HomeMy WebLinkAboutCLEAVES POINT PROPERTY OWNERSRev. ,$~2
BOARD OF TOWN TRUSTEES
Town Of Southold
Southold, New York 11971
Main Road
APPLICATION FOR A BULKHEAD, DIKE, OR JETTY '~
1. Does this project involve the use of WETLANDS as defined in the Southold Town Wetlands
Ordinance? YE~S or NO. If it does, you must file through the Town Clerk's Office.
2. Is the proposed work entirely within the boundaries of your own property as substantiated
by vour Deed or Survey? YES or N_~_,O. If it is, a Permit is NOT required from this Board,
b~t'the Town Building Inspector should be con~cted for full details.
3. Applicant s name one ooaress: .........................: .......... ~. ........ / ......................................................
.............
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~;. Contractor's name and address: ..~:...' ~ T. ..~...~..~ ...... ;..
5. Explain briefly the purpose of this epplicotion:: ........................ .G'.G...~. ............. .~.../~..P..~.../.?.~-- .......
..........
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/'g~ .~.e. · ./2., ...................... , ...................................................................
6. After issuance of Permit, expect to: (mark with an X)
(o) Commence work AT ONCE.....~......; ASAP ............; UNKNOWN TIME .............
(b) Complete work in ~;'DAY<~ ........... ; 1 MO ............. ; 1 YR ............. ; FUTURE ...........
7. Secure the correct Area Mtp from the Secretary of this Board, and by using an X WITHIN
A C!RCLE os a mark, indicate as closely as possible the location of this project. On the
reverse side, provide a SCALE DRAWING which will show Ordinary High Water ,Mark os well
as the size and shape of the structure or work to be done. Also include all dimensions for
portions which extend offshore from the O. H. W. M.
Accepted by:
8. Provide the following documen.ts:
(al A Licensed Engineer's Survey of the property involved.
(b) A copy of the Contractor's Plan and Soecifications.
Does this prolect extend into Town Wa~ers beyond an imaginary line or boundary formed
by existing works of a similar nature along this orea~s shoreline? YES or NO. f it does, state
the approximate distance beyond, .....~.P.... ft. (r :,~cz,~ ~/'~/
10 Will this construction require lhe Filling of any land offshore of the Ordinary High Water
Mark or the Dredging of any material from Town Lands under water? YES or N___.~O If it does,
Farm A/4 (Application for Dredging/Filling) must be completed and attached os part of this
application.
] ]. In requesting approval of fhis application, I submit that: the information presented herein
is true and correct to the best of my knowledge end belief; am the person accountable for
the performance of the work in accordance with the plans and specifications attached; I have
read or am familiar with the provisions of any Southold Town Ordinance pertinent to the work
involved; and further, intend to adhere ;o and abide by the Terms and Conditions of the
Permit, when and if issued to me.' ~'~,~r~ ~ -- ~ ~.~w.r->L~~.~:.,
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