HomeMy WebLinkAboutTR-38-2-33 GFBoard Of $outhold Town Trustees
S.OUTHOLD, NEW YORK
PERMIT NO. ~¢~.~ .~.~ DATE: ..!~.?.~.!~ .......
ISSUED TO .... ..(~..~c~-,'~ '~o,,.,'Z_o ¢.~.~¥ .........................................
PursUant to the provisions of Chapter 615 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 in accordance with the
Resolution of'The Board adopted at a meeting held on
19 .... and in consideration of the sum of $ ..~.~(~ paid bY
of .......................................................................................... N. Y. and subiect to the
Terms and Conditions listed on the reverse slde hereof,
~f Southold Town Trustees authorizes an,cl permits the following:
all in accordance wlfh the detailed specifications as presented in
the originating application.
IN WITNESS WHEREOF, The said Board of Trustees here-
by causes ifs Corporate Seal to be affixed, and these presents to
be subscribed by a majority of the said Board as of this dat,e.
Trustees
TRUSTEES
John M. Bredemeyer, III, President
Henry P. Smith, Vice President
Albert J. Krupski, Jr.
John L. Bednoski, Jr.
John B. Tuthill
Telephone (516) 765-1892
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
SCOTF L. HARRIS
Supervisor
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York t 1971
Fax (516) 765-1823
Telephone (516) 765-1800
GRANDFATHER APPLICATION
Name of
Mailing address: ~.
Address of Property:
Tax Map Number: 1000- ~ ~-~_~Approx.yr.of construct:
Prior owner if known
Diagram of existing structures,
included with this application:
including all dimensions, must be
Indicate on attached map:
pole number,
Signature of
Please note,
application.
Location, ie; reference point, telephone
adjacent proper~y owners, etc.
applicant: ~//~_r~ ~..~~ Date:
there is a one time fee of $50.00 for filing this