HomeMy WebLinkAboutTR-1208Board Of-Southold-Town-Trustees
SOUTHOLD, NEW YORK
PERMIT NO..~.~:~(2~...,..:._..:: ...... " DATE'.-
iSSUED TO ~ '
PursuaM' fo {'he provisions of Chaplet 615'of +he Laws of
~e S+a+e of New Y~k~ 1893; and Chep~r ~
S~afe ~ New York 1952; and fh~'So~fhold Town Ordinance~ eh-
flfled "RE~ULATIN~ AND THE PLACtN~ OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS and +he
~EMOVAL OF SAND, ~VEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN WATTS;" and ~n accordance wlfh +he
Resolu+ion of The Board adopfed
19..!~..; and in con~deraflon of+h~ sum o~ $ .....~].~..20 ....... pa~d by
Terms and Conditions lls+~ on +he reverse side hereof,
of Sou+hotd Town 'Trus+ees aufhorlz~s and permlfs fha follow'ng:
alt in accordance wifh fhe defai|ed speclfica{'ions as presenfed in
{'he origlna fin g ' appllca{.ion.
IN WITNESS WHEREOF, The said Board of Trusfees here-
by causes ifs Corpora{'e Seal fo be affixed, and fhese presenfs fo
be s~bscrlbed b'/a maiorify of fheseld Board as of fhis daf,e.
Trustees
P/~ P~ev/6/72'
BOARD OF TOWN TRUSTEES
Town of Southold
Main Road
Southold, New York 11971
Mail to: Norman Addy, P.O. Box 262, Mattituck N,Y. 11952
Gerard Gallian, Pine Tree Road, Cutchogue, N.Y.
............................... .~.~. ....... ~.7..6 ...................... has been reviewed by this
1. Your application, dated October 1
Board, at a meeting of the Trustees held on ........ ~Dacamb. er.-6.,.-.J-cJ~..6 .........................................
end resulting in the action, as indicated below:
(..~...) Application approved.
( ............ ) Application denied.
( ............ ) Application tabled.
2. Comments and remarks:
UpOn receipt of balance of fee due. permit will be mailed
3. If your application is approved above, A Permit Fee is now due, and should be made payable
to the order of the Board of Southold Town Trustees. This fee ps computed below according to
t~he Schedule of Rates as set forth in the Instruction Sheet (Form I/1).
If the Permit Fee is paid in person to the Secretary of the Boc~ra, The Permit will be obt'ainable
at the same time. If the fee is paid by mail, the permit will be mailed in repw.
Compu'ration of Permit Fee:
Ramp 8'x4' = 32 sq. ft. ~ 10¢ per sq. ft. = $ 3.20
Floa~ 20'x12'= 240 sq. ft. ~ 10¢ per sq. ft. = 24.00
$ 27.20
Less $5.00 filing fee paid - 5.00
$ 22.20 BALANCE DUE
Total Fee for this application ................. ,$. R .7. . ,. 2.0. ............................ $ ...... 2.~^2Q....B.~%..k_%..N...C..E...DUE
Signed .. AI~VAE..B...,~OLDS~I~I ......................
Ohm. Board of Southold Town Trustees.
Secretary.
Town ~ South&d
Southold,MMn NewR°ad York 11971
APPLICATION FOR FIXED and or FLOATING DOCKS
I. Applicant's name and addkess: ..................... , ...............
:2. Contractor's nome and eddress: .....................................................................................................
3. Briefly explaig; the purpose of this applic~,t, ion: ~...[ ......................... ~ .........................................
...... ................
(a) Commence work -- AT ONCE ............ ; ASAP ............ ; UNKNOWN .............
(b) Complete work in -- 1 DAY ............ ; 1 MO ............. ; 1 YR ............. ; FUTURE .............
5. Secure the correct Area Map from the Secretary of this Board, and by using an X WITHIN
A CIRCLE indicate as closely as possible the location of this dock. On the reverse side of this
map, provide a SCALE DRAWING which will show Ordinary High Water Mark, the shape
and size of the dock and any supplemental pilings which ore needed to hold a floating dock
or tie-up a boat. Give all dimensions necessary- to determine the area of the dock surface
which extends offshore from the O. H. W. M,
6. Wil any portion of this construction extend offshore into Town Waters beyond an ~maginary
line or boundary formed by other similar structures along the area's shoreline? ~ NO.
If it does emend beyond this so-called dock line indicate by how far, approximately,. ......... ft.
7~ Provide the following documents:
(a) A Licensed Engineer's Su,rvey of the property involved,
(b) A copy of the Contractor s Plans and Specifications.
8. Will this construction require the Filling of any land offshore of the Ordi~.nary High Water
Mark or the Dredging of any material from Town Lends under waterP~ NO If it does,
Form Al4 (Application for Dredging/Pilling) must be completed and attached as part of this
application.
9. [n requesting approval of this appli(~ation, 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 and abide by the Terms and Conditions of the
Permit, .wh~'~ and-if-issued to me,- la ' ~
k. S...~.................~ ......
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