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HomeMy WebLinkAboutTR-198 TOWN OF SOUTHOLD BOARD OF TOWN TRUSTEES PE IT No ...... .... Pursuant to the provisions of Chapter 615 of the Laws of 1893 of the State of New York ~nd Chapter 404 of the Laws of 1952 of the State of New York and in accordance with the resolution of the Board of Trustees of the Town of Southold adopted at o meeting of said Board on ........... ~....~...O.~....~...~..~ .................... and in consideration of the sum of $~ lO.(~Ola ,.. ~.~ ............ , w~u~ money of the United States, ~id by....~$~..~,,,~'..~..~ residing at ........ ~,~...~.~,....~ ........................................................ New York, the said Board of Trustees of the Town of Southold, Suffolk Coun~ New York, hereby a~or~zes and permits said ....... ~.~..~...~..~ ......................... to ~e a ~1 ~ the~ ~ On ~e~ts ~ 1000 The said ,.~,.~_,~.~..~...~.~...e...~-....~..~...~.~...., 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 saits that may arise or occur directly or indirectly as a result of any operation carried on under and pursuant to this permit, and will at his own expense, defend any and all suits which may be brought by third parties os a result of any operation carried on pursuant to or in accordance with the terms of this permit, and ~ssume full liability with respect thereto to the complete exclusion of said Board of Trustees and the Town of Southold. THiS PERMIT is subject to the Following terms and conditions: '~ 1, That there shall be no unreasonable interference w~th nawgotion as a reSuJrt 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 o~d high water mark. 3. That the wore shall be subject to the supervision and approval of 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. "~-~~..-,.~ ~L ~ ~ "J ; ~, "'~'~"~'~~.(L S.) ......... ................. ""-:~ ........... ~ .................. STATE OF NEW YORK ) SS: COUNTY OF SUFFOLK ON THIS......~..?..~..~......day of ............ .~..~. ~.~.~... 19...~.~., before me personally appeared ~s ~ ~ ~ ,~ all personally known ~o me, wha, 5eJng by me duly sworn, severally said that f~ey each resided in the ~own of Soul'old, County of Suffolk, State of New York, and were members of the Board of Trustees of said Town of Southold and constituted a ma]ori~ of the ~me; t~f they knew the corporate seal of said Town of Soufhold; that the s~l affixed fo the foregoing instrument wos such corporate seal; that it was so affix~ ~hereunfo ~y order of Board of Trustees of said Town of Southold and f~at each one signed his name thereto as c Trustee and by like order. ..... FORi~I NO. 1 TOWN OF SOUTHOLD BOARD OF TOWN TRUSTEES TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No .................. Permit No ...... 7..~...~. ............... Disa__rovedpp a/c ...... ..... ~ ..... chairman,: Board of Trustees ~) ,/ APPL]CATION FOR PERMIT INSTRUCTIONS A. This application to be completely filled in by typewriter or in ink and submitted to the Town Trustees in d - licate. B. Plot~ ~Ian showhng. . location of lot and buildings on premises, relation to adjoining premises, public streets, parks, ejcc; ~a~ad g~vmg detailed description of proposed layout of pro~ect must be drawn on dia~am which 0 th~ app~tmn, is part C. The W~rk, covered by this application may not be commenced before the issuance of a permit. Uppn approval of this application Town Trustees will ~ssue a permit ro applicant Such permit shall be kept Zhe premises and ava~Iab e ~or inspection at ali times E. Apghc~ shall notify the Board of Trustees upon completion of the work covered by permit. AP~ON ~8 H~REBY, MADE to the Board of Trustees of the Town of Southold ~_ffolkg- Count New Yo~k f*~ ~e ~ssuance o~ a pem~t pursuant to the laws Ordinanc~ and regulations governing construction of docks, plers~ B~I~e~ds, jettys and dr~gmg m under and over the waters of Town of Southold The a licant a tees ~ ,: , ', a ' . ' ' PP g to c¢~1~ ~th all a~hcable ~aws ordinances regulations and conditions specified by said trustees and to hold rite T~n'Bi~Sout~old, ~nd a~ Town offmials free from liability and damages of any kind. ..... .................... s~ ~a~s o~ ~ro~ ........ ~.~h.~... ~ome a~dr~i If Other Than Location ...... ~~ '~} ............................................ Perm~ Requited To ........ ~lff.. &~.~ ........................... Si~e o~ Pra~Bed Work: Length...>,.~Q ........ Width...~ ....... ~eighth Above ~igh Water ~ Depth Belo~ Lmv Water... ~. .......... Average Rise In Tide ..... ~ ...... Yards to Be Excavated .............. ~qdth of Canal. Creek or Bay Fronting Property..~¢~. ....... ~..( .gepth a~ Low Tide ...~.. ~ ~ r~ v~i~ Fo~ ~i~ o~ ~i~ u~....~.'~ ............. .... ~ Zo,i.g .... ~*.ti&~,' ....... / Complete plot plan to be drawn on reverse side of this application. STATE OF NEW YORK ) ~ ~ ~) S.S. COUNTY OF~ -,.../~..~.L..I.~.I :.~ing duiy 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 Southold and the a hcant a~rees to hol , Pp ~ d the Town of Southold and said trustees harmless and free from any and all damages and claims arising under or by virtue of said permit. Sworn to before e this ~ ~ da, o D ' ~' 19 ~ (applicant) .... fl~, 52-7~85800 S?folk ~erm ~xpir~s ~ar~h 80~