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Home My WebLink AboutTR-3988 BOard Of $outhold Town Trustees SOUTHOLD, NEW YORK Amended 6/24/93 PERMIT NO. 3988 DATE: Feb . 28, 1~92 ISSUED TO ......... . uthorizati n Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1893; and Chapter 404 of the Laws of the State of New York 1952; and the Southold Town Ordinance en- titled "REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LAND5 and the REMOVAL OF 5AND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;" and in accondance with the Resoluflon of The Board adopted at a meeting hel~ on . 2/.27/92 ,4- , 236,00 paid b~ 19 .9;~nd in consideration of the sum of :~...150..00 Latham ~and &. .G~av~l.. on behalf .of .E~rol...Forema~ ....... of Southold N.Y. and subject to the lerms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: To shorten 5' X 50~ fixed dock to 5' X 12~ and to conszruc~ a 3' X 12' ramp, & a 8' X 30' float in an "L" configuration. Located Jockey Creek, Southold all in accordance with the detailed specifications as presented 'n the originating application. IN WITNESS WHEREOF, The Bald Board of Trustees here- by causes ifs Corporate Seal to be affixed, and these presents be subscribed by a majority of Board as of this daf.e. TRUSTEES SUPERVISOR John'M. Bredemeyer, III. Presklent SCOTT L. HARRIS Albert J. Krupski. Jr., Vice President Henry P. Smilh Town Hall John 13. Tuthill 53095 Main Road William G. Albertson EO. Box 1179 Telephone (516) 765-1892 Southold. New York 11971 Fax (516) 765-1823 BOARD OF tOWN TRUSTEES TOWN OF SOUTHOLD June 25, 1993 Latham Sand & Gravel Main Road P.O. Box 776 Orient, N~ 11957 RE: Errol Forman SCTM ~1000-70-4-42 Dear Mr. Latham: The following action was taken by the ~outhold Town Board of Trustees on June 24, 1993: RESOLVED that the Southold Town Board of Trustees grants an amendment to Permit ~3988 to shorten dock to be as follows: 5' X I2' dock, 4' ~ 14' ramp, 8' X 16' float and a 8' X 30' float in an "L" or a "T" configuration subject to revised plans and fees according to which plan is used. If you have any questions, please do not hesitate to contact this office. truly yours. John M. Bredemeyer, III President, 13oard of Trustees JMB:jmd February 28, 1992 Latham Ss/ld & Gravel, Inc. 37725 Main Road P.O. Box 776 Orient, NY 11957 Re: Errol Forman SCTM #1000-70-4-42 Dear Mr. Latham: The following aotion was taker by the Board of Town T.rustee~ during its regular meeting held on February 27, 1992 regarding tt~ above matter: WHEREAS, LATHAM SAND AND GRAVEL ON BEHALF OF ERROL FORMAN applied to the Southold Town Trustees for a permit under the provisions of the .Wetland Ordinance of the Town of Southold, application dated January 16, 1992 and, Wn~mEAS, a public hearing was held by the TOwn Trustees with respect to said application on 1992 at which time all interested persons were ty to be heard, and, WHEREAS, have personally viewed and are familiar With~ the premises in guestion and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the Board has determined that the project as proposed will not affect tha health, safety and general welfare of the people of the town, NOW, THEREFORE BE IT RESOLVED THAT LATHAM SAND AND GRAVEL ON BEHALF OF ERROL FORMAN BE AND HEREBY IS GRANTED PERMISSION UNDER THE WW. TLAND ORDINANCE TO: Construct an 8' X 30' CCA-treated floating dock, a 3' X 12' ramp to be attached to an existing dock. Existing dock is 5' X 50~ and will be shortended to 5' X 34'. Installation of 6 related 30' pilings (4-floating, 2-tie off). This permit will expire two years from the date it is signed. ~ees must be paid, if applicable, and