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TOWN OF SOUTHOLD
BOARD OF TOWN TRUSTEES
PERMIT NO. .....Pll........
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 York and in accordance
with the resolution of the Board of Trustees of the Town of Southold adopted at a meeting
of said Board on..... Y..... .+. ' ...............and in consideration of the sum of
lawful.money of the United States,paid by .... ?a. ••••••.•.•••••••
residing at :.....k? ti ! ..A$§? 4 ...art 4*i4? 4r.., ar R............................ New York,
the said Board of Trustees of the Town of Southold, Suffolk County, New York, hereby
authorizes and permits said..... ec.. 4? ........... ... to
clean bog from in front of his property- Lot 13A, Na.aaau
Via, an to maKe a 'beach, approximate excavation 200
cubic oda+ a.11 in accordance with the applicatiOn
slatted.
The said............. ..:........................, as part of the consideration
for the issuance 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 may 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 bebrought by third
parties as a result of 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 exclusion of
said Board of Trustees and the Town of Southold.