HomeMy WebLinkAboutTR-494 TOWN OF SOUTHOLD
BOARD OF TOWN TRUSTEES
P]~RMIT HO .... .4.9.z}
Pursuant to the provisions of Chapter 615 of ,the Laws of 1893 of the State
of New Fork; 'Chapter 404 of the Laws of 1952 of the State of New York; the p~o-
visions of an m'dinafice entitled "Southold To~ Ordinate Re~atMg ~e Placing
of Obs~ctions in and on Town Waters and Public Lands, ~d the Remov~ of Sand,
Gravel or .other Materials from Lands und~ ~own Waters", ~d ~ ac~rdance with
the resolution ,of the Board of Trustees of fl}e Town of Sout~old adopted at a meet-
~ng of said Board on .~y .~..~9~ .......... and in consideration of the sum
of $... ~*'~, lawful m~ey of the United States, paid by
residing at .. ~$~h ~. ~. ...... , New ~k, the Said
o¢ Suffolk' Cg ty,
autbo~zed and pe~m,s smd ...... R~eh~d. ~ .~ ...................
The said ~..P~.~.~.a..~.d...J>...~.~..S..~.e~. .......... , as part rot the consideration
for the issuance of this pernlit does hereby release the said Board of Trustees and
ti~e Tbwn of South. old from any and all demages claims for damages or suits that
may arise .or occur directly or indirectly as a result of any operation ca,Tied on
~er a_nd 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 of any operation cs/Tied
on Dursuan~ to or in accordance with the te~ns of this permit, and assume f~il
liability with respect thereto to the complete exclusion of said Board of Trustees
and the Town of SouthoId.
2.
3.
4.
THIS PERMIT is subject to the following terms and conditions:
That there shall be no unreasonable intm'ferenee with navigation as a result of
the work herein authorized.
That there shall be no interference with the right ~f the public to pass and re-
pass ~ong thai portion of the beach between l~w and high water mark.
That the work skail be subject ~o the supervision and approval of the said
Board of Trustees or its agents.
That if future .operations of the Tow.n of Southold require the removal and/or
~teration in the location of the work herein authorized, or if, in the opinion
of the Board of Trustees of the Town of Southold, such work shall cause un-
reasonable obstruction to free navigation, the saidt~IA~ .J,..~.l:~.~. ....
will be required upon due notice from the said Board of Trustees, tn remove
or alter the location .of the work hereby authorized without expense to the
Town of Southold, so as t,o render navigation reasonably free and unobstruct-
ed,
The authority conferred by this permit may be terminated by the Board of Trustees
for a failure on the part of the said ........ .~.~.~.~'~..~.~...~f~ .................................. to
comply with the terms and conditions herein imoosed. In the event of such termination,
this permit'shall be deemed revoked five (5) days after the date when the Board of
Trustees shall mail tO the said ....~[..~T,,..~= ......... ;.....: ...................... at the
address given in his application, a certified copy of a resolution of the Board of Trustees
directing such termination.
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·
STATE OF NEW YORK )
SS:
COUNTY OF SUFFOLK )
5
ON TH S ...... ~ ......... day of .......... .~.]A~:~!~.?; ............................ , 19..,6..~..., before me
oersano!ly appeared A],ve,h ,~ ~~, ~a~ ~ ~ ~
all pers~ally known
to me, who, being by me duly sworn, severally said that they each resided in the Town
of Southold, County of Suffolk, State of New York, and were members of the Board of
Trustees of said Town of Southold and constituted a majori~ of the same; that they
knew the corporate see of said Town of ~thold; that the seal affixed to the foregoing
instrument was such corporate seal; that it was so affixed thereunto by order of the
Board of Trustees of said Town of Southold and that each one signed his name thereto as
a Trustee and by like order·
TOWN OF SOUTHOLD
BOARD OF TOWN TRUSTEES
TOWN CLERK'S OFFICE
SOUTHOLD, N, Y.
Examined .~../. ............. 19 .~...~>. Application No ...................
Approved zmlt No .........
l~fsappz~Tcd ~ ............................................................................................
..................................................... chairman, Board of Trustees
,APPLI TION FOR PE iT
A. This application to 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 buildiugs 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 work covered by this application may not be commenced before the issuance of n permit.
D. Upon approval of this application, Town Trustees will ~ssue a permk ro applicant. Such permit shall be kept on
the premises 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 o{ a permit pursuan't to the laws. Ordinances and regulations governing construction of: docks.
p~ers, 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 of Southold, and all Town/~,_ficials free from liability and damages of any kind~
Name of Owner of Premises ...f~.'./.C...Fc~...D . ~. .~.~x ~ ...................
Street Address of Property .~-.~,rf~..~.~ .... .~.~.-~..c..~. ....... .~Z3.~.~..-?A<..'..~,~,. .... ~..r~.~Y.f.g~,qC~? ..........
Home Address If Other Than Location .......................................................................
Creek, Bay or Harbor Fronting Property ~...~/.&?._~...~y.'~?. .... ~.~ .~.r~ ................. ; ..........
Permits Requested To: .~.~...~T....~...~...~.~.~.~?it...~ .... .~...~..o~.~..T-....~.,~..~.e..~). iiiiiiii .......
Size of Proposed Work: Length ... ~..~..t ..... Width ..... ./. ~f. f.. Heighth Above High Water . .Q. ~ .......
Depth Below Low Water .... . .~..r. ..... Average Rise In Tide . .~./. ........ Yards to Be Excavated .~....e-~.~....
Width of Canal, Creek or Bay Fronting Property .... .~...S~.. ~ ............. Depth a~ ' ~- ~
Low T~de ................
Is Thru For Private or Business Use~ /t~ -~ .................. Area Zoning .~..~.-.~...O ..........
Complete plot plan to be drawn on reverse side of this application.
STATE OF NEW YORK )
)S.S.
COUNTY OF )
....................... being duly sworn deposes and says that he is the apphcant for the above described
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 applicant agrees to hold the Town of Southold and said trustees harmless and free from any and
ali damages and claims arising under or by virtue Of said permi't. ~
SwOrn to before me this .... /~ .... day of.~............~ .. I9.~.~ ~
0, ..................
/~ ~RIO~ k RE~ENT
NOTARY PUBLIC, S~te of New York
No. 52-3233120 Suffolk County~
l~rm ~pir~s ~arch ~, 19~
JAMES H.RAMBO,ING.
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 728
Southold, New York 11971
CREEK STRUCTURES INVENTORY
Current Owner's Name:
Address; ~-~q
TELEPHONE
/515'~ 765-1892
Index No. Z~
Creek:
Purchase Date:
Telephone No.:
Previous Owners:
Date of Field Work:
Permit Applicant:
permit Nc.:
Permit ~Specifications:
Specifications Found:
Condi~ ion:
Commen~ s: