HomeMy WebLinkAboutTR-84YOUR ORIGINAL PER,MIT NUMBER
BOARD OF TO'TN TRUSTEES
Town of Southolfl
3Ia[n Road
Southola, hTew York 11971
APPLICATION FOR SPECIAL ICE DAMAGE PERMIT
INSTRUCTIONS: Fill out form below and return to above address. You
should have this application approved and returned to you within a week°
1. Applicant's Name & Address:.. ~&:.d.q~.C' .~..~.~ .......
.... / .......~ ........ , ......... ~'e x. No. .
2 Contractor's Names & Address: .~5~" '
................ Tel. No ..............
3% The purpose of this application: Redriving or replacing openwork
deck or openwork pier piling, and mooring piles, removal of damaced
piling, re~air, resetting or replacement of floating docks, ramps,
or decking, all necessitated by ice and storm damage resulting during
SPECIAL CONDITIONS
1. No dredging or filling is permitted.
2. Repairs to existing structures shall be limited to replacement of
timbers withoht change ~n design or dimension.
3. No repair or replacement of bulkheads is permitted under this permit.
4. No freshwater or tidal wetlands are to be disturbed under any
circumstances.
.5. A yellow permit sign provided by this office shall be displayed on
the project at all times while under replacement.
6. Original permit numbers (3'~ high) nust be permantl? displayed on
project.
(Tear of~ and return)
I, , certify that the work as authorized in
this permzn has been completed and is now ready for your inspection.
Also, the permit number required on this projecm is clearly visible.
PE~IIT NJIMBER
YOUR ORIGI..'~AL PER,gIT NUMBER
BOARD OF TOW*N TRUSTEES
Town of Southol~t
Main Road
Southold, New York 11971
APPLICATION FOR SPECIAL ICE DAMAGE
INSTRUCTIONS: Fill out form below and return to above address. You
Should have this application approved and returned to you within a week°
1. Applicant's Name & Address:. . .'~....'..,.~.;.--.-~-.~ ~ ...........
......... t ........ p g~Y~.r~. .... /.;&'e±. No. o
2 Contra tot Addre
. c ~s Names & ss: ............................ .
................................................. Tel. No ...............
3; The purpose of this application: Redriving or replacing openwork
dock or openwork pier piling, and mooring piles, removal of damaged
piling, repazr, resetting or replacement of floating docks, ramps,
or deckingS' all necessitated by ice and storm damage resulting during
~886-87 ' ~Winter.
SPECIAL CONDITIONS
1. No dredging or filling is permitted.
2. Repairs to existing structures shall be limited to replacement of
timbers withoht change in design or dimension.
3. No reoair or replacement of bulkheads is permitted under this permit.
4. No freshwater or ~idal wetlands are to be disturbed under any
circumstances.
.5. A yellow permit szgn provided by this office shall be displayed on
the pro~ecc am all times while under replacement.
6. Original permit numbers (3'~ high) must be-permantly displayed on
projecg.
.............................. iTear off a~d ret~r~i
I, ., certify that the work as authorized in
this permzm has been completed and is now reaty for your inspection.
Also, the permit number required on this project is clearly visible.
PE~,I rT NwJMBER
certify that the work. a~u,~h'9~ed in
~eted and is now ready for your inspection.
uired on this project is clearly visible.