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HomeMy WebLinkAboutBUGDIN, JOSEPH CTOWN OF SOUTHOLD BOARD OF TOWN TRUSTEES TOWN CLERK'S OFF~CE SOUTHOLD, N. Y. Examined ................................ 19 ..... Approved ............................................. Disapproved a c Application No ................... - P~rmit No ............................. ..................................................... 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 To%vn Trustees in dup- licate. B. Plot plan showing location of lot and buildings on premises, relation to adjoining premises, public streets, parks. etc., and Wing detailed description of proposed Iayour of project must be drawn on diagram which is part of this application. C. The work covered by this application may nor be commenced before the issuance of a permit. D. Upon approval of this application. Town Trustees will issue a permit ro applicant. Such permit shall be kept on the premises and available for inspection at ail times. E. Applicant shall notify the Board of Trustees upon completion of the work covered by permit. APPLICATION iS HEREBY MADE ro the Board of Trustees of the Town of Southold, Suffolk County, New York. for the msuance of a permit pursuan't 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 ro comply with ali applicable laws. ordinances, regulations and conditions specified by said trustees, and to hold the Town of Southold, and all Tow~ o~ff~c~l~free f~rc~n liab~ty~na damages of a~y kind. Name of Owner of Premises. ~a~....~. ~. :~..~¢~..~-~...~. ~,~ ....., ,~ ,~ ......... ;~ ....... ...~.~ .....,~. -o ........ ~_ .....~ ...................... k~ .... Home Address If Other Than Location ..... ~;~.~.~...t~..~..~.../..~...,~...~.~q ......... . Permits Requested To: ........ ..................................................... Size of Proposed Work: Length r ....... Heighth Above High Water .. Depth Below Low Water ............. Average Rise In Tide -.;~... Yards to Be Excavated ............ V~qdth of Canal, Creek or Bay Fronting Pronertv / ~'~'~ ~'~'... Depth at Low Tide .................. is Th s rivate or Business se?..o .. .................... Area Zoning .................... Complete plot plan to be drawn on reverse side of this application. STATE OF NEW YORK ) )s.s. COUNTY OFJ/ ~,~ ~/ ) z~_~'~Tr~'~//.'~.--~.z~..q~-~...-m~-~, being duly sworn dcposes and says that he is the applicant ~or the above described ~[,2~nd that g statement, s contained herein are true ro the best of his knowledge and belief; that the work ~zll b~ done in the manner set forth in the application and as approved by the Board of Trustees o~ the Town of Southold, and the applicant agrees to hold the Town of Southold and sa~d trustees harmless and free from any and all damages and claims arising under or by ~rtue of said permit ' Sworn to beforZ:this .~ ....... day of ~ ...... Cr''tt"2¢~'l];~J;eC ................... publicA~C~~ ...... county of Notary TOWN OF SOUTHOLD BOARD OF TOWN TRUSTEES TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ................................ 19 ..... Application No ................... Approved ............................................. Permit No ............................. Disapproved aic ............................................................................................. ..................................................... chairman. Board of Trustees ~APPUCAT~ON FOR PERM~ INSTRUCTIONS A. This application to be completely filled in by typewriter or in ink and submitted to the To~vn Trustees in dup- licate. B, Plasma_tan shelving location of lot and buildings on. premises, relation to adjoining premises, public streets, parks. et~j~and g~wn§ detailed description of proposed layout of project must be drawn on diagram which ts part of this ~'ph catmm . ¢C. The~work covered by this application may not be commenced before the issuance of a permit. D..Upon approvaPof this application, Town Trustees will issue a permit to applicant. Such pe'rmit shall be kept on thepremises and available for inspection at ali 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 pursuan'r 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 0£~5oUth0~d, and all Town~ic. ic~ial~4fr/]ee from~abili~ty.,_~pd damages of any kind. Creek, ~ay or Harbor Fronting Property ..... ~~..' .................................... ' ............... SiaePermitSof Requested To: '~ /7' ~r~' ............................................. .~. lJ ~ ........ Proposed,Vork: eugth ..... Width ........ · Heighth Above High Water ..~-. Depth Below Low Water. ..... ~ Average Rise, t ;e/~r/In Tid~z.: ........... Yards~[o Be Excavated ........... Width or Bay Fronting Property./...~. ~ .~..,~..'. ......... Depth at Low Tide ................. Canal, Creek Is This For Private or Business Use~ , ~.'.~. · · .~ZA~..(- .~'-~...~.-.~ ............ Area Zoning ................... Complete plot plan ~o be drawn on reverse side of this app Iication. STATE OF NEW YORK ) f , )s.s. COUNTY 0~~5 ~....'~'.~.. ...... ~/-<.... being duly sworn deposes and says that he is the applicant for the,abd~e described (d~rmit,fand 'that al~statements contained herein are true to the best of h~s knowledge and' behef; that ¢he work will be done in the manner sec forth in the application and as approved by the Board 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 said pekmi't. ............... ~ ~ ~ / (applicant) ...........