HomeMy WebLinkAboutGEIDEMAN, JOHNBOARD OF TOWN TRUSTEES
Town of S0uthold
Main Road
Southold, New York 11971
P/1 ~ev/6/72
To:
l. Your application dated ..../~ ..~.4~...~.~.../.._~..~..a ....................... boa been reviewed by this
and resulting in the action, os indicated below:
(.....~'.......) Application approved.
( ............ ) Application denied.
( ............ ) Application tabled.
2, Comments and remarks:
3. If your application is approved above, A Permit Fee is new due, and should be made payable
to the order of the Board of Southold Town Trustees. Th s fee is computed below according to
the Scheaule 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 Board, The Permit wiU be ob?ainob[e
at the same time. If the fee is paid by mail, the permit will be mailed in reply.
Computation of Permit Fee:
Total Fee for this application ............................................................ $ ....q~'~.._....-:=. ..................
Signed ....~.. ..................................................... :..4.
Chm. Board of Sour-hold Town Trustees.
Seck~et~a ry.
BOARD OF TOWN TRUSTEES
Town Of Southold
Main Road
$outhold, New York 11971
APPLICATION FOR FIXED and/or FLOATING DOCKS
.................................................................................. ............
2. Contractor's name and address: .......~'.'...~...f..f'..~., ...... ./..'- -~...~.../.~: ..................................................
...............................
3. Briefly explain the purpose of this application: .......... ..~...~....~./...~.Y~..~..~.:..~...~.. .........
. : : ..:. . : : . . . .': . . :. .'. /. . .'. . .:'. .> . . . . . Z . . .::. : . . . . '.:. . . . . . .'. . . . :
After issuance of a Permit, expect to: (mark by an X)
(a) Commence work -- AT ONCE ..,../~...~...; ASAP ........... ; UNKNOWN .............
(b) Complete work in 1 DAY ............ ; 1 MO...'.~.. ....... ; ] YR ............. ; FUTURE .............
Secure the correct Area Map from the Secretary of this Board, and by using an X WITHIN
4, 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 ~ boat. Give oil dimensions necessary to determine the area of the dock surface
which extends offshore from the O. H. W. M.
6 Will any por'rion of this construction extend offshore into Town Waters beyond an imaginary
line or boundary formed by other s~m~iar structures along the area s shorehne. ~o,r NO.
If it does extend beyond this so-called dock line indicate by how far, approximately,./¥~..ft.
Provide the following documents:
(a) A Licensed Engineer's Survey of the property involved.
(b) A copy of the Contractor's Plans and Specifications.
Will this construction require the :illing of any [and offshore of the Ordinary High Water
Mark or the Dredging of any material from Town Lands under water? YES or NO. If it does,
Form A/4 (Application for Dredging/Filling) must be completed and attached as part of this
application.
~Accepted by:
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 and abide by the Terms and Conditions of the
Permit, when and Jf issued to me.
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