permit issued within six months Permit will b~ payment of be Water Mark: 446 sq.ft, new - s00 sq.ft, old = 246 sq.ft. X Very truly yours, John M. Bredemeyer, Iti President, Board of T~ustee JMB: jt cc: Bldg. Dept. conServation Advisory Council file TRUSTEES John M. Bredemeyer, III, President SUPERVISOR Henry P. Smith, Vice President SCOTT L. HARRIS Albert J. Kmpski, Jr. John L. Bednaski, Jr. Town Hall John B. Tuthill 53095 Main Road P.O. Box 1179 Telephone (516) 765-1892 BOARD OF TOWN TRUSTEES Southold, New York 11971 Fax (516) 765-1823 TOWN OF SOUTHOLD S.E.Q.R.A. NEGATIVE DECLARATION NOTICE OF NO SIGNIFICANT EFFECT ON THE ENVIRONMENT APPLICATION NO. 1000-70-4-42 NAME: Errol Forman DATE: January 30, 1992 RESOLVED that pursuant to Article 8 of the Environmental Conservation Law, State Environmental Quality Review and 6NYCRR Part 617, Section 617.10 and Chapter 44 of the Code of the Town of Southo!d, notice is hereby given that the Southold Town Trustees, as Lead Agency for the action described below, has determined that the project will not have a significant effect on the environment. Please take further notice that this declaration should not be considered a determination made for any other department or agency which may also have an application pending for the same or similar project. TYPE OF ACTION: Type II DESCRIPTION OF ACTION: Construct an 8' X 30' CCA-treated floating dock, a 3' X 12' ramp to be attached to an existing dock. Existing dock is 5' X 50' and will be shortened to 5' X 34' Installation of 6 related 30' piling (4-floating, 2-tie off). LOCATION: Tax map No. 1000-70-4-42 REASONS SUPPORTING THIS DETERMINATION: 1. An on site inspection has been conducted by the Board of Trustees. 2. An environmental assessment, submitted by the applicant and completed by the Board of Trustees, has indicated that reviewed and no significant adverse effects to the environment are likely to occur should the project be implemented as planned. cc: Applicant, CAC TRUSTEES SCOWl' L. HARRIS John M. Bredemeyer. III. President ~ Supervisor Henry P. Smith. Vice President Town Hall. 53095 Main Ro; Albert J. Kmpski. Jr, - t?'-O. Box 1179 John B. Tuthill BOARD OF TOWN TRUS I~$ ~4(516) 765-1823 OF SOUTHOLD ~ mm-'> Tcl~llone (516) 765-180¢ Telephone/516) 765-1892 TOWN ,JhN I 6 ~v<. .~J IOWN OF $OUTHOLD APPLICATION IS HEREBY MADE TO THE TOWN TRUSTEES, TOWN OF SOUTHOLD, SUFFOLK COUNTY, NEW YORK, FOR THE ISSUANCE OF A PERMIT PURSUANT TO THE LAWS, ORDINANCES ~ND REGULATIONS GOVERNING THE COASTAL AND INTERIOR WETLANDS, FLOOD PLAINS AND DRAINAGE AREAS OF SOUTHOLD TOWN, AND THE ISSUANCE OF PERMITS PURSUANT TO CHAPTER 32 OF THE CODE OF THE TOWN OF SOUTHOLD. APPLICANT'S NAME: Errol & Beverly Forman: TEL. NO. (516) 765-6~072 MAILING ADDRESS: P.O. Box 1063, Southold, NY 1197] AGENT: Latham Sand & Gravel, Inc. TEL NO. (516) 323-2585 AGENT ADDRESS: 37725 Main Rd., P.O. Box 776, Orient, NY 11957 PERMIT REQUESTED TO: Construct an $'x30' CCA-treated floating dock, a 3'x12' ramp to be attached To an existing dock. Existing dock is 5'x50' and will 6 be shortened to 5'×34'. Installation of~related 30' piling ~4-float, ~2wt.ie offQ:. LOCATION OF PROPERTY FOR REQUESTED PERMIT: 2655 Calves Neck Road, Southold, NY 11957 TOWN: Southold TAX MAp NO: 1000- 70-04-42 'CREEK. BAY OR HARBOR FRONTING PROPERTY: Jockey Creek SIZE 3F PROPOSED WORK: LENGTH: Floating Dock - 8'x30'; Ramp - 3'x12' WIDTH: Floating Dock-- 8' wide; Ramp - 3' wide ~Xpp. Page YDS. TO BE EXCAVATED: N/A YDS. TO BE FILLED: N/A MANNER IN WHICH MATERIAL WILL BE REMOVED OR DEPOSITED: N/A WIDTH OF CANAL, CREEK OR BAY FRONTING PROPERTY: DEPTH AT LOW TIDE: 5' AVER. RISE