HomeMy WebLinkAboutTR-1488Board Of $outhold Town Trustees
SOUTHOLD, NEW YORK
PERMIT NO. lZ188 DATE: ..~.~g.~...6.~....~981
ISSUED TO ...:.~-~9.~...n...t-:...~.~.,_..~.~.g./o P-
Pursuant fo the provisions of Chapter 615 of the Laws of:
fha State of New Yor~ 1893' and Chapter ~4 of ~e L~ of ~he
state o~ New Y0rk 1952 and fha Sou+hold Town ~Ord~nance an-:
rifled "REGULATING AND THE PLACING OF ~STRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC ~NDS and the
EE~OVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN WATERS;" and in'accordance with the
Resolution of The Board adopted afa meeting held on ~.~.~....5.,
19..8~ , and in consideration of fhe sum of $ ~.t.~g paid by
of .............. ~;~og~.~ ............. N.Y. and subjecf fo fhe
Terms and Oondiflons lisfed on fhe reverse side hereof,
of Soufhold Town Trusfees aufhorizes and permifs fhe following:
all in accordance with the defeiJed specifications as presented in
the originating application.
IN WITNESS WHEREOF, The said Board of Trustees here-
by causes, ifs Corporate. Seal to be affixed, and these presents to
be subscribed by a malorify of the said Board as of this daf, e.
Environment East, Inc.
R. R~ No. 3 - 3075 Indian Neck Lane
Peconic New York 11958
516-734-7474
A J3 - Rev.
BOARD OF TOWN TRUSTEES
Town O~ Southold
Southold, New York ]1971
Main Road
APPLICATION FOR A BITLKHEAD, DIKE, OR JETTY
1. Does this pr~:~c.~ involve the use of W~fLANDS as defined in the Southold Town Wetlands
Ordinance? ~E~or NO. If it does, you must file through the Town Clerk's Office.
2. Is the pragosed work entirely/ within the boundaries of your own property as substantiated
by your Deed or Survey? YES or NO. If it is, o Permit is NOT required from this Board,
but the Town Building inspector should be contacted for full details.
3. Appli?a~t's name ana,4~t;dress: .~.~,~..~..../i .~:..~....~'=~....~.~q~. ............... :: .....
/
...... ......
4. Cor~actors name and address: ........ .~..~./¢a<.%.¢~....~.. ..................................................................
......
..... ....i
6. After issuance of PermiL I expect to: (mark with on X)
fa) Commence work -- AT ONCE .......... ; ASAP ............ ; UNKNOWN TIME .............
(b) Complete work in- 1 DAY ............ ; 1 MO ............. ; I YR. .; FUTURE
7. Secure the correct Area Map from the Secretary of this Board, and by using an X WiTHiN
A CIRCLE as a mark, indicate as closely as possible the location of this project. On the
reverse side, provide a SCALE DRAWING which wJH show Ordinary High Water ,Mark as 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.
8. Provide the following documents:
fa) A Licensed Engineer's Survey of the property involved.
(b) A copy of the Contractor's Plan and Specifications.
9. Does this prelect extend into Town Waters beyond ,an imaginary lin,,mz~boundary formed
by existing works of a similar nature along this area's shoreline? YED~_~ If it does, state
the approximate distance beyond, . ........... ft.
10. Will this construction require the Filling of any land offshore of the Ordinary~.J-~gh Water
Mark or the Dredging of any material from Town Lands under water? YES o~'~iO~/If it does,
. arm A/4 (Apphcatton for Dredg,ng/Fdhng) must be completed and attached as part of this
application.
1 I. In requesting approval of this application, I submit that: the information presented herein
is true and correct to the best of my knowledge and belief; I 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, I intend to adhere to an~:/~crb~Terms and Conditions of the
Permit, when and if issued to me.
Ac cap ted by: ~ ~Dated.' ~ "~4'--~.c¢~
j ~5'0~,