HomeMy WebLinkAboutTR-111-13-6Board Of $outhoid Town Trustees
SOUTHOLD, NEW YORK
PERMIT NO. I1~ -" t'~-~,(:, DATE: .....j.- !~'1-~'~
ISSUED TO .~cC.~........~..~.~
uthor za io
Pursuant fo the provisions of Chapter 615 of the Laws of
the State of New York, 189:3; and Chapter 4.04- of the Laws of the
S~'ate of New York 1952; and the Southold Town Ordinance eno
titled 'REC~ULATING AND THE PLACINC'= OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS and the
REMOVAL OF SAND, C-RAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN WATERS;" and in aecordence with the
Resolution of The Board adopted a~' a meeting held on
19 ....... and in consideration of the sum of $ ~c~,'~p'l~p~id by
of N.Y. and subject to the
Terms and Conditions listed on the reverse side hereof,
of Southold Town Trustees authorizes and permits the following:
ell in accordance with the detailed specifications as presented in
the originating application. '
IN WITNESS WHEREOF, The said Board of Trustees here-
by causes its Corporate Seal to be affixed, end these presents to
be subscribed by a majority of the said Board as of +his da~,e.
?~,~.?~.~ ._~....!~
...................................... .................................
$oh~ M. Bmdetaeye~ ]lrf, ~P~dd~nt sUPERVISOR
Henty p. S~fl~ Vice ~ldeh/ SCOTt L. HARRIS
Albert ~. ~ld, Ir.
ioh~ L; PalM, Jr. Town Hall
J~BIT. u~ii~ll. ".. 53095 Main Road
P.O. Box 1179
~' '~[iJSTEES sodhold, New York 11971
COASTAL ~ROSI6N MANAGEMENT PERMIT, A~PLICATION
T0~ WETLANDS ~ A~PLiC~Tio~
_Coa~tAI~
Apps, Date: JAN - ~ ~j~
Date:
mand~ · Date Rec. by Office
Application Fee:
/
Date Pr~are~ ~
Interest~ (owner, consul%ant,lessee,etc.)
~ner ~f Property:
Address
. ' Phone ( )
Sub~ec% Property Location:
Provide LILCO Pole 9, Distance to cross Streets if not on
location map)
T~IS IS NOT A PE~IT
Yd~ ~ to be fille~: ~0
deposited:
Width
tide: ~
Distance Pro3ecmt
structures,
; a-
The also include plans for reclamation
of principle and
acc~
and i
AuthoriZation (Where~the applicant is not the o~ez)
I
- ~ residing at
'- (Print-owner of subject property) (Mailing address-phone)
~0 he~gby authorize to apply for
CoaStal/ErosiOn per,it(s) fro~ ~he So~thold Town Trustees
S~nature
THIS IS'NOT A PE~IT
County of Suffolk
State of New York
~ E0 ~_~ ~, COST~AL0~ S'~ BEING DULY SWORN DEPOSES AND
AFFIRMS THAT HE/SHE IS TH~ APPLICANT FOR THE ABOVE DESCRIBED
PEP~I~(S) AND THA~ ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO
THE BEST OF HiS/HER KNOWLEDGE AND BELIEF, AND THAT WORK WILL BE
.DoNE IN THE ~NNER SET FORTH IN THIS APPLICATION AND AS MAY BE
APPROVED BY THE SOUTHOLD TOWN BOAED OF TRUSTEES. THE APPLICANT
TOWN TRUSTEES
CLAIMS ARISING
THE ONTO MY PROPERTY '
SES ~
S~NATURE
SWORN TO BEFORE ME THIS ~ DaY OF b~Cg~-~__ ,199~2.
~~y ~ // No. 01U.'.94958343
(;om .Oualified in Suffolk County
P L m~ssion Expires N~wember ~, 19_7_3
SUggested space for location Map
THIS IS NOT A PERMIT
N~:55^ t/ PO~ r,-I -f goal5>
AUIlIUIUZAi iON LEI IHt "'~
the authority to act as agent in my behalf In applying
tn order for I~ork to be done on ~y property described
8bore ~