IN TIDE: 2 1/2' DISTANCE TO NEAREST CHANNEL: 150' DISTANCE PROJECT EXTENDS BEYOND SIMILAR PROJECTS IN AREA: 10' AREA ZONING: Residentail IS PROJECT FOR PRIVATE OR BUS. USE: Private INTENDED USE OF PROPERTY: Private Residence - dock used for pleasure boat DESCRIBE KNOWN PRIOR OPERATIONS CONDUCTED ON PREMISES: Private Residence HAS ANY PRIOR LICENSE OR PERMIT BEEN ISSUED TO ERECT STRUCTURES. DREDGE, OR DEPOSI~ FILL ON SAID PREMISES: Yes HAS ANY LICENSE OR PERMIT EVER BEEN REVOKED OR SUSPENDED BY A GOVERNMENTAL AGENCY: Nn DESCRIBE FULLY THE REHABILITATION OF PROPERTY: PrivaTe Residence - Existing dock no be shortened by 26'; new float & ramp installed. DESCRIBE PROPOSED CONDITION OF PROPERTY AFTER WORK IS COMPLETED. INCLUDE AN ADDITIONAL SURVEY OF PROPERTY SITE IF NECESSARY: 34' Dock, 12' to 8'x30' float ARE THERE ANY COVENANTS OR RESTRICTIONS IN YOUR DEED WHICH WOULD PROHIBIT THIS PROJECT: Nc, WRITTEN CONSENT OF OWNER IF NOT THE SAME AS APPLICANT: ~mnr/ADplicant - Errol & Beverly Forman - consent attached Aeen~ - Latham Sand & Gravel, Inc. ., . [ PROJECT I.D. NUMBER 617.21 SEQ [ / Appendix C State Environmental Quality Review '- - SHORT ENVIRON MENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I--PROJECT INFORMATION ,rTo be coracle/ed by Applicant or Project soonsorl 1. ~2~[~/~T2~[~L~N~X t 2. PROJECT NAME Agent - Latham Sand & Gravel. Inc. I Forman property - floating dock & ramp 2655 Calves Neck Road, Southold, NY 11971 (old Hildreth property, just East of Harper Rd., S. side Calves Neck/Hill Rd.) 5. IS PROPOSED ACTION: [] New ~[~ Exoamsiort [] Modificatfor~lalteration 6. DESCRIBE PROJECT BRIEFLY: I, Shorten existing 50' dock co 34' and install a new 3'x12' ramp ~o a aew 8'x30' floating dock. Installation of 4 piling no secure float and 2 tie-off piling. 7. AMOUNT OF LANe AFFECTED: --9. WHAT IS PRESENT LAND USE iN VICINITY OF PROJECT? [~ Res,dent/al [] !ndustrial [~ Commercial [] Agriculture [] ParklForestlOgen sc~ace [] Other Describe: Residential homes - those on Jockey Creek have bulkheads, docks, etc. 10. DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDING..NOW OR ULT[MAYELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STALE OR LOCAL)? E~Yes [] No If yes, llst agency(s) and permitlaoDrOValS N.Y.S. Dept. Environmental Conservation & Army Corps of Engineers 11. DOES ANy ASPECT OF THE ACT/O/,! HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [] Yes ~ RD I! ye~. Ils/ agency name and oermittaDoroval AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? []Yes [~]NO I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE I! the action is in the Coastal Area. and you are a state agency, complete tho I Coastal Assessment Form before proceeding with this assessment OVER 1 PARr II--ENVIRONMENTAL ASF-~.SSMENT /To be comoleled by Agency) C3. Vegetation or fauna, fish, sheUfish or wddlife soecies, significant habitals, or threatened or endangered species? Ex0~ain briefly: THERE. OR IS THERE UKELY TO SE. CONTROVERSY RELATED TO POTEr-JTIAL ADVERSE ENVIRONMEI~TAL I~,IF'ACTS? [] Yea [] NO If Yes. expla,n briefly PART III--DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or other, vise significant Each effect should be assessed in connechon wilh its {a] setting (i.e. urban or rural); (bl probabitity o[ occurring; Ici duration; irfevers~billty; lei geographic sccoe: and (fi magnitude. If necessary, add attachments or reference su~3nortiRg materials. Ensure thal exptanaI~ons contain sufficient derail fo show that all relevant aoverse impacts have been identified and aoeauatety addressed. [~ Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. [~ Check this box if you