HomeMy WebLinkAboutTR-239 TOWN OF SOUTHOLD
BOARD OF TOWN TRUSTEES
.....
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 in accordcmce
with the resolution of the Board of Trustees of the Town of Southold adopted at a meeting
of said Board on ....... .~..~.~.~.i.2..~.....~...~..~..3...~. ...................... and in consideration of the sum of
$.,...[,.{~,., lawful money of the United States, paid by....~[~J?.~J~i.C~,...J~.~.' ....
;....~,.~.~.~;..;~ ,.[~ ................................ New York,
the sa[d Board ~ of South~ld, SUffolk County, New York, hereby
authorizes and permits said.~ ........... ~~..~.,.~~ ................................... to
sa~a ~l~ng ~k l~a~ ~n ~gene ~eek~ cu-~e,
The said ..,..~.~.~..~...e.~.e....g.t...~.e.A .................... , os part of the consideration
for the issuance of this permit does hereby release the said Board of Trustees and the
Town of Southold from any and all damages, Claims for damages or suitsthotmay arise or
occur directly or indirectly as a result of any operation carried on under and pursuant to this
permit, andWill .at his own expense, defend any and all suits which may be brought by third
par~ies os a ~dsult of any operation carried on pursuant to or in accordance with the terms of
~hi$ permit, and assume full liability with respect thereto to the complete exclusion of
said Board 0f Trustees and the Town of Southold.
THIS PERMIT is subject to the following terms and conditions:
1. That there shall be no unreasonable interference with navigation as a, 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 of the said Board of
Trustees or its agents.
IN WITNESS WHEREOF, the said Beard 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.
seaJ
STATE OF NEW YORK )
SS:
COUNTY OF SUFFOLK )
personally appeared
PhXI/~ ~:L~Ler ~ A1vah
all personally known
to me, who, being by me duly sworn, severally said that they each resided in the Town
of Southold, County of Suffolk, State of New York, and were members of 1:he Board of
Trustees of said Town of Southold and constituted a majority of the same; 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 ~he
Board of Trustees of said Town of Southold and that each one signed his ,name. thereto as
a Trustee and by like order.
~rota ry Public
JUD!TH T. BOKEN
N'ota~ PubEc. State of New Yor[~
No. 52-0344963, Suffolk C0unt~
AVe.,
July
FO~I~[ NO. 1
TOWN OF SOUTHOLD
BOARD OF TOWN TRUSTEES
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y,
..... · .'~~~...'.~)~..m ~cz.> ..... ...?. chairman, Board of Trustees
,/ APPLICATION FOR PERMIT
INSTRUCTION~
A. This application to be completely fi!led~in- by.typewriter oi* in ink and submitted to the Town Trustees in dup-
licate. ~ ~ ~ ~
B. Plot plan showing location of lot a/nd buildings on premises, relatlon to adjoining premises, public streets,
parks, etc., and giving detailed description of proposed l~yout of project must be drawn on diagram which is part
of this application.
C. The woPk covered by this appl{cafi~o. 'n'~ma3r-rrot~be'~commenced before the issuance of a permit.
D. Upon approval of this appl~catibn, To~-n Trusrees',wLl.~ issue a permit to applicant. Such permit shall be kept
on the premises and availab}e £6¥,inspe~tion a~ all tim~s.
E. Applicant shall notify the Board--'B~ 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 I~ws, 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, 0rdina~nces, reg{fl~itions and conditions specified by said trustees, and to hold
the Town of Southold, and all Town officials free from liability and damages of any kind.
Name of owner of premises ..... .~..J.~..~..~..~.~?....~.:. ~.~.~ i .............................................
Street Address of Property~ ~.9.~ ~.~. ~.Y.¢.
Home address If Other Than Logation ~[7..~.k ~.~
Creek, ~y or ~ Fronting Property..~q.~ ~..~ ~.
Permit RequeSted To: . C.O%~I.~.¢K...~r~4~,~...~ ~.~..~ .... ~l~e~ ....... : ...... ~::: ....
Size of Proposed Work: Length..'~ ....... Wid~ .............. Heighth 'Agoyg;-Hig~ W-ater-...:.; .; ..... ,..
Depth Below Lo;v Water ................ vera~e Rme In T~de .............. Ya[d~t6 Be Excavated.~..,..
Width of Canal, Creek or Bay Fronting Property ........ =::...; ........ -~.'Depfh ~ Low Tide .....................
Is This For Private or Business Use? . .~ i]g~.¢ ............................... Area Zoning . ,~ ......................
Complete plot plan to be drawn on reverse side of this application.
STATE OF NEW YORK )
n ) 8.8.
COUNTY >
........... C~.' .... being duly sworn deposes and says that he is the applicant for the above de-
scribed permit, and that all statements contained herein are true to the best of his knowledge and belief; that the
work will be done in the manner set forth in the application and as approved by the Board of Trustees of the Town
of Sonthold, and the applicant agrees to hold the Town of Southold and said trustees harmless and iree from at~y
and all damages and claims arising under or by virtue of said ~erm~it.
....... .......
/ BSRSARA M. HAURu$ No. fi2-~806770
]~) ~c~<
TELEPHONE
(516) 765-1892
BOARD OF TOWN TRUSTEES
TOWN OF $OUTHOLD
Town Hall, 53095 Main Road
P.O. Box 728
Southold, New York 11971
CREEK STRUCTURES INVENTORY
Current Owner's Name:
Address
Index No.
Creek:
Purchase Date:
Telephone No.:
Previous Owners:
Dare of Field Work:
Permit Applicant:
Permit No.: ~,%%~
Permit Specifications:
Specifications Found: