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HomeMy WebLinkAboutTR-169 TOWN OF SOUTHOLD BOARD OF TOWN TRUSTEES PEP, MIT NO ....... 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 Yerk~nd i-fi ~iccordonce with the resolution of the Board of Trustees of the Town of Southqld adgpted at a meeting of saie Board on ....... ~...~(J,...~]~- ....................... and in consideration of the sum of $..3~.i~., lawful money of the United States, paid by;.,..~;.~...~ ........... residing at ...... ~.~~~..~.W&.~...~}.~.., H~.~¢~].~,...~.,, ........ , New York, the said Board of Trustees of the To~ of Southold, Suffolk Count, ~w .York, hereby authorizes and permits said.: ....... ~...~...~ .............................................. to ~he a~l~ca~bon Sa]~e~ The said ....... ..~.~..1..p~.~.....~..,...~.k...1.~ ....................... .~ as l~art of the consideration for the ssuance 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 suits that ma~ 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 as a result o~ any operation carried on pursuant to or in accordance with the terms of this permit, and assume full liability with respect thereto to the complete exclusio~ of said Board of TrUstees and the Town of Southold. THIS PERMIT is subject to the following terms and conditions: 3. ~Ea~ there shall be no unreasonable interference with navigation as e result Of Be work herein authorized, 2. That there shall be no interference with the right of the public to pass and re~oss along that portion of the beach between Iow and high water mark. 3. That the work shall be subject to t~e supervision and approval of the safd 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 o majority of the said Board of Trustees, the day and year above written. seaJ STATE OF NEW YORK', SS: COUNTY OF SUFFOLK ) ON THIS. ,.,.~:?.,'~.~.~......day of .......... ~.~,~.~. .................................. 19.~...~Y.., before me personally appeared ~,m~O~ ~l~[~. ~ ~ ~ ~Jl personally known to me, who, being ~y me duly sworn, severally said that they each resided in the Town of Southold, Cou,n~ of Suffolk, State of New York, and were members of the Board of Trustees of said ~own of Southold and constituted o majority of the same; that they knew the corporate seal of said Town of Southold; that the seal affixed to the foregoing instrument was ~uch corporate seaJ; that it was so affixed thereunto by order of the Board of Trustees of said Town of ~uthold and that each ~e sign~ his~name thereto as o Trustee and ~y like order. ................ JUDIT~ T, FORM NO. 1 TOWN OF SOUTHOLD BOARD OF TOWN TRUSTEES TOWN CLERK'S OFFICE SOUTHOLD, N. Y. J; Examined . .-'~.QctO~. ~ ............ 19d'.F~... Applica.tion ?,o,L. ............... ....... Permit No ....... ./.O-./ ............... Approved Disapproved d/c ...................... ~ ............ ~ ...................................... ] ............... ............... ehairmau. Board of T ustees / APPUCATION FOR PERMIT A. This application ro be completely filled in by typewriter or in ink and submitted to the Town Trustees in dup- licate. B. Plot plan showing location of lot and buildings on premises, relation to adjoining premises, public streets, parks, etc.. and giving detailed description of proposed layout of project must be drawn on diagram which is part of this application. C. The ,;cork covered by this application may not be commenced before the issuance of a permit. D. Upon approval of this application, Town Trustees will issue a permit to applicant. Such permit shall be kept on the premises and available for inspection at all 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 pursuant to ihe 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, regniations and conditions specified by said trus~tees, and to hold the Town of Southold and all Tdwn officials free_ from liability and damages of any kind. Xame of owner of premises. ~.Z.~),..~.. - .~)..~. -~-~'. -~-~/.'~-. d ~. &r../~..//...~. ................................ ~reer ~ p ~ .................. ';"~'_'~ ......... ~ ~ Home address If Uther ±nan Locat n ........... ........... ~ ..... 2 ........................................... Creek or arbor P;o erty ....... ..................................... Permit Reques!ted To: .. ~..-~.'. =.- ................ : .................. ' ............... ,: .................... ....... ~ ~/~' A,~era~e Rise In Tide ~. ~.~._ Yards to Be Excavated. xff..$-.? ....... Depth l~eiow J~ow vvater...~-~.~. ..... o ~. · .... ~' '* .... Width of Canal, Creek or Bay Fronting I?~rty... ~=o..~..~.~..~ ..... Depth at Low Tide~ ..................... Is This For Private or Business Use ? .... ~..~j././J .~.~..//.~ ....... Area Zoning . .'~..~..o.$././Y~.¥.5 ....... Complete plot plan ro be drawn on reverse side of this application. STATE OF NEW YORK ) ) S.S. COUNTY O~&. !. ~..~.~.:.~ ...... being duly sworn deposes and says that he is applicant the ~or the above 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 free from any and all damages and claims arising under or by virtue of said-~rmit /.? / ............... (applicant) Sworn t0 before me this day of ..... ~~. "~9 ~&.. ~. ~0~449~3, Suffolk C0un~