have determfned, based on the informatio~ and analysis above and any supporting documentation, that the proposed action WILL NOT result n any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: COUNTY OF SUFFOLK ) STATE OF NEW YORK ) '_~e~J~-~ ~0~'~,~ BEING DULY SWORN DEPOSES ~D SAY~ THAT ~E IS THE APPLIC~T FOR T~ ~O~ DESCRIBED P~ITS, ~ T~T ALL STAT~NTS CO~AIN~ :HEREIN ~ TRUE TO ~E BEST OF HIS ~OWLEDGE ~D BELIEF, ~D THAT WO~ WILL BE DONE IN THE ~NER SET FORTH IN THIS ~PLICATtO~ ~D AS ~Y BE APPROVED BY T~ TO~ BO~ OF THE TO~ OF SO~HOLD. THE APPLIC~T AGR~S TO HOLD THE TO~ OF SOUTHOLD ~D ~ TO~ TRUSTEES H~ESS ~ F~E FROM ~ ~ ALL D~GES ~ CLAIMS ~ISING UNDER OR BY VIRTUE OF SAID PE~IT, IF G~ED. IN CO~LET!NG THIS APPLI~TION, I HE.BY AUTHORIZE THE TRUSTEES, THEIR AGENT OR REPRESENTATIVE, TO ENTER ONTO ~ PROPERTY TO ~NSPECT ~E P~MISES IN CONJ~NCTION WiTH REVIEW OF THIS APPLICATION. S Applicant SWORN TO BEFORE ME T~IS 16q~''~ 'DAY OF ~'~'~,~::~v,,u~,o.~'~ , 19 ~ % NOTARY PUBLIC N~ ~7~, ~0!~ EXAMINED BY APPROVED DISAPPROVED CONDITIONS (If any) SIGNATURE OF CHAIRMAN COMPUTATION OF FEES Approved 2/27/85 -' 1% ", DEPARTMENT OF THE ARMY ~ JACOB K. JAVITS FEOERAL BUILDING / NEw YORK. N.Y. 0278-0090 · 06 JULY 1992 ~ ~,~o~ JUL ~ 0 ~ ~ Eastern Permits Section TO N OF SOUTHO[D SUBJECT: Application No. 92-0315-L2 by Errol & Beverly Forman To Whom It May Concern: The New York District, Co[ps of Engineers has received a request for Department of the Army authorization for the following activity: ACTIVITY: Shorten existing 5 feet by 50 feet fixed pier to 5 feet by 34 feet; construct a 3 feet by 12 feet hinged walk-ramp and an B feet by 20 feet float secured by pilings, and install 2 outer mooring piles. IN: Jockey Creek, Shelter Island Sound AT; Town of Southold, Suffolk County, New York APPLIC~ION BY: Errol & Beverly Forman 2655 Calves Neck Road P.O. Box 1063 Southold, New York 11971 As this work is minor in nature, authorization may be by letter of Permission. This is in accordance with current Federal ~gulations governing in navigable waters of ~he United States. To accomplish the coordination requireo, prior to the ~ssuance of a letter of Permission, your review of ~ne enclosed drawing(s) ~s reques%ed, Pursuant to Section 307 (c) of the Coastal Zone Management Act of 1972 as amended [(16 U.S.C. 1456 (c)], the applicant has certified that the activity complies with and will be conducted in a manner that is consistent with the Coastal Zone Management Program of the State of New York. To allow for the timely processing of the subject application, your comments are requested within 20 days of the date of this letter. Sincerely, S~even A. Schumach Acting Chief, Eastern Permits Section Enclosure LATHAM l SAND & GRAVEL, INC. ~me 323-2585 · FAX 323-2566 * ~me 7~-~9~ ,ii ~ ~ TOWN OF UTHOLD June 21, lg93 Board of Town Trustees Town of Southold P.O. Box 1179 Southold, NY 11971 Re: Errol Forman SCTM #i000-70-4-42 Dear Sirs: Due to the concerns of neighbors regarding the length of this projecn, we would like to request a modification enabling us to meet these concerns by re-arrangmng the configuration of the floating dock and shortening the fixed dock. %n order to shorten the entire project, we propose to construct a 5' x 12' fixed dock where the existing 5' x 50' ~xisting dock is now, with a 4' x 14' ramp leading to an 8' x 16' floating dock which would be attached to an 8' x 30' floating dock in an "L" configuration instead of the originally proposed and approved "T" configuration. We will still require the installation of 6 related piling. Enclosed for your review are copies of the new design. We hope you will be