with respect thereto to the complete exclusion af
said Board of Trustees and the Town of Southold.
Il
THIS PERMIT is ~ubject to the following terms and conditions:
1. That there shall be no unreasonable interference with navigation as o result of the
work herein authorized.
2. That there shall be no interference with the right of the public to pass and repass
along that portion of the beach between Iow and high water mark
3. That the work shall be subject to the supervision and approval o7 the said Board of
Trustees or its agents.
IN WITNESS WHEREOF, the said Board of Trustees of the Town of Southold has
caused its corporate seal to be hereunto affixed and these presents to be subscribed by
a majority of the said Board of TrusteeS, the day and year above written.
seal
STATE OF NEW YORK
COUNTY OF SUFFOLK
)
SS:
)
ON THIS......~.~....;.day of ......... ~¢)41~. ................................ 19..~))~., before me
personally appeared
gll personally known
to me, who, being by me duty sworn, severally said that they each resided in the Town
of Southold, COunty of Suffolk, State of New York, and were members of the Board of
Trustees of said Town of S~thold and constituted a majority of the ~me; that they
knew the corporate seal of said Town of Southold; that the seal affixed to the foregoing
instrument was such corporate seal; that it was so affixed thereunto by order of the
Board of T~stees of said Town of Southold and that each one signed his name thereto as
.a Trustee a.nd by like order.
Notary Public
?~ARiDI~ A. REGE~,IT
nOTARY PUBLJO, State of ~ew York
No, 52-3233].20 Suffolk
Term Expires March 30, 19_(~7
BULKHEADING
DI~EDGING
CRANE & TRACTOR WORK
JAMES. H. RAMBO
~xari~e ~o~rac~or
MATTITUCK, L I., N. Y.
PHONE: PECO'NIC 6488
FO~,DI NO, 1
TOWN 'OF SOUTHOLD
BOARD O[ TOWN TRUSTEES
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
DisaPproved a/c ...................~;~.. ......... :~ : .............. chairman, Board of Trustees
APPLICATION FOR PERMIT
INSTRUCTIONS
A. This application to be completely filled in by typewriter or in ink and submitted to the Town Trustees in dup~
licate.
B. Plot plan sho~ving location of lot and buildings on premises, relation to adjoining premises, public streets,
parks, etc., and giving detailed description of proposed layout of project must be drawn on diagram wvhich is part
of this application.
C. The work covered by this application may not be commenced before the issuance of a permit.
D. Upon approval of this application, Town Trustees will issue a permit to applicant. Such permit shall be kept
on the premises and available for inspection at all times·
E. Applicant shall notify the Board of Trustees upon completion of the work covered by permit.
APPLICATION IS HEREBY MADE to the Board of Trustees of the Town of Southold, Suffolk County, New
York, for the issuance of a permit pursuant to the laws, Ordinances and regulations governing construction of: docks,
piers, bulkheads, jettys and dredging in, under, and over the waters of Town of Southold. The applicant agrees
to comply with all applicable laws, ordinances, regulations and conditions specified by said trustees, and to hold
the ToWn of Southold, and all Town officials fre~e from liability a/ad damages of any kind.
Name of owner of premises ...~. · "".';, ................................
Street Address of Property ............ ' ...............................
Home address If Other Than Location ................... ~... :~.~..
Creek, Ba or Harbor Fr ng Property . -; -, .......................................
"Permit'., ReY uestedq To'~. ~ . ~.~ ~'- .~. · · - ~-~ ~-~.¢; · .:' ~,. ,, ~ .............................................. . .
~ize of Proposed Work: Length....~.~..~..~ ..... Width:~....~./~..He~ghth Above H~gh Water ..............
Depth' Below Low Water ............... 2Average Prise In Tide .............. Yards to Be Excavated... :., ........
Width of Canal, Creek or Bay Fronting Proper_~ ...................... Depth at Low Tide .....................
Is This For Private or BUsiness Use? .. ~ ............. Area Zoning ..........................
Complete plot plan to be drawn on reverse side of this application.
STATE OF N~W YORK )
)s.s.
COUNTY
_'~_[4~].g . ~,,... :(.[<.(.~j~..r~..".~?. being duly sworn deposes and sa3s that he iS the app icarlt o the above de-
}~ed p~r~nit, and that al~ ~ 1 statements contained herein are true to the best of his knowledge and belief; that the
w})~k will be done in the manner set forth in the apphcatmn and as approved by the Board of Trustees of the Town
of Southold, and the applicant agrees to hold the Town of Southold and said trustees harmless and free from any
and all damages and claims arising under or by virtue of
Sworn to before me this..~,//,~,~. ....
day
of,
Notary public. ~. 0. ~. -{ .~,'~ · · · county[
~o. 52-3889~85
Capplicant)