able to expedite this modification to allow for immediate construction. Thank you for your assistance in this matter. Very truly yours, C. Terry President CTL:mgl Marine Construction · Dredging · Precasf Cesspools o Excavating and Land Development Southold, L.I. April 17 69 Fir. Pierson R. Hildreth 176 Riverside Avenue, Amity~ille, New York Apr. 14, 1969 Permit to dredge in Jockey Creek according to application $ 25 00 Perm/t to construct dock 40' x 5' 25 00 TOWN OF SOUTHOLD ,, BOARD OF TOWN TRUSTEES ...... .... Pursuant to the provisions of, Chapter 615 of the Laws of 1893 Of the State ,. - of New York; Chapter 40i of ll!e Laws of 1952 of the State of New York; the p~o- ~ visions of an ordinance entit~d f'Southold Town Ordinan~ Re~a~ng ~e Plac~g of Obsi~cti,~ns in and on Town Waters and Pubic Lands, and the~ of Sand, Gravel or 3ther Materials ~om L~ds under Town Waters", an~ in aec~d~ wilh the resolution of the Bo~,d ?f T~t~s of the ToWn of South~ld ad0pie~at a meet- ing of said Board on .. A~. ~..~R ...... and in co~s}der%~ ~ the;sum of S-~'A~ .... lgWful ~oney of the U~ Sta~s, paid by residing at . ~ ~.. ~e~,. ;~,. ~,~, ......... , New :Y~,. the said ~oa~ of ~l~S(~es ~ the Town. ~f Southold, Suffo~'COUn~, ~-y~rk; he~e~y adtko~zed an~ ~ermits said . ..~i~s~n ,~..~i%~ ................... to ~igh ~ ~rk ~n The said .... .~.~'.~.~.~ .~e..~..1.~.~ ...... , as part .of the consideration for the issuance of this permit does hereby release the .said Board of ~rustees and the Town of SouZhold from any and all d~mages claims for damages or suits that may arise .or occur directly or indirectly as a result of any operation carried on un- der 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 ef 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 Trt~stees and the Town of Southold. TI-KS PEL~hCIT is subject to the following terms and conditions: That there shail be no unreasonable interference with navigation 'as a result of the work herein authorized. 2. That there shall be no interference with the right of the public to pass and re- pass along that portion of the beach between iow and high water mark. 3. That the work s.hall be subject to the supervision and appruva! of the said Board of Trustees or i~s agents. 4. That if future operations of the Tow,n of Southold require the removal and/or alteration in the ~ocation of the work herein authorized, or fi, in the opinion of the Board of Trustees of the Town of Southold, such work shall cause un- reasonable Obstruction to f.ree navigation, the said . P,i$'~ .~: J~l~l...c~..e.g.h. will be required upon due notice from the said Board of Trustees, to remove or aiter the location of the work hereby authorized without expense to the Town of $outhold, so as to ~ender navigation reasonably free and unobstruct- ecl The authority conferred by this permit may be terminated bythe Board of Trustees for a failure on the part of the said ........... ?...~.e.~.~.~......~......~,.'~..~..~...~. ............................ to comply with the terms and conditions herein imm)seal. In the event of such te~minatiorb this permit shall be deemed revoked five (5) days after the date: when the Board of Trusfees shall mail to the:said ........... ?..~...~...'....~...~.~'..~....:: ...... :.:z ........... at the address given in his application, a certified copy of a resolution of the Beard of Trustees directing such termination. tN 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 s~bscribed by a majority of the said Board of Trustees, the day and year above written. eo, ....................................................... {L. S.) STATE OF NEW YORK ) SS: COUNTY OF SUFFOLK ) ON THIS ...~.~.. ..... day of ................ ..Y~..~ ............................. , 19.~...9...., before me ~ersonally appeared ~lvah ~. ~ol~s~ith, Frank Dawson~ ~:[~f,. George Simpson an~ Douglas Robe~ctson, all personally 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 majority of the same; that they knew the corporate seal of said Town of Southoid; 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. Notary Public ~ ~,~. ~0, 52-3233~20 ~ Term ~p~res ~arch 30, FOP,3I NO. ! TOWN OF SOUTHOLD BOARD OF TOWN TRUSTEES TOWN CLERK'S OFF]CE SOUTHOLD, N.Y.. Examined ............................. 19 ...... Application No ........ Approved .... ............... '. ........... Disapproved a/c .. ~.. ,...~.,. ,~,--, ~',. ~. ~; .... : ........... ~-<~...~ ....... - APPLICATION FOR PERMIT ' INSTRUCTION~ 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 buildings on premises, relation to adjoining premtses, public streets, parks, em., and g~ving detailed description of proposed layou~ of project must be drawn on diagram which is part of this applicatiou. C. The work covered by this application may nor be commenced before the zssuance of a permit. D. Upon approval of this application, Town Trustees will issue a permit ro applicant. Such permit shall be kept on the premises and available for inspection az 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 o{ Trustees of the Town of Southold, Sut~olk County, New York, for the issuance of a permk pursuant to the laws, Ordinances and regulations governing eoustruction of: docks, piers, bulkheads, jettys and dredging in, under, dud over the wamrs of Town o{ Southold. The applicant agrees ro comply with all applicable laws, ordinances, regulations and conditions specified by said trustees, and to hold the Town of Southold, and all Town oEicials free from'liability and damages of any kind. Name of owner of premises . Judge. P.i°-t~on. F~;..lrI.i,l~l:.~¢la ............................................. Street Address of Property ...~l.i..]:.]...S..t.~.e.e..'c.,...S.o.u..~.h.o..1.d.,...N?.w...Y.o..a:.k. ........................................ Home address If Other Than Location 17.~. Ri'~:rsi.de .&~.~,~e~. t~Jlil~.i,l~e~. Ne~..¥o;r~ .................. Creek. Bay or Harbor Fronting Property . .J. 9..c!$.9Y..g.~.e..e.k. ..................................................... Permit Requested To: ... p. Ke..clx!...m!.d' ~.o.9.§t..a:.u..c,t.i.o..n' ~Do..c~.~ ................................................ iJ:~eo, ge: ~ · D'rec~ge :.~,J · ' Size of Proposed Work: Length.Dock.: .... 4<1L..\¥idthDozk.~. ~3....t-Ieighth Above High Water.DU..c1$. J..~..8."... Depth Below Lo~v Water.D..o~..k..:..5. ~ ..... Average Rise In Tide...2.8.." ........ Yards to Be Excavated..B..0~...Y..cl.. .... Width of Canal, Creek or Bay Fronting Property ...... 5..0~..'. ........... Depth at Low Tide . .1..By. ............... Is This For Private or Business Use? ...P.~.i.v..~.t.e. ...................... Ares Zoning ...R..e.s.i..cl.e?..'c.i.~..1 ......... Complete plot plan to be drawn on reverse side of this application. STATE OF NEV~ YORK ) )s.s. "/'/~'~F'"' being duly sworn deposes and says that he is the applicant for the above scribed permit, and that allUstatemeuts contained herein are true to the be~t 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 hamles~ and ~ree {rom any and all damages and claims arising under or by virtue of said permit. Sworn to before me this .... ~C~ .... day of.~~~ ....... 19.~.. Not~ry public ...................... county ~~.. / ~ ~. ~ ~ _~ NOTARY PUBLIC,~te of New York ~~ ~ ~ ~ Qualified in Suffolk Term Expkes March 30,